Multiple uterine fibroids and neoplasms. About methods of treatment of multiple uterine fibroids

Article last updated 07.12.2019

One of the most common types of cancer reproductive system in women is fibroids. The disease is characterized by a benign abnormal growth of the tissues of the uterine organ. There are single formations and multiple uterine fibroids. The multiple form occurs much more frequently and can lead to severe complications.

Several myoma nodes will grow on the uterus at once, which differ in different sizes and types.

Science divides the uterine nodes into several categories.

Depending on the size, they are as follows:

• Small forms not exceeding 20 mm
• Medium no more than 60 mm
• And large from 60 mm and above

According to the location of the tumor in the uterus, the following types are distinguished:

• - myometrium nodes are formed under the mucous layer of the organ. They are adjacent to the body of the uterus.
• Interstitial fibroids nodes are located in muscle layer walls of the uterus.
• Subserous myoma- nodes cover the outer side of the organ and are attached to the uterus with the help of legs. They are also called subperitoneal, as they grow towards the abdominal cavity.
• Intraligamentary fibroids- such nodes appear in the interconnective space.
• cervical fibroids- develops on the cervix.

As a rule, the multiple form of uterine fibroids entails a violation of the functions of the entire reproductive system. The menstrual cycle gets off, there are pains in the abdomen, it becomes difficult for a woman to conceive a child.

Causes

A multiple tumor on the uterus develops for a number of reasons:

• Violation of the processes of cell division in the tissues of smooth muscle fibers.
• Spasm of the arteries during menstruation, leading to ischemia.
• Inflammatory diseases of the pelvic organs: endometriosis, metroendometritis, adenomyosis, etc.
• Hormonal failure, causing a high concentration of estrogens - female sex hormones.
• Low levels of progesterone in the blood.
• Injury to the inner layer of the uterus as a result of several abortions, operations.
• Long-term use of hormonal contraceptives and wearing an IUD.

In addition to the main causes, there are also risk factors that can trigger the development of the disease:

• hereditary predisposition
• Chronic fatigue and stress
• Hypothyroidism and obesity
• Prolonged lack of sexual activity and dissatisfaction in the sexual sphere
• Permanently postponing pregnancy

If you have found any items from the above list, do not rush to panic, fibroids do not always occur for obvious reasons. Completely healthy woman a tumor can also form, and such cases are not rare. But still, it is better to visit a specialist in order to undergo an examination to exclude the disease or its early detection.

Symptoms of the disease

With small sizes of myomatous nodes and on early stage the pathological process of the tumor does not manifest itself. Only a doctor on ultrasound can detect a neoplasm on the uterus.

But if you have a large multiple uterine fibroids, and even with submucosal or intramural types of nodes, then you will certainly feel the following symptoms:

• Acyclic bleeding that occurs in the middle of the menstrual cycle and leads to large blood loss.
• Cyclical haemorrhages with large volume of blood and sensitive pains.
• As a result, anemia and pallor of the skin develop.
• Pay attention to the nature of the pain. If they are pulling, long and do not depend on the cycle, then most likely you have a muscular type of fibroids. When the pain is cramping, sharp and occurs during menstruation, this indicates a submucosal type of tumor.

• If the number of nodes is significant and their size is constantly increasing, then the work of organs close in location to the uterus is disrupted. There are problems with urination and the act of defecation.

Due to the multiple form of oncology, the mucous layer of the uterus is gradually deformed and may completely cease to perform its function.

If you do not detect the disease in time, you can get serious complications. For example, torsion of the stalk of fibroids with subserous formations leads to tissue necrosis and the development purulent process in the area of ​​the peritoneum.

Multiple fibroids and pregnancy

Numerous nodes on the uterus affect both the process of fertilization itself and the period of pregnancy in a woman. A separate type of oncology, such as a small subserous node, will not have a negative effect on the function of the reproductive organ. However, during childbearing, myomatous formations can behave differently. Some fibroids begin to increase in size, others, on the contrary, fade away or freeze.

• The neoplasm itself does not allow the egg to enter the uterus due to the high pressure on the fallopian tubes.
• Also, in the presence of a tumor, patency is impaired cervical canal. This prevents normal fertilization.
• Various concomitant pathologies of the endometrium do not allow the egg to attach to the body of the uterus and interfere with the onset of pregnancy.

If pregnancy does occur, then there are certain risks and complications in the course of its course:

• High uterine tone contributes to spontaneous miscarriage on early dates.
• When the nodes are located close to the placenta, its detachment or early aging may occur.
• There is a high probability of premature birth, sudden bleeding.
• In the worst cases, fetal malnutrition and the development of anatomical defects occur.
• The very process of delivery can be weakened in the presence of fibroids.

It is important to know that after surgery to remove multiple fibroids, you should not plan to conceive for at least a year so that the body and its hormonal levels can recover properly.

Diagnosis of the disease

First, the doctor examines the patient on the gynecological chair. The specialist can determine how much the uterus is enlarged in size, examine the surface of the organ, the mobility of the nodes and their number.

