Uterine fibroid: treatment, diagnosis and symptoms of the disease

The diagnosis of uterine fibroids (fibroma, fibromyoma) is made quite often, and just as often the disease raises questions among patients: what is it, how dangerous is it, how and what to treat, what will happen if left untreated, etc.

You can get answers to all these questions, as well as diagnose the presence of the disease, only at an appointment with a gynecologist

. You can sign up for a consultation and undergo examination at a medical center at a time convenient for you.

Causes of uterine fibroids

The main cause of the development of the disease is a malfunction of the ovaries when they begin to produce too much of the hormone estrogen. Contraceptives with a high concentration of this hormone can provoke fibroids and their intensive growth. Also, fibroids can occur after an abortion, complications during pregnancy, endometriosis, as a result of inflammation of the ovaries and fallopian tubes. At risk are nulliparous women over 30 years of age. Often the cause of the formation of nodes is obesity, low physical activity, disruption of the endocrine and immune systems, and a long period of insolation (stay under active sunlight). There is also a hereditary factor.

Factors promoting tumor formation

According to research results, the key factor in the occurrence of fibroids is an increase in estrogen with progesterone deficiency, which is associated with ovarian dysfunction. Estrogen promotes the growth of certain muscle groups of the uterus. An increase in the production of female hormones is provoked not only by inflammatory and infectious diseases of the reproductive system, abortions, contraceptives, but also by poor nutrition. Thus, foods high in refined carbohydrates, saturated fatty acids and insufficient fiber when consumed regularly increase the risk of developing tumors.

Fibroids can also appear as a result of trauma to the uterus - trauma during childbirth, curettage, diagnostic hysteroscopy, insertion of an IUD (intrauterine device). Women who are overweight are susceptible to tumor processes - fatty tissue transforms androgens into estrogens. Therefore, this disease occurs 3 times more often in patients weighing more than 70 kg. The distribution of fat mass affects the production of estrogen, so women with deposits in the upper torso and waist (apple body type) are most susceptible to fibroids. Hormonal levels are affected by hypertension, psycho-emotional stress, a sedentary lifestyle, regional factors, and incompatibility with a sexual partner.

Uterine fibroids and its types

Based on the sites of placement, the following types of tumors are distinguished:

1. Subserous. It is located on the outside of the uterus and develops into the outer part of the pelvic cavity. It does not affect the functioning of the reproductive system and the menstrual cycle, but it compresses neighboring organs and tissues. Therefore, pain in the lumbar region, during bowel movements, and a feeling of incomplete bowel movement are possible.
2. Intramuscular (intramural). It is formed in the middle muscle layers, causing an enlargement of the organ. This type of tumor is the most common among patients and is characterized by disruption of the menstrual cycle, pain, and heaviness in the pelvic area.
3. Submucosal (submucosal). It develops under the mucous membrane lining the uterine cavity, growing deep into the organ and leading to acute symptoms.
4. Intermuscular (interstitial). The nodes form inside the muscular layer of the uterus. This type of tumor is characterized by heavy menstrual flow, pain appears only with intensive growth of the fibroid, its necrosis or swelling, and neighboring organs - the rectum and bladder - also suffer. The enlargement of the uterus is uniform.

Symptoms

Myoma does not always have obvious symptoms, the most characteristic of which, occurring in most patients, are the following:

• disturbance, abnormal course of the cycle - increased duration (8 or more days), pain, blood clots;
• pain in the pelvic area;
• feeling of heaviness, pressure in the MT area (pelvis);
• pain in the legs and back;
• pain, discomfort during intimacy;
• frequent urination with little emptying of the bladder, which is associated with compression of the organ;
• constipation due to tight intestines;
• increase in abdominal volume.

If you have at least one symptom, you should urgently contact an antenatal clinic. If a visual examination and palpation are not enough, the doctor will prescribe an ultrasound, blood test, urine test, or smear test. Depending on the result, additional examination methods may be used.

