07 November 2017 32305 0

Uterine fibromyoma is a benign tumor that last years are increasingly being diagnosed even in young girls. Pathology can proceed for a long time without clinical symptoms, until the tumor reaches an impressive size, as a result of which it begins to compress nearby organs. Fibromyoma is a neoplasm that does not degenerate into a malignant neoplasm, but can significantly impair the quality of life.

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Fibroma and uterine fibroids: what is the difference between pathologies?

Uterine fibroids is a neoplasm that consists of muscle fibers, which is the difference between fibroids and uterine fibroids, since connective cells predominate in the latter. This is practically the only difference between these types of tumors localized in the uterus or cervix. Both fibroids and fibroids are benign, present with similar symptoms, and require similar treatments.

Uterine fibromyoma: causes of development

The exact causes of the development of uterine fibroids have not been elucidated to this day. However, according to one version, the occurrence of a benign tumor is associated with hormonal imbalance - increased level estrogen in the blood. The proof of this is the fact of the reduction or disappearance of fibroids in women in the postmenopausal period, when the production female hormone decreases.

In addition, the development of uterine fibroids can be triggered by the following factors:

• hereditary predisposition;
• uncontrolled long-term hormonal contraception;
• violation of the hormone-producing function of the ovaries;
• prolonged exposure to UV radiation;
• the absence of pregnancies in women under 30;
• inflammatory processes in the organs of the reproductive system;
• hemodynamic disorders of the small pelvis;
• ovarian cysts;
• abortion and diagnostic curettage.

According to statistical studies, most often, surgical intervention to remove uterine fibroids is required for women aged 43 to 45 years. Removal of the uterus becomes necessary with the accelerated growth of fibroids, the presence of pathologies of the endometrium and ovaries. In women over 40, ovarian function decreases and estrogen levels decrease, which is accompanied by immune, hormonal and neuroendocrine disorders.

Uterine fibromyoma: symptoms and signs

Small uterine fibroids may not show any symptoms for a long time. However, its intensive growth is accompanied by the following.

• intermenstrual bleeding;
• painful sensations during menstruation, an increase in their duration and volume;
• increased urination due to pressure Bladder enlarged fibromatous node;
• feeling of pressure and heaviness in the lower abdomen;
• painful sensations during intimacy;
• constipation associated with compression of intestinal fibroids;
• unreasonable increase in the volume of the abdomen;
• pain in the lumbar region;
• infertility;
• neurological and psychiatric disorders.

The manifestation of symptoms is affected by the localization of uterine fibromyoma, its size and tendency to grow.

In the early stages of the development of the disease, a woman’s menstrual cycle is disturbed, which should be an “alarm bell” and a reason to contact a gynecologist.

At least half of the patients suffer from heavy menstruation. Most often these are women of childbearing age. Abundant discharge gradually becomes the cause of the development of anemia. In addition, significant blood loss causes cardiovascular pathologies, coagulation disorders. Similar symptoms occur with uterine fibroids of submucosal and intermuscular localization.

Pain in uterine fibromyoma can have a diverse character: from pulling and aching to intense, cramping.

With intraligamentary localization of the fibromatous node, the ureters are compressed, as a result of which a woman may complain of urinary incontinence and other pathologies of the urination process. When the intestines are compressed, constipation occurs.

Uterine fibromyoma is often accompanied by abnormal changes in liver function, which leads to hormonal failure. The metabolic processes of fats, carbohydrates and proteins are also disturbed. There may be a disorder of the thermoregulation system, in which daily temperature fluctuations are observed.

Uterine fibromyoma: diagnosis

Most often, uterine fibromyoma is detected by a gynecologist during a preventive examination. The presence of a fibromatous node can be suspected with an increase in the uterus.

To confirm the diagnosis, a life history is collected, a survey of the patient's complaints is carried out.

In addition, a bimanual examination, smears for cytology and flora are prescribed.

To clarify the localization of fibromatous nodes and the number of tumors, additional diagnostic examinations are prescribed:

• clinical and laboratory studies and a pregnancy test;
• ultrasound examination of the pelvic organs - to detect pathological processes occurring in the uterus;
• hysteroscopy - examination of the uterus with a special apparatus and an optical instrument to establish the features of the hyperplastic process occurring in the uterus, as well as to identify suspicious areas of the endometrium and conduct a biopsy;
• laparoscopy - during the study, a specialist examines the uterus using an endoscope;
• metrosalpingography - an x-ray examination of the uterine cavity, during which the patency of the fallopian tubes is assessed.