The main diagnosis of the disease is carried out by instrumental methods:

• Doppler ultrasound helps to determine the exact number of nodes, their position on the uterus, the nature of the blood flow.
• Hysteroscopy and MRI of the reproductive organs clarify some of the nuances of the course of fibroids, especially of the submucosal type.

• The method of diagnostic laparoscopy is aimed at distinguishing subserous fibroids from severe pathology of the ovaries and peritoneal tumors.
• Histological biopsy determines the nature of tumor tissues and their possible malignancy.

In addition to the above diagnostic methods, the doctor prescribes blood tests for the hormonal composition to the woman, examines the discharge and takes a smear.

And only after receiving all the information about the pathological process, the gynecologist decides which treatment is better to choose in a particular case.

Treatment of multiple fibroids

Treatment of fibroids is always selected individually. The choice of method depends on many factors: the behavior and nature of the neoplasm, the symptoms of the disease, the patient's well-being, the age of the woman and her desire to have a baby in the future.

conservative method

This treatment is prescribed in the absence of complications and the mild course of the disease. It consists in taking special medications that can affect the hormonal background of the body. These drugs include:

• Gonadoliberin agonists - Diferelin, Buserelin.
• Antigonadotropic drugs - Danazol, Gestrinone.

• Gestagen preparations - Norkolut, Dydrogesterone.
• Antiestrogen drugs - Tamoxifen.
• Progesterone antagonists - mifepristone, etc.
• Patients of reproductive age are prescribed combined oral contraceptives with low doses of active ingredients.
• Mirena has a good effect on the treatment of fibroids.

The intake of any hormonal drug should be monitored by a doctor. Women must strictly follow all specialist instructions and medication regimens.

Operational method

Surgical treatment of multiple forms of fibroids is indicated in cases of severe disease.

1. If a woman has strong uterine bleeding.
2. The large size of the uterus with a myomatous node and the accelerated development of the process.
3. Infertility and difficulty bearing a fetus.
4. Severe pain and too low level hemoglobin.
5. Violation of the work of neighboring organs.
6. Necrosis of tumor tissues and the development of an inflammatory-infectious process.

The type of surgical intervention is determined individually. When a woman is planning a future pregnancy, doctors perform organ-preserving operations:

1. Myomectomy
2. Hysteroresectoscopy
3. Embolization of the uterine arteries

If the pathology is complicated by other diseases, when a woman is already in the menopause period or when fibroids degenerate into cancer, it is recommended complete removal uterus together with the tumor from the body or its supravaginal amputation.

All women who are seen by a specialist with a diagnosis of multiple fibroids are supposed to have regular ultrasound scans, at least once every 6 months.

It is forbidden to stay in the sun for a long time and any warming procedures in the form of baths, a solarium, as well as massage in the lumbar region.

Myoma is benign tumor, which can develop inside or on the surface of the uterus or in the myometrium. In some patients, a single neoplasm may not cause inconvenience and require only observation. But if multiple uterine fibroids develop, therapy is mandatory.

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What is a multinodular fibromyoma?

Multiple myoma uterus - a neoplasm that has several nodes that differ in diameter and shape. It is detected in almost 80% of patients who were diagnosed with fibromyoma. A feature of the pathology is that the neoplasm can appear in any layer of the reproductive organ. Multiple nodes of uterine fibroids can be of one type or several.

Photo of multinodular uterine fibroids

The disease has a different prognosis, which depends on the diameter, location, growth rate of the neoplasm, and the age of the patient.

Classification of multinodular fibroids

Depending on the size of the neoplasm, there are:

• uterine fibroids of small sizes, the diameter of which is a maximum of 2 cm;
• medium fibromyomas, no larger than 6 cm;
• large, at least 6 cm.

Depending on the place where multiple uterine fibroids grow, it happens:

• , nodes grow under the lining of the uterus;
• , the neoplasm develops in the depth of the myometrium of the reproductive organ;
• , it grows towards the abdominal cavity;
• intraligamentary, grows in the ligamentous apparatus of the uterus;
• fibromyoma.

Etiology

Provoke the appearance of multiple uterine fibroids can various reasons. But most experts believe that the disease most often develops due to hormonal imbalance.

In addition, the cause of the pathology can be:

• lack of pregnancy and natural feeding;
• abortions and purges;
• inflammation of the reproductive organs;
• metabolic disorder;
• excess weight;
• heredity;
• excessive physical activity;
• constant stress;
• damage to the pelvic organs;
• prolonged use of the IUD;
• lack of sexual intercourse for a long time, sexual dissatisfaction, private change of partners;
• endocrine disorders (hypofunction of the thyroid gland).