Non-invasive treatment options

HIFU ablation

High-intensity focused ultrasound can be used to eliminate benign tumors. The procedure is not considered a full-fledged operation because it is performed without incisions and is performed on an outpatient basis. HIFU ablation is performed in an MRI scanner equipped with an ultrasound transducer. Under the influence of ultrasonic waves, the tumor heats up and begins to collapse.

Advantages of HIFU ablation:

• low risk of developing inflammatory processes;
• disappearance of adverse symptoms within a few days after the procedure;
• fertility preservation;
• the opportunity to return to normal daily life immediately after discharge from the hospital.

HIFU ablation is a safe procedure that will be effective for small fibroids.

Uterine artery embolization

In modern clinics, procedures are carried out to destroy uterine fibroids without surgery. Medical Center of Professor S.A. Kapranov removes tumors by embolization of the uterine arteries. Special blocking drugs interrupt the blood flow to the fibroids and provoke the death of blood vessels. Minimally invasive surgery allows you not only to get rid of the tumor, but also to forget about the accompanying unpleasant symptoms. Embolization does not provoke serious side effects or complications. But for several weeks after the procedure, the patient may complain of lethargy, periodic nausea, and fever. After just 7 days, the woman will be able to return to normal daily life and forget about pain.

Brown or reddish vaginal discharge is considered a normal consequence of embolization. The use of sanitary pads is recommended, but tampons are strictly prohibited. Watery discharge is also considered normal. Thick yellowish leucorrhoea with an unpleasant odor should cause concern. If the situation is complicated by a sharp increase in temperature or pain in the pelvic area, you should urgently consult a doctor.

Specialists at the Center for Endovascular Surgery support their patients at all stages. You can seek help even if you had embolization months ago.

Laparoscopic or transcervical cryomyolysis

An alternative method of minimally invasive surgery: cryomyolysis. The procedure is performed transcervically or during laparoscopy. Neoplasm tissues are destroyed under the influence of extremely low temperatures. To gain access to the uterine cavity, the doctor may make 2 small incisions in the patient's lower abdomen. After exposure to a cryoprobe, the neoplasm may become denser. Within 12 months after the procedure, the pathological tissues will gradually soften and come out with the next menstruation. Laparoscopic cryomyolysis is considered one of the most effective methods of treating fibroids without surgery. Unlike a full-fledged surgical intervention, the recovery period after laparoscopy lasts only 4-5 days.

Laser endometrial ablation

The procedure is performed without incisions, transcervically. To remove fibroids, a special instrument that emits microwave energy or electric current is inserted into the uterine cavity. Under the influence of ultra-high temperatures, the endometrium, including fibroids, is completely destroyed. Ablation is effective only when diagnosing submucosal neoplasms. For subserous uterine fibroids, a different treatment method is selected.

The disadvantages of laser ablation include:

• loss of fertility;
• no effect on large tumors;
• the need to regularly take contraceptives (to prevent the implantation of the fertilized egg outside the uterine cavity).

It is necessary to understand that treating large fibroids without surgery does not provide a 100% guarantee of absence of relapses. Only with physical removal of the uterus can the patient count on the fact that the disease will not develop again.

Fibroids and pregnancy

Patients who have a tumor are concerned about the possibility of conception and pregnancy. This problem is very relevant, since the main age category of mothers is women over 30-35 years old, who are at risk.

Conception

The neoplasm is not the cause of infertility, but it does cause some difficulties: it compresses the fallopian tubes, disrupts ovulation, and reduces the permeability of sperm. Therefore, if the patient does not become pregnant and a large fibroid is detected, drug or surgical treatment is recommended. With hypertrophic growth of fibroids and significant enlargement and deformation of the uterus, restoring the ability to bear children is problematic, sometimes impossible.

1st trimester of pregnancy

Problems are fraught with contact of the tumor with the placenta, especially if the fibroids are large. With a small tumor, which occurs in 60% of women during pregnancy, there are no complications or symptoms, but early termination of pregnancy occurs. Causes:

• increase in the number of uterine contractions;
• impaired uterine circulation;
• problems in the functioning of the neuroendocrine system;
• chronic infections;
• proliferation of the uterine mucosa due to polyposis, hyperplasia.