When a complex uterine fibroid is detected, a woman needs immediate treatment to improve the condition.

Uterine fibromyoma: treatment

The main difficulty in the treatment of uterine fibroids lies in the heterogeneity of a benign neoplasm. Therefore, before his appointment, a woman needs a thorough examination.

Treatment of uterine fibroids can be conservative or.

Uterine fibromyoma: conservative therapy

With small and medium sizes of the fibromatous node, a therapeutic treatment is carried out - hormonal therapy. Conservative treatment is prescribed for the following indications:

• small tumor sizes (no more than 12 weeks of pregnancy);
• mild symptoms that do not reduce the quality of life;
• the need to preserve childbearing function;
• extragenital diseases that are contraindications for surgical interventions;
• postoperative rehabilitation or preparation for myomectomy.

The positive effect of hormone therapy is achieved, on average, after six months of use. When choosing the necessary drug, the age of the patient and the characteristics of the course of the pathology are taken into account.

As a means of hormonal treatment, estrogen-gestagenic, gestagenic and androgenic drugs, as well as GnRH agonists and antigonadotropic drugs, are prescribed.

Conservative therapy of uterine fibroids is contraindicated in the following conditions:

• intensive increase in the size of the neoplasm;
• pronounced pain syndrome with the development of bleeding;
• the size of the uterus, exceeding the 12-week pregnancy;
• concomitant diseases of the pelvic organs;
• somatic pathologies (with diabetes, hypercoagulability, hypertension, etc.).

Uterine fibromyoma: specific treatment

In addition to hormone therapy, methods of non-specific treatment of uterine fibroids are also used, aimed at eliminating the causes of the development of the disease:

• vitamin therapy - taking vitamin and mineral complexes;
• diet therapy - enrichment of the diet with iron and protein products;
• sedatives for women with vegetovascular pathologies;
• venotonics - normalizing the menstrual cycle;
• antianemic therapy - is prescribed for large blood loss during menstruation;
• immunomodulatory therapy - increasing the protective functions of the body;
• carrying out physiotherapeutic procedures - magnetotherapy, electrophoresis, autotransfusion, etc.

In the absence of negative symptoms and an increase in the growth of uterine fibroids, therapy may not be carried out. In such cases, dynamic monitoring is prescribed, which implies a regular examination by a gynecologist and an ultrasound scan.

Uterine fibromyoma: surgical treatment

Surgery is indicated for the following:

• pathologies of the pelvic organs;
• excessive enlargement of the fibromatous node (more than 12 weeks);
• lack of effectiveness of treatment with conservative methods;
• strong painful sensations and heavy bleeding
• acceleration of fibromyoma growth (by more than 4 weeks per year);
• degenerative pathologies of fibroids;
• twisting of the fibromyoma node of subserous localization;
• prolonged heavy menstrual flow in women with submucosal fibroids.

Surgical treatment of uterine fibroids is contraindicated in women with the following conditions:

• cardiovascular diseases;
• impaired renal function;
• endocrine disorders;
• diseases of the upper respiratory tract;
• infectious diseases of the pelvic organs (until complete recovery).

Surgery can be carried out in several ways:

• with the help of abdominal surgery - semi-radical (supravaginal amputation, defundation of the uterus), radical (extirpation of the uterus, supravaginal amputation of the uterus with appendages), palliative (myomectomy: conservative and reconstruction of the uterus);
• through minilaparotomy - removal of pathological areas through a small incision on the abdominal wall;
• laparoscopic method - indicated for women with uterine destruction and uterine fibromyoma of subserous localization;
• with the help of transcervical myomectomy - electrosurgical or mechanical method is used. Requires the use of a hysteroscopic apparatus. Before performing, hormonal preparation is carried out;
• through uterine artery embolization (UAE) – modern method treatment of uterine fibroids, which is currently considered the most effective and safe.

Embolization of the uterine arteries is carried out in the leading medical centers in Moscow, equipped with expensive innovative technology.

The effectiveness of UAE directly depends on the competence and experience of endovascular surgeons who perform the procedure. Make an appointment with the leading specialists of Moscow: endovascular surgeon, candidate of medical sciences Bobrov B.Yu., gynecologist, candidate of medical sciences Lubnin D.M. can .