Clinical picture

If the neoplasms are small in diameter and localized outside the uterus or in the depths of the myometrium, then most women have no obvious signs of pathology, and it is diagnosed by chance during an ultrasound examination. If at least one node is localized under the mucosa or directed inside the reproductive organ, then the following clinical manifestations may be observed:

1. Changes menstrual cycle. An acyclic discharge of blood may appear, which is not associated with menstruation and can be on any day of the cycle. Menstrual bleeding itself becomes strong and prolonged, clots may be present in them. Due to the large loss of blood, there is a risk of developing anemia.
2. The appearance of pain different nature. If the fibromyoma is localized under the mucosa, then, as a rule, pain is observed before menstruation and has a cramping paroxysmal character. When the neoplasm appeared inside the myometrium, the pain can be constant. They can occur due to the fact that fibroids compress adjacent tissues and disrupt blood circulation in them. Pain may radiate to the lumbar region.
3. If a multinodular uterine fibroid of a large size appears, which compresses bladder and intestines, then can be observed frequent urges for urination and constipation. In addition, there may be pain when emptying the intestines and bladder.
4. Enlargement of the abdomen with the rapid growth of the tumor.
5. Appearance during the period menstrual bleeding nausea, weakness due to large blood loss, dizziness, lack of appetite.

Complications

A tumor consisting of several nodes provokes deformation of the uterus. Neoplasms of small size do not interfere with the onset of pregnancy, but during the bearing of a child they can grow. And an increase in fibroids can cause late toxicosis, premature birth, spontaneous abortion, placental abruption.

Large multinodular uterine fibroids can cause problems with conception, which can be observed, both due to the inability of the embryo to implant into the wall of the organ, and due to hormonal disorders.

Multinodular fibroids more often than a single neoplasm degenerates into a malignant tumor.

Diagnostics

When making a diagnosis, taking an anamnesis helps, the doctor asks the patient about the presence of close relatives with such a pathology, gynecological operations, previous pregnancies, childbirth, and lactation.

The gynecologist conducts a two-handed examination of the patient, which allows you to identify seals, uneven surface of the uterus.

Schedule laboratory and instrumental methods research:

• and urine;
• , including in the Doppler mode;
• CT scan;
• magnetic resonance imaging;
• cerviscopy;
• hysterosalpingography.

Treatment

If the patient has multiple nodes of uterine fibroids, then the treatment is selected individually.

Due to the risk of rapid tumor growth, therapy should not be delayed. The choice of treatment tactics depends on:

• woman's age;
• node localization;
• related pathologies.

Conservative therapy for multinodular fibroids is prescribed only if its size is small and the disease does not progress.

With such a course of pathology, medications are prescribed before surgery in order to reduce the size of the nodes and the operation was less traumatic. Medications prescribed after the operation help to fix the result from it.

A small neoplasm can regress if hormones are prescribed (see).

Preparations

Can be written:

1. Progesterone analogues (Dufaston,), which reduce the activity of estrogens, hormones that cause the progression of fibroids in most cases. But in some women, these drugs, on the contrary, can cause tumor growth, so self-medication with them is not permissible.
2. Synthetic androgens (Danazol, Gestrinone). They inhibit the production of follicle-stimulating and luteinizing hormone. With their deficiency, the ovaries produce less estrogens and progestins; without these hormones, the tumor stops growing.
3. GnRH agonists (Buserelin) create conditions in the body as during menopause: the ovaries cease to function, sex hormones do not enter the bloodstream, and tumor growth stops.

After consultation with a specialist and as aids you can apply traditional medicine recipes.

upland uterus

The upland uterus can stop bleeding and reduce the size of fibroids.

To prepare an infusion from it 1 tbsp. raw materials must be poured with a glass of boiling water and placed on water bath for 5 minutes. Then turn off the gas and leave on the stove for another 3 hours. Take an infusion of 3 tbsp. l. 3 times a day. You can read more about the use of folk remedies in the article " Folk methods treatment of uterine fibroids.

If there are large nodes, then resort to surgical therapy.

Operation

It is shown if there are:

• painful periods, accompanied by large blood loss;
• neoplasm of large size;
• myoma is growing rapidly;
• there is a risk of rebirth.

Emergency operation shown:

• heavy bleeding has opened;
• torsion of the node is observed;
• growth of fibroids in the cavity of the reproductive organ.

More details about surgical therapy can be found in the article "".

Multinodular uterine fibroids are more difficult to treat than a single neoplasm. Therefore, it is imperative to visit a doctor at least once a year.

- the presence of two or more myomatous nodes of various sizes, types of growth and localization. Clinical manifestations and their severity depend on the size and location of the fibroids. Abundant and prolonged menstruation may occur; sensations of heaviness, pressure and pain in the lower abdomen, problems with conception and pregnancy. A gynecological examination, pelvic ultrasound, HSG, hysteroscopy, and laparoscopy help to detect multiple uterine fibroids. Taking into account many factors (number, size, location of nodes, age and reproductive plans of the patient), the choice can be made in favor of conservative therapy or surgical treatment (myomectomy, hysterectomy).