2nd, 3rd trimesters

The risk of miscarriage increases as the space required for the fetus decreases and the intensity of uterine contractions increases. The number, size, location of neoplasms, and their contact with the placenta play an important role. If a miscarriage does not occur, fibroids can negatively affect the development of the fetus, causing deformations of the skull and other parts of the body, and infringement of internal organs.

Childbirth

The neoplasm is often the cause of protracted labor; doctors often decide on a caesarean section. The tumor itself does not affect the birth process, the reason is that due to their presence, there is an anomaly of presentation, the position of the child, when it is impossible to give birth naturally (pelvic, facial, transverse position). Also, during a caesarean section, the surgeon can immediately remove the tumor.

Placental abruption is a particular difficulty, especially if a tumor has formed behind it. During the birth process, doctors must take this into account.

Postpartum period

Myoma causes complications during the postpartum period. They can be early - causing bleeding, placenta accreta, and late. These include involution (the uterus does not return to its original size) and infections.

Impact on the pelvic organs

As the leiomyoma grows, it puts pressure on the bladder, which causes problems with urination. As a result, inflammation occurs, which can spread to the kidneys. In this case, an increase in temperature and the appearance of pathological impurities in the urine are observed. Localization of fibroid formation on the posterior uterine wall causes constipation and flatulence.

A large submucosal fibroma emerges through the uterine cervix into the vagina, which causes rupture of the neoplasm and severe bleeding. Against this background, inflammatory processes and painful sensations develop.

Pregnancy, childbirth and fibroids

During pregnancy, there is an increased production of estrogen and progesterone, which affects the condition of the tumor. Along with hormonal changes, physical changes occur - the myometrium stretches and increases in volume. Therefore, the location of the tumor and its size are important. The increase is typical for the 1st and 2nd trimesters, while in the 3rd trimester the fibroid decreases. In practice, most patients with this disease do not experience intensive tumor growth during pregnancy and childbirth, and it does not cause significant problems. The opposite effect is more common - destruction of the tumor, necrosis. This is a negative change that can cause bleeding, swelling, and the appearance of cysts. Necrosis of fibroid tissue is accompanied by an increase in body temperature, an increase in leukocytes in the blood, an increase in the level of ESR, and pain in the area where the node is located. If ultrasound and tests confirm the diagnosis, the pregnant woman is hospitalized and treated in a hospital. Surgical interventions are almost never prescribed.

Diagnostics

Initially, experienced specialists - oncologists or multidisciplinary surgeons - conduct a detailed examination of the patient, record all the complaints that exist, palpate the formation and make a preliminary diagnosis.
Then you need to determine the nature of the tumor. After this, you need to conduct an ultrasound examination of the tissues where the tumor is located to determine its size, nature, and changes in the tissues. If necessary, an X-ray examination is performed. If questions remain, a biopsy of the suspicious area should be performed to rule out a malignant process. Fibroids can be detected by palpation (feeling with fingers or hands) performed as part of a pelvic examination, or diagnosed through imaging procedures such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).

Treatment

Therapy of neoplasms can be medicinal and surgical. For the treatment of patients of reproductive age, medicinal methods with the use of drugs are usually used; it is extremely rare that fibroids are removed surgically, as this jeopardizes the possibility of becoming pregnant in the future.

Drug therapy involves the use of iron supplements, vitamins B, E, A, which have a positive effect on the functioning of the endocrine and nervous systems, folic and ascorbic acids. Usually these are balanced complexes, dietary supplements. A good effect is observed after prescribing a special diet aimed at reducing body weight (often with fibroids, lipid metabolism is disrupted, which provokes weight gain). The patient's diet is adjusted, animal fats are replaced with vegetable fats, carbohydrate intake is limited, and fruit and vegetable juices are included. Hormonal drugs with a high content of progesterone, which inhibits the growth of tumors, are also prescribed. Thus, drug treatment is carried out in the following cases:

• childbearing age;
• if the fibroid is located in the muscle layer;
• the uterus is small in size and has not changed shape.