Bibliography

• Lipsky A.A.,. Gynecology // encyclopedic Dictionary Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
• Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State publishing house of medical literature, 2010. - 368 p.
• Braude, I.L. Operative gynecology / I.L. Braude. - M.: State publishing house of medical literature, 2008. - 728 p.

A neoplasm consisting of muscle and connective tissues in the structure of the body of the uterus, which differs as benign and hormone-dependent. The predominance of muscle elements in it is defined as fibromyoma, and connective - as fibromyoma. Fibromyoma is diagnosed when the amount of connective tissue in the neoplasm exceeds the amount of muscle by 2-3 times. If there is more muscle tissue (4-5 times), then fibroids occur. A fibroid composed of smooth muscle cells of the myometrium is a leiomyoma, and a fibroid of striated myometrial cells is a rhabdomyoma.

The pathological condition develops under the influence of many factors that somehow affect the functioning of the endocrine or reproductive system of a woman:

• violation of the synthesis of hormones by the ovaries;
• imbalance in the number of estrogen- and progesterone-sensitive myometrial cell receptors;
• violation of hemodynamics (blood flow) in the small pelvis;
• inflammation of the internal genital organs;
• violations of metabolic processes;
• abstinence from sexual activity;
• dysfunction of the immune system, incl. state of immunodeficiency;
• disorders of neurological origin, vegetovascular disorders;
• anovulation and infertility against its background;
• underdevelopment of the genital organs, infantilism;
• hereditary predisposition, incl. oncological diseases of the abdominal cavity and small pelvis in a family analysis;

The presence of one or more of the conditions described above does not at all mean the likelihood of a risk of developing fibroids, with regard to the latter, several theories have been deduced that describe the totality of processes that accompany the onset of a neoplasm under the influence of just the above factors:

• hormonal theory- its adherents explain the neoplasm by a hormonal imbalance with an increased concentration of estrogen, follicle-stimulating and luteinizing hormones throughout each menstrual cycle, as well as with the absence of an ovulatory peak; against this background, changes occur in the receptor apparatus of myometrium cells and the vascular system of the uterus and ovaries, ovarian function suffers, maturation of follicles is disturbed, metabolism in tumor tissues and unchanged uterine tissues is disturbed;
• extramedin theory- hormonal imbalance stimulates epidermal, heparin-binding, transforming, vascular endothelial, insulin-like growth factors and extracellular matrix; the abundance of growth zones in the body of the uterus initiates the development and growth of myomatous nodes;
• theory of myogenic hyperplasia- its adherents call myoma not so much a tumor as myometrial hyperplasia, which usually occurs against the background of a normal menstrual cycle; tissue hypoxia of the muscular elements of the uterus becomes a trigger mechanism, it leads to a violation of the differentiation of myometrial cells, acquiring the ability to proliferate.

Causes of uterine fibroids in such an increased number compared to previous decades, they call, firstly, the increase in aggressive gynecological interventions - abortions, hystero- and laparoscopies, hysterosalpingography, biopsies and coagulations of the cervix, diagnostic curettage, removal of the IUD. Secondly, the trend is associated with the active spread of sexually transmitted infections. The frequency of fibromyoma today is also associated with the improvement of diagnostic procedures, which makes it possible to detect pathology on early dates and in the absence of characteristic symptoms, even in young ladies. It is noted that fibroids are typical for women of reproductive age, 20-40 years old, their share of the total number of gynecological diseases is 30%.

Fibromyoma in its development goes through three main stages:

• the formation of an active growth zone in the myometrium with the acceleration of metabolic processes;

• intensive tumor growth without signs of differentiation of cellular elements;
• expansive tumor growth with its differentiation and maturation of cellular elements.

There are several types of uterine fibroids:

• submucosal - prone to atypical degeneration, may be complicated by bleeding and infection; in the patients themselves, metabolism is often disturbed, reproductive function suffers;
• intermuscular - characterized by rapid growth, often asymmetric or spherical in shape, usually large in size; develops into degenerative tissues up to aseptic necrosis;
• cervical - characteristic of the site in the supravaginal segment of the cervix, contributes to the displacement of adjacent organs and disruption of their function; does not change in size, accompanied by pain and menstrual dysfunction.

Fibromyoma, which develops benignly, like muscle hyperplasia (with characteristic slow growth and without proliferative processes), is called simple. When mitotic activity is observed, fast growth, but no atypical cells are observed - this is a proliferating myoma. Presarcoma is a neoplasm with atypical phenomena and heterogeneous cell nuclei.