General information

Multiple (multinodular) uterine fibroids (leiomyoma, fibromyoma) - several benign tumor growths emanating from the myometrium. Multiple uterine fibroids are determined in 80% of patients with this pathology. In recent decades, the age of women with myomatosis has rejuvenated - if earlier disease predominantly diagnosed in late reproductive and premenopausal ages (40-50 years), today fibroids are increasingly detected in patients aged 30-35 years.

Nodes can meet at the same time different sizes: small - up to 2 cm, medium - up to 6 cm, large - more than 6 cm in diameter. Fibroids may have the same or different localization(in the body or cervix) and the direction of growth (subserous, submucosal, interstitial, interligamentous uterine fibroids). In some cases, multiple uterine fibroids are detected, growing according to the “knot within a node” type. In 95% of all observations, the nodes are located in the body of the uterus, less often in the region of the cervix and ligamentous apparatus. Quite often, multiple uterine fibroids cause menstrual and reproductive dysfunction, so its treatment and prevention are the most important tasks of clinical gynecology.

Causes of multiple uterine fibroids

According to most researchers, uterine fibroids occur as a result of dysregulation of the growth of smooth muscle cells of the myometrium. Such a process can be initiated by ischemia caused by arterial spasm during menstruation, endometriosis, inflammatory diseases(metritis, metroendometritis), hormonal imbalance, damage to the myometrium during gynecological manipulations (abortions, separate diagnostic curettage), long-term use of the IUD. These damaged smooth muscle cells become the beginnings of future myomatous nodes.

AT initial stage growth of uterine fibroids occurs under the influence of changes in the concentration of sex hormones during the menstrual cycle, however, in the future, due to the inclusion of autocrine-paracrine regulation mechanisms, the growth of nodes becomes relatively autonomous, independent of the general hormonal background. An increase in the size of the node occurs both due to an increase in the proportion connective tissue in its structure, and due to the local production of estrogens.

Factors stimulating the growth of multiple uterine fibroids can be hereditary predisposition, stress, endocrine-metabolic disorders (hypothyroidism, obesity), prolonged sexual abstinence, sexual dissatisfaction. Important role in the pathogenesis of the disease plays an imbalance between estrogen and progesterone in female body, which is largely facilitated by the absence of pregnancies and childbirth, repeated artificial termination of pregnancy.

Symptoms of multiple uterine fibroids

Both single and multiple uterine fibroids have similar clinical manifestations, which depend mainly on the size and nature of the growth of the nodes. Small fibroids, especially those with a subserous location, are often asymptomatic: menstruation comes regularly and on time, there are no abdominal pains. As a rule, asymptomatic multiple uterine fibroids are detected during a routine ultrasound of the pelvic organs.

For submucosal (submucosal) and interstitial (intramural) myomatous nodes, menorrhagia is characteristic. Uterine bleeding of varying intensity can also occur in the intermenstrual period. Constant blood loss leads to the development of iron deficiency anemia. Menstruation is usually accompanied by strong painful sensations. The growth of old and the appearance of new nodes in multiple uterine fibroids leads to the fact that aching pain in the pelvic region become permanent. Large interstitial and subserous uterine fibroids can exert strong pressure on neighboring organs (bladder, ureter, rectum), resulting in difficulty or frequent urination, chronic constipation, hydronephrosis.

With multiple uterine fibroids of any localization, the transformation of the mucous layer of the uterus is noted: from glandular-cystic hyperplasia and polyposis to endometrial atrophy. In case of malnutrition of one or more nodes (due to ischemia of the interstitial fibroids, twisting of the legs of the subserous fibroids), symptoms of an acute abdomen develop: sharp abdominal pain, nausea and vomiting, fever, muscle tension of the anterior abdominal wall.

Multiple uterine fibroids and pregnancy

The impact of multiple uterine fibroids on a woman's ability to conceive, bear and have a normal child is ambiguous. Some fibroids (subserous, small) may not have any significant effect on fertility. At the same time, during pregnancy, the myomatous nodes themselves can behave differently: slightly increase, decrease, or stabilize in size.

The impossibility of conception with multiple uterine fibroids may be associated with the following factors: anovulation due to hormonal imbalance; violation of the patency of the cervical canal or fallopian tubes, preventing fertilization; pathology of the endometrium, impeding implantation. As a rule, reproductive function is reduced in the presence of fibroids with submucosal and interstitial growth.

However, even if pregnancy has occurred, multiple uterine fibroids is a risk factor for its complicated course. First of all, in connection with increased tone myometrium increases the likelihood of miscarriage in the early stages, and in the second or third trimester there is an increased risk of developing placental pathology (premature aging, detachment), bleeding, premature birth. With large nodes that deform the uterine cavity, fetal hypotrophy and the formation of various anatomical defects are possible. Immediately during and after childbirth, multiple uterine fibroids can cause weak labor activity, uterine atony and postpartum hemorrhage, prolonged uterine involution.