If the tumor is large and continues to grow, a decision is made about surgical intervention. Indications:

• uterine bleeding accompanied by anemia;
• large volume of the uterus;
• fibroids have formed under the mucosa;
• compression of the rectum, bladder;
• growth of neoplasm in postmenopause;
• the tumor is located in the cervix.

If there are indications, myomectomy (removal of fibroids) or embolization of the uterine arteries is performed in order to cut off the supply to the node, which leads to its reduction. Complete removal of the uterus can be practiced in exceptional cases, and also if the patient is over 45 years old.

Watch a video about fibroids

Predictions of why fibroids are dangerous

Dermatofibroma does not have serious complications.
Complications of plantar fibroids usually occur as a result of surgical interventions. These include flattening of the arch of the foot, postoperative nerve entrapment, and postoperative growth of larger and recurrent fibromas. Article sources:

1. Desmoid fibroma. Staged, organ-preserving surgical treatment. Khvastunov R.A., Mozgovoy P.V., Lukovskova A.A., Yusifova A.A. Volgograd scientific and medical journal No. 2, 2021. p. 54-57
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927520/ Central odontogenic fibroma: a case report with long-term follow-up. Marco T Brazão-Silva, Alexandre V Fernandes, Antônio F Durighetto-Júnior, Sérgio V Cardoso, Adriano M Loyolacorresponding
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351722/ Literature survey on epidemiology and pathology of cardiac fibroma. SuguruTorimitsu, Tetsuo Nemoto, Megumi Wakayama, Yoichiro Okubo, Tomoyuki Yokose, Kanako Kitahara, Tsukasa Ozawa, Haruo Nakayama, Minoru Shinozaki, Daisuke Sasai, Takao Ishiwatari, Kensuke Takuma, Kazutoshi Shibuya

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

What will happen if left untreated?

Experts disagree about the need to treat fibroids. Some people prefer to watch and wait, as there are situations when the hormonal levels return to normal and the tumors resolve. This is especially true for young women of childbearing age and girls going through puberty. Vitamin complexes and proper nutrition are prescribed as aids.

Another category of specialists insists on immediate treatment, including hormonal agents, in order to promptly prevent further tumor growth and preserve the ability to bear children.

The decision is made after a series of analyses:

• blood,
• urine,
• for hormones
• smears for PPIs,
• Ultrasound diagnostics.

The fact is that if fibroids are not treated or folk methods are used, self-medication can lead to serious consequences - disruption of the functioning of other organs of the reproductive system, neighboring organs, and the development of other neoplasms. Considering that in the initial stages the disease occurs without symptoms, women are recommended to be checked annually, twice a year, by a gynecologist.

Physiotherapy

For small fibroids, especially when long-term observation is chosen, a woman can try alternative methods of therapy. Physical therapy exercises, massages, and acupuncture sessions will help eliminate unpleasant symptoms.

For painful menstruation, it is recommended to make compresses with castor oil. It is necessary to soak a clean flannel cloth with warm castor oil, wrap it in bandages and apply it to the lower abdomen. The cramps should go away within 10-15 minutes. You can also perform self-massage on a daily basis.

1. Apply warm castor oil all over your belly.
2. Make several circular stroking movements clockwise and counterclockwise.
3. To relieve spasms, you can do a cycle of rubbing movements.

Aromatherapy enthusiasts can add a few drops of organic lavender essential oil to castor oil. The aroma of lavender activates blood circulation and promotes complete relaxation.

If you have uterine fibroids, you can also do yoga and perform simple physical therapy exercises.

Complications

After reducing or removing a tumor, it is necessary to pay attention to the body and see a doctor to prevent the development or appearance of a new tumor. This can be caused by various negative factors, hormonal imbalances, including those associated with the restructuring of the body during menopause. If surgical intervention was performed, you can plan a pregnancy no earlier than six months later, after consulting with your doctor. Otherwise, an unhealed postoperative scar on the uterus may cause it to rupture during childbirth.

During drug treatment, you should adhere to medical recommendations, lead a healthy lifestyle, play sports, regular intimacy and contraception prescribed by a gynecologist are important.