The symptomatology of uterine fibromyoma is determined by the age of the woman, the duration of the course of the pathological process, the localization of the myomatous nodes, the presence of concomitant genital or extragenital pathology.

To the main symptoms of uterine fibroids include:

• uterine bleeding - more often in the reproductive period, profuse long-term menstruation, sometimes taking on the character of metrorrhagia, followed by anemia;
• pain in the lower abdomen and lower back - more often in the postmenopausal period, as well as in young patients with a large tumor; may be accompanied by an increase in body temperature, pain, symptoms of peritoneal irritation, accelerated ESR, an increase in the number of leukocytes; the pains themselves can be of the most diverse nature;
• violations of the function of extragenital organs and systems - dysuric phenomena and constipation

How to treat uterine fibroids?

For the treatment of uterine fibroids, conservative and surgical treatment can be undertaken.

Indications
For conservative treatment	For surgical treatment
	large uterus (more than 13-14 weeks)
course of the disease with mild symptoms	rapid growth (more than 4 weeks per year) or resistance to conservative therapy
uterine fibroids not exceeding the size of a 12-week pregnancy	the presence of pain, bleeding, dysfunction of other organs of the small pelvis
interstitial or subserous (on a broad basis) location of the node	signs of violation of the trophism of the node, necrosis of the node, myoma with degenerative changes in the tumor
myoma, which is accompanied by extragenital diseases with a high surgical risk	submucosal fibroids, accompanied by prolonged and heavy menstruation, anemia; "nascent" fibromatous node
as a preparatory stage for surgery or rehabilitation therapy in the postoperative period	signs of torsion of the subserous node on the "leg"
	myoma, combined with tumors of the genital organs of other localization, adenomyosis, chronic salpingo-oophoritis, endometrial hyperplastic processes
	cervical fibroids

Conservative treatment is complex, includes the following components:

• diet therapy - complete protein nutrition, improvement of liver function, consumption of foods containing iron;
• vitamin therapy - vitamin and mineral complexes, folic acid, iron preparations, ascorutin;
• the use of sedatives - to prevent and eliminate vegetovascular disorders; for example, motherwort tincture;
• the use of drugs to normalize periodic blood flow;
• the use of immunomodulators and immunostimulants;
• the use of antianemic drugs - to prevent anemia in the presence of bleeding;
• the use of funds to normalize liver function - medicines or choleretic herbs;
• the use of hormones (usually at least six months) - gestagens, estrogen, progesterone, GnRH agonists and antagonists, androgens;

Hormone therapy has a number of contraindications:

• the size of the uterus with fibroids, exceeding those at 12 weeks of pregnancy;
• submucosal fibroids and fibroids with interstitial localization of the node with centripetal growth;
• fast-growing uterine fibroids, incl. with suspicion of sarcoma;
• fibroids with bleeding and severe pain syndrome;
• fibroids in combination with other diseases of the genitals, for example, ovaries, endometrium, uterine appendages;
• somatic pathology, for example, hypertension, obesity, diabetes mellitus, varicose veins, hypercoagulation syndrome, etc.

As part of the treatment of fibroids, it is advisable to use physiotherapeutic methods. in this case it is:

• electrophoresis of copper sulfate, zinc sulfate or zinc with iodine;
• radon baths;
• iodine-bromine baths;
• constant magnetic field on the pelvic area;
• low-frequency magnetic field on the pelvic area;
• autotransfusion of UV-irradiated blood;
• laser irradiation of blood.

What diseases can be associated

The progression of fibromyoma in its development entails the following functional disorders in the body:

• on the part of the urinary system - expansion of the pelvicalyceal system up to hydronephrosis, can also result in urinary incontinence;
• on the part of the liver - violations of hormonal metabolism, metabolism of proteins, fats and carbohydrates;
• on the part of the cardiovascular system - myocardial dystrophy, anemia, hypoxia, hypovolemia, disorders of the coagulation system;
• from the side nervous system- there is a tendency to hysteria, depression, psychasthenia;
• on the part of the intestine - violations of the act of defecation (with the so-called posterior cervical fibroids).

Uterine fibromyoma is usually associated with such diseases:

Uterine fibroids are a predisposing factor in the development , which is associated not only with the size and location of myomatous nodes, but also with dysfunction of the ovaries, inflammatory diseases of the uterus and appendages, concomitant endometriosis.