Diagnosis of multiple uterine fibroids

Confirming the presence of multiple uterine fibroids is possible only with the help of instrumental imaging methods. Gynecological examination and analysis of complaints allow only a rough estimate of the size and type of growth of the nodes. With a two-handed examination, the gynecologist determines an increase in the uterus, its bumpy surface, the presence of nodes of various sizes and mobility.

The standard examination is supplemented by a combined gynecological ultrasound (TA+TV). During the study, the number, size, location and condition of multinodular fibroids are specified. color doppler mapping and dopplerometry allow to obtain information about the nature of the blood flow in the myoma nodes, which is important for the subsequent choice medical tactics. Significantly expands the possibilities of ultrasound in the diagnosis of submucosal fibroids ultrasonic hysterosalpingoscopy, in which the uterine cavity is contrasted with liquid media.

To clarify diagnostic information, it is possible to perform hysterosalpingography, hysteroscopy (with submucosal fibroids), MRI of the pelvic organs. If it is necessary to exclude malignancy of multiple uterine fibroids, an RDD is performed with histological examination scraping or aspiration biopsy with aspirate cytology. Diagnostic laparoscopy is indicated mainly for differential diagnosis subserous myomas with solid ovarian tumors, and retroperitoneal neoplasms.

Treatment of multiple uterine fibroids

The decision on conservative or surgical treatment of multiple uterine fibroids is made taking into account many factors: the age of the woman, the presence of plans for pregnancy, the number and location of nodes, as well as their size, clinical manifestations, influence on childbearing function.

Patients of reproductive age with small neoplasms can be treated with low-dose combined oral contraceptives to slow their growth. positive healing effect has the use of the intrauterine hormonal system "Mirena". The possibilities of using agonists of gonadotropic releasing hormones (goserelin, triptorelin, buserelin) in the treatment of multiple uterine fibroids are limited due to a number of side effects. Firstly, their intake causes a temporary regression of fibroids, and after the drug is discontinued, the size of the nodes quickly increases again. Secondly, GnRH causes a woman to undergo pharmacological menopause with all its symptoms, so in young patients the course of treatment should not exceed three months. Individually, antigonadotropins (danazol, gestrinone), antiestrogen (tamoxifen), gestagens (norethisterone, dydrogesterone) and progesterone antagonists (mifepristone), etc. can be prescribed.

Indications for surgical treatment multiple uterine fibroids are considered uterine bleeding, fast growth or large size of the nodes, infertility and miscarriage, pain and anemic syndrome, compression of neighboring organs, malnutrition in the myomatous node. In women of reproductive age, preference is given to the removal of nodes while preserving the uterus and, therefore, the possibility of pregnancy. In these cases, laparoscopic myomectomy, conservative myomectomy with laparotomic access, hysteroresectoscopy of nodes can be performed. Uterine artery embolization also belongs to organ-preserving methods of treatment of multiple uterine fibroids. In women who do not plan childbearing, in perimenopausal age, with a combination of multiple uterine fibroids with adenomyosis, signs of fibroid malignancy, supravaginal amputation of the uterus or hysterectomy is performed - removal of the uterus along with the cervix.

Patients who are observed by a gynecologist for multiple uterine fibroids are recommended to have an ultrasound of the OMT twice a year. You should limit your exposure to the sun, exclude visits to the solarium, baths and saunas, conduct thermal procedures on the lumbar region and abdomen, massage the lumbosacral spine, since these procedures can provoke the growth of nodes and aggravate the clinical manifestations of multiple uterine fibroids.

Services table

Multiple nodular uterine fibroids: what is it?

Multiple (multiple) uterine fibroids is the presence in reproductive organ two or more nodes of a benign nature, consisting of hypertrophied cells of the middle layer of the uterus - myometrium.

Uterine fibroids mixed form: what is it?

Multiple nodes of uterine fibroids can be located completely in its various layers: both in the subserous, in the myometrium and intramurally.

Such a pathological condition is sometimes called mixed uterine fibroids, since the nodes are localized in different places of the organ and can give completely versatile symptoms, mixed, characteristic of both subserous localization of the neoplasm and submucous. This pathology is not uncommon, but rather, on the contrary, about 70% of uterine fibroids encountered in women are multiple. Previously it was thought that this disease is more pathognomonic for women in age group after 35 years, however, at present, the incidence statistics are inexorably growing and indicate a rejuvenation of the incidence. So now and at the age of 20, doctors make such diagnoses.

Multiple fibroids in the same uterus can be characterized as different localization, and in size: small ones have dimensions not exceeding two centimeters, medium ones - from two to six centimeters, and large ones - more than 6 centimeters, respectively.

etiological factors that affect hypersensitivity myocytes can be inflammatory processes traumatic factors, medical interventions on the organs of the female reproductive system, as well as genetic factors.

The pathogenesis of such neoplasms also has a hormonal character, which consists in the effect of an increased estrogen background on the compromised muscle cells of the uterus.

