Fibromyoma of the uterus is a true benign tumor of the uterus. It develops from muscle tissue.
Depending on the ratio of the muscular and connective tissue in its composition, this tumor previously had different names: myoma. fibroma. fibroids. However, taking into account that the nodes of fibroids more often develop from the muscle cell, most authors consider the term “leiofibromioma” to be more correct (fibromyoma.
Fibromyoma of the uterus has its own characteristics.
This is the most common tumor of the uterus in women 35 55 years of age.
It is capable of growing, decreasing and even completely disappearing into menopause. However, in 10-15% of patients in the first 10 years of the postmenopausal period, the tumor may increase.
Fibromioma of the small uterus (up to 10 weeks of gestation) can remain stable for a long time, but under the influence of provoking factors (inflammatory process of the uterus and appendages, curettage of the uterus, prolonged venous plethora of the pelvic organs) increases rapidly and very quickly (the so-called growth jump.
The tumor is characterized by a variety of clinical options, depending on the location, size, location and nature of growth.
Fibromyoma of the uterus has an autonomous growth, due to the influence of growth factors and the formation of hormone sensitive and growth receptors.
As with any tumor, the process of growth and development of fibroids is accompanied by the formation of new vessels, but in this case the vessels differ from normal ones. have a sinusoidal character.
The onset of uterine fibroids is 30 years, when women accumulate somatic, gynecological diseases and neuroendocrinal disorders.
Causes and risk factors.
For the subsequent growth of the nodes, further accumulation of unfavorable factors causing a tumor progression is required.
absence of birth and lactation by the age of 30.
prolonged inadequate contraception.
chronic, subacute and acute inflammation of the uterus and appendages.
formation of cysts and ovarian cyst.
At the age of 44 to 45 years, the highest frequency of surgical interventions (most often this is the removal of the uterus) is the indication to which is the rapid growth of the fibroids of makti, its large size, the combination of the tumor with the pathology of the endometrium and the ovaries.
The growth of fibroids increases at the age of 35 45 years, when the functional activity of the ovaries decreases and their sensitivity to hormones, chronic functional tension of the regulation systems (neuroendocrine, hormonal, immune) arises and most often the homeostasis is broken (internal balance of the organism.
Negative role is played by long-existing neuroendocrine disorders, pathological menopause. the effect of factors such as obesity. violation of carbohydrate and lipid metabolism, endometriosis. adenomyosis.
Photo: scheme of the location of the nodes of the uterine myoma (highlighted in red.
Manifestations of uterine fibroids.
Fibroids of the uterus are distinguished by a great variety of clinical course. Complaints of patients depend on many factors: the localization and magnitude of the tumor, the duration of the disease, the presence of concomitant gynecological pathology, etc. The predominance of these or other factors affects the symptoms of the disease.
Often the main and the earliest symptom of fibroids of the uterus is the violation of menstrual function – uterine bleeding or meager prolonged spotting spotting. Along with uterine bleeding, pain is often noted, usually located in the lower abdomen, in the lumbosacral region, sometimes with spreading to the lower extremities.
Treatment of uterine fibroids is a very difficult problem, because despite the hormonal dependence, this tumor is very heterogeneous.
Initially, unconditional indications for surgical treatment should be identified.
submucosal localization of fibroids.
large size of the node (the total value corresponds to the uterus 14 weeks gestation.
uterine bleeding, accompanied by chronic anemia.
rapid growth of the tumor.
acute disturbance of feeding of myomas (torsion of the legs of the subserous node, death of the tumor.
combination of uterine fibroids with endometrial hyperplasia. an ovarian tumor.
compression of the ureter, bladder, rectum.
presence of a node in the region of the tube angle of the uterus, which is the cause of infertility.
cervical and cervical erectile localization.
non-progressing and growing uterine myoma in postmenopausal age.
The scope of surgical intervention is largely determined by the age of the patient.
Up to 40 years, if there are indications for surgical treatment, if technical possibilities permit, conservative myomectomy is produced. It is especially advisable to remove myomatous nodes of medium size (in diameter from 2 to 5 cm), until their intensive increase in size occurred. The preferred technique is laparoscopic. Relapses with conservative myomectomy in uterine myomas take place in 15 37% of cases.
After 40 years and postmenopausal age, in the presence of surgical indications, the operation of removal of the myomatous uterus is necessary, if myoma did not regress in the first 2 years of postmenopause, its further existence is accompanied by a danger of oncology (adenocarcinoma, sarcoma.
According to Corr. RAMS, Professor IS. Sidorov, the risk factors for uterine fibroids growth are: the presence of cysts and ovarian cyst, proliferative endometrium processes, untimely termination of ovarian hormonal activity (late menopause) and severe obesity, violations of carbohydrate metabolism or liver disease.
Conservative treatment of uterine fibroids.
Conservative treatment, conducted immediately after the detection of small and medium-sized myomatous nodes, allows in some cases to slow down further growth of the tumor, to prevent surgery to remove the uterus, and to save the opportunity to give birth to a child.