Treatment of uterine fibroids at home

Treatment of uterine fibroids possibly at home, if the choice falls on conservative therapy. However, the introduction of drugs often occurs on an outpatient basis, where the patient is under the constant supervision of specialists. For reception medicines and conducting physiotherapy procedures, a woman can be shown a regular visit to a medical institution, but the need for surgical intervention is a reason for full hospitalization.

The rehabilitation period after the elimination of fibroids can take place in a sanatorium-resort environment. Women with such a diagnosis are shown balneotherapy using radon and iodine-bromine waters. Subsequently, the woman needs regular dispensary observation.

What drugs to treat uterine fibroids?

Hormonal drugs

• gestagenic - according to the scheme prescribed by the doctor from the 16th to the 25th day of the cycle, from the 5th to the 25th day of the cycle or in continuous mode
  • - 10 mg per day;
  • - 10 mg per day;
  • - 20 mg under the tongue 3 times a day;
  • - 1 ml of a 1% solution intramuscularly for 10 days;
  • Utrozhestan - 1 capsule in the morning an hour before meals and 1-2 capsules in the evening;
  • - 10-20 mg daily;
• estrogen-gestagenic - relevant for a disturbed menstrual cycle, acyclic bleeding in reproductive age (up to 45 years), are prescribed in the interval from the 5th to the 25th day of the cycle with a break of 7 days
  • norinil
• GnRH agonists
  • - in the form of a depot, contains 3.6 mg of goserelin acetate, one dose is injected subcutaneously into the anterior abdominal wall every 28 days;
  • - in the form of a depot, contains 3.75 mg of triptorelin, one dose is administered intramuscularly every 28 days;
• GnRH antagonists
  • - 200-400 mg 1-2 times a day for 3-6 months.
• androgens - over the age of 45, to stop the menstrual cycle
  • - 1 ml intramuscularly on the 14th day of the menstrual cycle for 3 subsequent cycles;
  • - 1 ml intramuscularly on the 14th day of the menstrual cycle for 3 subsequent cycles;
  • - 50 mg (1 ml of a 5% solution) intramuscularly on the 2nd, 6th, 12th, 13th day of the cycle for 3 cycles (6 injections in total).

Antianemic drugs (mainly iron preparations)

• (100 mg of iron) - 5 ml intravenously 1 time in two days;
• Ferroplex (50 mg iron and 30 mg ascorbic acid) - 1 tablet 3 times a day;
• (80 mg of iron) - tablets of prolonged action, 1 tablet 2 times a day.

Preparations for the normalization of periodic blood flow

• - 1 tablet 2 times a day;
• Curantil - 25-50 mg 3 times a day 1 hour before meals;
• Trental - 0.2 g 3 times a day with meals for 1-2 weeks;
• - 1 capsule 2 times a day.

Treatment of uterine fibroids with folk methods

As a stand-alone treatment folk remedies ineffective in uterine fibroids. However, it can be a good addition during the recovery phase or as an adjunct to medical, often hormonal, therapy. Any prescription deserves discussion with the attending physician, after the approval of which they can be applied:

• mountain arnica - alcohol tincture, bottles of 15, 25, 40 ml are sold in a pharmacy; take 30-40 drops three times a day;
• initial medicinal letter - pour 10 grams of dried grass into 100 ml of vodka, leave for 10-12 days in a dark place, strain; take 25 drops three times a day;
• heady hareslip - pour 20 grams of dried leaves with a glass of water, place in a water bath and, stirring regularly, stand for 15 minutes, strain after 45 minutes; take 1/3 cup three times a day;
• stinging nettle - 1 tbsp. crushed leaves pour a glass of boiling water, cover with a napkin, leave to cool, then strain; take 1 tbsp. three times a day before meals;
• stinging nettle - 1-2 tbsp. crushed flowers pour a glass of boiling water, insist under a lid or a napkin for up to two hours, strain; take 2-3 tbsp. three times a day;
• gray alder - place 10 grams of fruits and alder bark in a thermos, pour a glass of boiling water, leave for 12 hours. after strain; take 3-4 times a day after meals;
• cotton - 10 grams of crushed dried cotton root pour a glass of water, place on a slow fire and boil for 15-20 minutes, then cool and strain; take 1 tbsp. three times a day.