In myomatous nodes, two stages of development are distinguished, characterized by different sources of estrogenic effects: so on initial stage the growth of nodes occurs due to a general altered hormonal background with a component of hyperestrogenism, when subsequently such formations become independent of the general hormonal background, and autonomously synthesize estrogens, which support the development of these nodes.

The clinical picture of this pathological condition depends on the size of the formation, as well as the anatomical location of the myomatous nodes.

Multiple small uterine fibroids

If the size of the nodes of even multiple fibroids is insignificant, then there may be no clinical symptoms at all. Such a fibroid may be an accidental finding on scheduled inspection at the gynecologist or preventive passage of ultrasound.

The symptoms mainly depend on where the nodes are located: if there is a submucosal node, then the symptoms can manifest themselves in the form of heavy menstruation, uncharacteristic for a particular woman, cramping pains in the lower abdomen. Such blood loss leads to increased blood loss, which is not physiological, but pathological. As a result, complications such as posthemorrhagic anemia, that is, a decrease in hemoglobin levels in clinical analysis blood.

Complaints of fatigue, fatigue, decreased performance are added.

What is the danger of multiple uterine fibroids of large sizes?

A striking manifestation of myomatous nodes is pain syndrome, which can be both slightly pronounced and quite intense. Pain can be given as multiple uterine fibroids with subserous node that compress nearby organs and nerve plexuses, and submucosal fibroids, especially on a thin stalk, which turn over time into those born. With this type of myomatous neoplasms, pain acquires a cramping character, sometimes dagger-like, penetrating. Treatment of such fibroids should be carried out as soon as possible in an operative way to prevent malnutrition of the node, and in the future its necrosis. there are also signs of compression of neighboring organs, which have clinical symptoms of constipation, intestinal colic, intestinal obstruction, cystitis, frequent urination, on the contrary, lack of urination, also with large tumors, the outflow of urine from the kidneys can be disturbed, thereby a clinic of pyelonephritis, hydronephrosis appears, accompanied by hyperthermic reactions, pain in the lumbar region from the affected organ.

What is multiple uterine fibroids and pregnancy: can it occur?

One of the frequent complaints of women in the presence of uterine fibroids is infertility, despite repeated attempts to conceive a child, none of them are successful.
Of course, this situation requires urgent treatment, since the more the process is started, the worse the consequences will be for the woman's reproductive system and her reproductive function.

To identify such a pathological process, a complex of clinical and laboratory examinations should be prescribed to confirm or refute this pathological process. These include a gynecological examination by an obstetrician-gynecologist, ultrasound examination with both abdominal and vaginal probes, ultrasonic Doppler blood flow in the nodes, and magnetic resonance imaging. minimally invasive technologies such as hysteroscopy and laparoscopy are also used, which, in turn, can be both diagnostic and therapeutic.

Treatment also depends on many parameters of myoma formations.

With the diagnosis of multiple uterine fibroids, treatment without surgery can be carried out with a small size of fibroids. With significant size, compression related bodies, symptomatic fibroids shows surgical treatment.

Multiple uterine fibroids: symptoms

Symptoms or clinical manifestations of multiple uterine fibroids can be:

• Menorrhagia - increased uterine bleeding;
• Acyclic uterine bleeding - bleeding that did not start according to the cycle schedule;
• Pain in the lower abdomen from slight discomfort in the lower abdomen to dagger piercing pains;
• Posthemorrhagic iron deficiency anemia;

Signs of dysfunction of adjacent organs as a result of their compression of large uterine fibroids: constipation, violations of the act of defecation, impaired urine outflow and dysuric manifestations.

Signs of multiple uterine fibroids

All signs of uterine fibroids depend on its location in the uterus, where exactly the tumor is localized: in the body or neck, intramural or subserous. And also the size of the fibroids plays huge role in the appearance of its symptoms.

So large subserous fibroids begin to manifest themselves with significant pain in the lower abdomen, pressure on anus, constipation, and frequent urination.

Submucosal fibroids can be suspected on such a basis as an increase in menstrual blood loss, that is, a woman’s periods become more abundant and after they end, the woman feels significant weakness and fatigue.

How to treat multiple uterine fibroids?

Treatment of such a diagnosis as multiple uterine fibroids can be of three types:

1. conservative therapy;
2. Operative treatment;
3. combination therapy;

Conservative therapy is to use medications such as:

• Combined oral contraceptives, drugs that combine in their composition an estrogen and a progestogen drug;
• Gonadotropin-releasing hormone agonists;
• Antagonists of gonadotropin-releasing hormones;
• Gestagens both in the form of capsules and in the form of intrauterine devices;
• Antiestrogenic drugs;

Surgical treatment can be performed in three ways: laparotomically, laparoscopically, hysteroscopically, and operations are divided into:

Organ-preserving - surgical interventions that make up the organ itself - the uterus. These include myomectomy - the removal of only myoma formation.

Radical - involve the removal of the uterus or part of it (defundation, supravaginal amputation or extirpation of the uterus).