Indications for conservative treatment.
young age of the patient.
small size of the myomatous uterus (up to 10 12 weeks of pregnancy.
intermuscular arrangement of myomatous nodes.
relatively slow growth of fibroids.
absence of deformation of the uterine cavity.
Conservative treatment is the normalization of systemic disorders characteristic of patients with uterine fibroids, among them.
inflammatory processes of the uterus and appendages.
violation of the blood supply of the pelvic organs with predominance of venous congestion and a decrease in the arterial blood supply.
violation of the functional state of the nervous system and vegetative equilibrium.
The methods for correcting systemic disorders include the following.
adherence to a healthy lifestyle (sleep normalization, rational nutrition, physical activity, rejection of bad habits, control of body weight.
normalization of sexual life.
periodic intake of vitamins and trace elements in the winter spring period.
treatment of anemia.
neurotropic effects, if the patient shows traits of disharmonious personality.
If there is a pregnancy, not even planned, it is necessary to save it, because postpartum reduction of the uterus, breastfeeding of the child at least 4 6 months, contribute to a change in the composition of fibroids, its transition to a simple and in some cases cessation of its further development.
To prevent the inevitable removal of the uterus with the growth of the tumor, preservation and maintenance of the reproductive function of up to 40 years is of great importance.
The effectiveness of hormonal therapy is very different, depending on the nature of hormonal disorders, the presence and density of receptors in myomatous nodes and myometrium. In fibroma, where the connective tissue prevails, and also in the nodes of large sizes, hormonal receptors, as a rule, are absent. Therefore, hormone therapy in these patients is not very effective.
Nevertheless, it is used when correcting the impaired menstrual cycle. To this end, use progesterone and its derivatives (dydrogesterone, cyproterone acetate), as well as derivatives of androgens, 19 norsteroids (levonorgestrel, norethisterone acetate). The latter are undesirable at a young age, with obesity, diabetes. cardiovascular diseases.
The most promising drugs in the treatment of patients with fibroids of the uterus are antigonadotropins (gestrinone, danazol), which have an antiestrogenic and antiprogestronic effect, causing temporary amenorrhea, as well as gonadotropin releasing hormone agonists (tryptorelin, goserelin, buzerelin), causing a state of reversible hypogonadism.
In Russia, the following antigonadotropin preparations have been registered.
Depot goserelin 3.6 mg p / k; Triptorelin 3.75 mg IM and p / k; leuprorelin 3.75 mg IM The drug is a ready-made kit with various methods of administration. Treatment begins with 2 4 days of the menstrual cycle: 1 injection every 28 days.
Endonasal spray 0.2% solution of buserelin acetate 0.9 mg per day. Treatment begins with 1-2 days of the menstrual cycle: 0.15 mg in each nasal passage 3 times a day through equal time intervals.
Preparation for surgery with the help of antigonadotropins in the presence of uterine fibroids allows for sparing organ-preserving operations using endoscopic technique.
To date, several strategies of long-term therapy with antigonadotropins have been described, which allow to avoid pronounced side effects while maintaining high clinical efficacy.
Add back the combination of antigonadotropins with small doses of estradiol.
On off treatment with antigonadotropins intermittent courses (three-month therapy with a three-month break up to 2 years.
Drow back the use of high doses of antigonadotropins for 8 weeks with the transition to reduced doses of the drug for 18 weeks.
A likely response to treatment can be predicted in most cases 4 weeks after the first injection.
Drugs are well tolerated, do not possess antigenic properties, do not cumulate, do not affect the lipid spectrum of the blood. Side effects: hot flashes, sweating, dryness in the vagina, headache, depression. nervousness, change in libido, seborrhea. peripheral edema, worsening of prospective memory, decreased bone density.
Discontinuation of therapy leads to the restoration of the normal menstrual cycle and estrogenic status approximately 60,100 after the drug is discontinued and the rapid re-growth of the uterine fibroids to their original size (during the first 3 to 4 menstrual cycles) with all clinical symptoms (although some authors note that these symptoms less pronounced.
Prevention of uterine fibroids.
In addition to general recommendations for the observance of a rational mode of life, prevention of common diseases in childhood and adulthood, the role is played by the exclusion of abortions, the timely correction of hormonal disorders, the adequate treatment of gynecological diseases.
There is also a specific prevention of uterine fibroids. This is the timely implementation of reproductive function. The first birth is recommended in 22 years, the second at 25 years, the subsequent planned delivery up to 35 years. Late first births lead to premature aging of myocytes, a decrease in adaptive capacity for stretching and contraction. Abortions and inflammations damage the structure of the myometrium.
It should be taken into account that the most frequent period of detection of uterine myoma occurs in 30-35 years, when the actions of damaging factors are summed up.
It is necessary to preserve the first pregnancy, especially in young women with a so-called hereditary fibroid. Abortion causes the growth of myomatous nodules and growing myomas grow intensively from microscopic nodes.
Avoid excessive ultraviolet irradiation, increased temperature effects, especially after 30 years. In the presence of hereditary risk (fibroids of the uterus in the mother and close relatives), the tumor develops 5-10 years earlier, i.e. in 20-25 years. Continuation of breastfeeding for 4-6 months after childbirth normalizes the content of prolactin. which affects the growth of fibroids.