Treatment of uterine fibroids during pregnancy

According to experts, it is getting younger and today it is diagnosed in women not only of late reproductive age, but also in young girls. This is largely determined by the hereditary factor and the impact of various causes. Uterine fibroids do not belong to malignant diseases, and therefore surgery is not welcome. Against this background, doctors allow a woman to become pregnant, and therefore pregnancy and fibroids are quite compatible phenomena. Of course, one should not expect that the pregnancy will be carefree.

The most common consequences of this combination are changes in myomatous nodes and changes in the placental bed and various morphological changes in the placenta. The most common complications include premature termination of pregnancy, isthmic-cervical insufficiency, placental insufficiency. Therapeutic measures for uterine fibroids in a pregnant woman are aimed solely at the prevention or treatment of such complications.

It is recommended to maintain pregnancy in patients with low-risk uterine fibroids. With a high risk of complicated pregnancy and childbirth, the issue of maintaining pregnancy should be approached individually.

Contraindications to maintaining pregnancy in patients with high-risk uterine fibroids are as follows:

• suspicion of a malignant tumor of any localization;
• submucosal localization of the myomatous node, which disrupts the condition and growth of the fetus;
  necrosis of the myomatous node and a high risk of the spread of the inflammatory process throughout the uterus;
• cervical-isthmus localization of a large myomatous node, which means a real threat of miscarriage, the development of intrauterine infections of the fetus, bleeding;
• large myomatous nodes (more than 15 cm in diameter), their low location and multiple.
• the large size of the myomatous-modified uterus;
• critically late age of the primipara (over 43-45 years old) in combination with high risk factors;
• poor health of the patient.

An extreme measure of influence on a neoplasm in a pregnant woman is myomectomy. This is a very unsafe operation during pregnancy. The technique in case of pregnancy is different from that for a non-pregnant woman. The operation is performed only with torsion of the leg of the subperitoneal node and the phenomena of "acute abdomen". Very rarely, a vessel rupture is possible on the surface of one of the fibroid nodes with symptoms of acute intra-abdominal bleeding.

At 37-38 weeks, pregnant women with fibromyoma are hospitalized for examination, preparation for childbirth and the choice of a rational method of delivery. Often this becomes a caesarean section, and in some indications, removal of the uterus after the extraction of the fetus.

Which doctors to contact if you have uterine fibromyoma

A woman usually turns to a narrowly focused specialist with characteristic complaints, the doctor gets acquainted with the anamnesis of life and disease, conducts an objective study (thyroid and mammary glands, determines the presence of obesity, body hair, degree of anemia), clarifies the presence of concomitant diseases.

A gynecological examination is usually of a prolonged nature, carried out on the same days of the cycle, and allows you to determine the size of the tumor, the direction of its growth, localization, diffuse or focal nature. Colposcopy is reasonable. A pregnancy test may be ordered.

The doctor also takes smears for microflora and oncocytology, prescribes laboratory diagnostics (general blood and urine analysis; blood test for group and Rh factor; biochemical blood test for bilirubin, creatinine, urea, total protein, ACT, ALT; blood test for glucose; analysis for RW, HbsAg, HIV; coagulogram).

Additionally, within the framework of specific diagnostics, the following are prescribed:

• ovarian function tests- smear for hormonal colpocytology; measurement of basal temperature; determination of the level of estrogen and progesterone in the blood;
• ultrasound- determination of the size, shape, localization of nodes, risk options and structure of fibroids, possible processes of degeneration and malignancy;
• echography and color Doppler mapping- for differential diagnosis simple and proliferating uterine fibroids; carried out in the first phase with an unchanged menstrual cycle by transabdominal or transcervical access with a convex probe; ultrasound allows you to assess the size of the uterus, size, shape, structure, number and localization of nodes, and Doppler mapping - the presence, localization and number of color signals from intratumoral blood vessels;
• metrosalpingography (MSG)- to assess the state of the endometrium, determine the presence of submucosal nodes, their localization, the structural characteristics of the nodes, the size of the uterine cavity and its deformation;
• bicontrast pelviography- for simultaneous contrasting of the uterine cavity (MSH) and the external contours of the uterus and ovaries;
• hysteroscopy - examination of the surface of the mucous membrane of the uterine cavity (identification of more suspicious areas of the endometrium and biopsy with further pathohistological examination;
• laparoscopy- for differential diagnosis of subserous fibroids and ovarian tumors;
• intrauterine phlebography- to determine the location of myomatous nodes.