Only a doctor should prescribe therapy in each case, individually approaching, with a diagnosis of multiple uterine fibroids, treatment folk remedies only delays the process and aggravates the patient's condition.

Multiple uterine fibroids: operation, reviews

Removal of multiple uterine fibroids is indicated for small neoplasms and the presence of an expected effect after such an operation. To remove a separate myomatous node, a conservative myomectomy is chosen, accesses are also selected depending on the size of the tumor. With its impressive size, of course, the doctor chooses a laparotomy access, and with minor - laparoscopy. With submucosal localization, hysteroresectoscopy is performed.

However, the opinion of doctors coincides with multiple uterine fibroids - removal of the uterus is effective. Such surgical interventions can be performed laparotomically or vaginally. There are combined surgical interventions that involve the implementation of the laparoscopic part of the removal of the uterus, followed by the vaginal stage.

In modern medical technologies, an innovation has appeared in the tactics of treating fibroids - embolization of the uterine arteries. The meaning of this procedure is the introduction of emboli (in other words, blood clots) into the vessels that feed the tumors. As a result of the cessation of blood circulation in them, necrotization and a decrease in this myomatous formation occur.

Also, a non-invasive method for removing fibroids is currently FUS-ablation - the use of an ultrasonic wave of a certain frequency, which is aimed at myomatous formation, as a result of which the tissues are heated to a temperature of 60 degrees and the tumor tissue is simply necrotic. Due to non-invasiveness this method more and more doctors prefer this method.

But we repeat that only a doctor can adequately evaluate all the data of objective research methods and choose tactics surgical intervention in each case, taking into account all the nuances of a particular woman.

Can you get pregnant with multiple uterine fibroids?

Of course, you can, however, it is worth noting that it all depends on the size of the myomatous tumor and its location. These characteristics of the neoplasm appear in all matters relating to this diagnosis.

With a small uterine myoma, its subserous location, albeit a few nodes, pregnancy is quite real. However, if we are talking about a large submucosal fibroid that deforms the uterine cavity, as well as about a fibroid that is located in the cervix or close to the internal uterine os, then the chances of pregnancy in this case are very small. The large size of the tumors also negatively affects the gestational period, as it can cause complications such as placental abruption, placental dysfunction, chronic fetal hypoxia, which ultimately leads to intrauterine growth retardation syndrome and fetal distress. In the most deplorable cases, there may be a threat of termination of pregnancy, the threat of premature birth, as well as antenatal death of the fetus.

A very important point is the monitoring of Doppler parameters of blood flow in the vessels feeding the tumor. Since there may be complications associated with malnutrition of the node and their necrosis.

Who gave birth with multiple uterine fibroids, reviews?

With this diagnosis, the birth plan can be chosen both through natural birth canal and by caesarean section. If the tumors are small and do not interfere with the birth process, then delivery is fully indicated. naturally. And if the tumor is located in the area of ​​\u200b\u200bthe internal pharynx and cervix, then such childbirth is impossible and the woman must be delivered by caesarean section.

Content

Multiple uterine fibroids are found in about 50% of women who visit a gynecologist. Uterine fibroids are tumor-like formations diagnosed in the myometrium.

Uterine fibroids can be either single or multiple. In gynecological practice, the plural form is more common. Neoplasms in multiple myoma have different amount, appearance and form.

Pathology refers to a benign disease, however, the prognosis depends on many factors. Volume, localization, growth rate and type of nodes are essential.

The multiple form, such as the subserous variety, often progresses asymptomatically. Its detection may be random during preventive ultrasound of the pelvic organs and referral to a specialist for another reason. Multiple uterine fibroids, for example, submucosal type, subject to mandatory treatment on different reasons. The lack of timely diagnosis and treatment of the submucosal variety can cause an increase in nodes, which often leads to unpleasant consequences.

Varieties of multiple uterine fibroids

Pathology is represented by several options. Myomatous neoplasms are classified depending on their size, localization and cellular composition.

Multiple uterine fibroids come in the following sizes:

• big;
• average;
• small.

Depending on the location, several types of nodes are distinguished.

• Submucous or submucosal. Gynecologists refer such education to one of the most dangerous forms. This is due to the fact that the submucosal or submucosal node is characterized by rapid growth and severe symptoms. The submucosal node is located under the mucosa or endometrium, which is the reason for its different name.

In some cases early appearance symptoms in submucosal myoma is the reason for its detection at the initial stage.

• Intramural. Multiple uterine fibroids of this type are localized in the thickness of the myometrium. Doctors note that the intramural node is considered the most common tumor.
• Subserous. Myoma nodes with subserous myoma are located directly under the serous membrane outside the uterus. The subserous variety is a common tumor.
• Intraligamentary. Such a formation can be diagnosed between the sheets of the broad ligament of the body of the uterus.
• Retroperitoneal. This type differs in growth from the cervix or other departments behind the peritoneum of the organ.

With multiple uterine fibroids, neoplasms are diagnosed, which may be located on different stages progression and have different forms and clinical manifestations.

Multiple nodes often prevent pregnancy and can provoke premature birth, placental abruption and cause various complications in the process of delivery.

Reasons for the development of multiple uterine fibroids

The causes of the appearance and progression of a uterine tumor, in particular, of a multiple nature, are constantly being reviewed. This is due to the fact that the disease belongs to little-studied pathologies.

In general, one can distinguish two main theories explaining the cause of multiple, in particular, submucosal or submucosal uterine fibroids.

• congenital nature of the disease. Pathological changes occur during fetal development of the genital organs. The growth of multiple uterine fibroids debuts after the first menstruation.
• Acquired pathology. Changes in the hormonal regulation of the cycle, imbalance of sex hormones, stimulates excessive growth and cell division. Some experts consider multiple fibroids a type of hyperplasia.

In their development, myomatous nodes go through three main stages:

• the formation of a growth zone of fibroids;
• the appearance of a microscopic nodule;
• definition of a tumor macroscopically.

It is known that the growth of myomatous nodes, for example, subserous or submucosal, is accompanied by a violation of the production and ratio of sex hormones. Scientists call as the reason for the appearance of multiple uterine fibroids, including submucosal type, a change in the level of estrogen and progesterone in favor of estrogen.

Among the factors provoking the growth of myomatous nodes, there are:

• complicated surgical interventions anamnesis;
• genetic predisposition;
• stress;
• inflammatory diseases of the reproductive sphere;
• overweight;
• endocrine pathologies;
• hypodynamia;
• hypertension;
• smoking;
• long-term use of COCs;
• early onset of menstruation in girls;
• lack of orgasms as the reason venous congestion in the small pelvis;
• adverse environmental impact.

The reason for the development of multiple fibroids, in particular, subserous and submucosal varieties, is often a combination of several adverse factors.

Symptoms of multiple uterine fibroids

Gynecologists note that often multiple fibroids, for example, subserous varieties, progress without clinical manifestations. Symptoms of pathology depend on the location of the nodes and their size. Usually, severe symptoms are observed with a submucosal or submucosal form.

Uterus, including the submucosal type, include:

• pains of a different nature and localization, aggravated during critical days;
• an increase in the volume of the abdomen;
• compression of internal organs, manifested by frequent urination and constipation;
• increase spotting during menstruation;
• intermenstrual bleeding;
• infertility;
• miscarriage.

Often, with multiple uterine fibroids, doctors diagnose anemia, caused by excessive blood loss during menstruation and bleeding.

Anemia needs timely treatment, as it is dangerous complication. Signs of anemia include:

• fragility of nails;
• dryness and pallor of the skin;
• dizziness;
• weakness.

The clinical picture, in particular, of the submucosal type, is of decisive importance for the appointment of adequate treatment. In some cases, with multiple uterine fibroids, signs of an "acute abdomen" associated with torsion of the node's leg may appear. This complication accompanied by nausea, vomiting, fever and severe pain. To prevent the development of node necrosis, surgical treatment is performed.

Diagnosis and treatment of multiple uterine fibroids

Identification of pathology occurs in the process gynecological examination. In most cases, for diagnosis and treatment, for example, with uterine fibroids with submucosal formation or a large intramural tumor, an examination by a doctor on a chair and ultrasound is sufficient.

Additional diagnostic methods include:

• hysteroscopy;
• laparoscopy;
• aspiration biopsy;
• blood tests for hormone levels.

A detailed examination is necessary to prescribe the correct treatment. It is important to identify the causes of the pathology and eliminate the factors provoking the disease before treatment.

Treatment for multiple uterine fibroids can be:

• conservative;
• surgical.

Subserous, submucosal formation, intramural tumor of small size (up to 5 cm) at an early stage can be treated with medication. Conservative treatment affects the causes of the disease, helps to stabilize the hormonal background and the size of the nodes. Properly selected treatment also allows you to eliminate the painful manifestations of a submucosal or submucosal tumor.

Among hormonal drugs apply:

• agonists of gonadotropic releasing hormones;
• antigonadotropins;
• antiestrogen;
• gestagens;
• progesterone antagonists.

Hormonal drugs have side effects and are not always effective in multiple neoplasms.

Surgical treatment includes two main tactics.

• Organ-preserving. As part of given treatment use:

1. FUS-ablation;
2. embolization of the uterine arteries;
3. myomectomy by laparoscopy, laparotomy, hysteroscopy.

• Radical. With oncological alertness, profuse blood loss and progression of the disease after the onset of menopause, the uterus is amputated, which involves hysterectomy or extirpation.

The multiple form of the disease needs timely treatment, especially with large neoplasms of the submucosal or subserous variety.

As a preventive measure for the onset of the disease, doctors recommend conducting preventive examinations, study timely treatment gynecological diseases, observe the culture of sexual relations and avoid abortions.