Treatment of other diseases with the letter - f

Uterine fibromyoma is a true benign tumor of the uterus. It develops from muscle tissue.

Depending on the ratio of muscle and connective tissue in its composition, this tumor previously had various names: myoma, fibroma, fibromyoma. However, taking into account that fibromyoma nodes often develop from a muscle cell, most authors consider the term leiofibroma (fibromyoma) to be more correct.

Uterine fibromyoma has its own characteristic features:

• It is the most common uterine tumor in women aged 35-55.
• It is capable of growth, reduction and even complete disappearance at menopause. However, in 10-15% of patients in the first 10 years of the postmenopausal period, the tumor may increase.
• Uterine fibroids of small size (up to 10 weeks of pregnancy) can remain stable for a long time, but when exposed to provoking factors (inflammatory process of the uterus and appendages, curettage of the uterus, prolonged venous plethora of the pelvic organs) increases quickly and very quickly (the so-called "growth spurt" ).
• The tumor is characterized by a variety of clinical variants, depending on the localization, size, location and nature of growth.
• Uterine fibromyoma has 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, because. are sinusoidal.

The onset of uterine fibromyoma nodes occurs at the age of 30, when somatic, gynecological diseases and neuroendocrine disorders accumulate in women.

Causes and risk factors

Further growth of nodes requires further accumulation adverse factors that cause tumor progression:

• absence of childbirth and lactation by the age of 30
• abortions
• prolonged inadequate contraception
• chronic, subacute and acute inflammation uterus and appendages
• stress
• ultraviolet irradiation
• formation of cysts and ovarian cysts.

At the age of 44-45 years, there is the highest frequency of surgical interventions (most often this is the removal of the uterus), the indication for which is the rapid growth of makti fibromyoma, its large size, the combination of a tumor with pathology of the endometrium and ovaries.

The growth of fibroids increases at the age of 35-45 years, when the functional activity of the ovaries and their sensitivity to hormones decrease, chronic functional tension of the regulatory systems (neuroendocrine, hormonal, immune) occurs, and homeostasis (internal balance of the body) is most often disturbed.

A negative role is played by long-term neuroendocrine disorders, pathological menopause, the action of factors such as obesity, impaired carbohydrate and lipid metabolism, endometriosis, adenomyosis.

Manifestations of uterine fibroids

Uterine fibromyomas are distinguished by a wide variety of clinical course. Complaints of patients depend on many factors: the location and size of the tumor, the duration of the disease, the presence of concomitant gynecological pathology, etc. The predominance of certain factors is reflected in the symptoms of the disease.

Often the main and most early symptom uterine fibromyoma is a violation of menstrual function - uterine bleeding or scanty prolonged spotting spotting. Along with uterine bleeding, pain is often noted, usually localized in the lower abdomen, in the lumbosacral region, sometimes spreading to the lower extremities.

Treatment

Treatment of uterine fibroids is a very difficult problem, because. despite hormonal dependence, this tumor is very heterogeneous.

Surgery

Initially, unconditional indications for surgical treatment:

• submucosal localization of fibroids
• large size of the node (the total value corresponds to the uterus of 14 weeks of gestation)
• uterine bleeding accompanied by chronic anemia
• rapid tumor growth
• acute malnutrition of fibroids (torsion of the legs of the subserous node, tumor death)
• combination of uterine fibroids with endometrial hyperplasia, ovarian tumor
• compression of the ureter, bladder, rectum
• the presence of a node in the area of ​​the tubal angle of the uterus, which is the cause of infertility
• cervical and cervical isthmus localization
• non-regressing and growing uterine fibroids in postmenopausal age.

The volume of surgical intervention is largely determined by the age of the patient.

Up to 40 years of age, if there are indications for surgical treatment, if technical capabilities allow, a conservative myomectomy is performed. It is especially advisable to remove medium-sized myoma nodes (in diameter from 2 to 5 cm), until their intensive increase in size has occurred. The preferred technique is laparoscopic. Relapses with conservative myomectomy for uterine myoma occur in 15-37% of cases.

After 40 years and postmenopausal age, in the presence of surgical indications, an operation is necessary to remove the myomatous uterus, because. if the myoma did not regress in the first 2 years of postmenopause, its further existence is accompanied by the risk of oncology (adenocarcinoma, sarcoma).

According to Corr. RAMS, professor I.S. Sidorov, risk factors for the growth of uterine fibroids are: the presence of cysts and ovarian cysts, endometrial proliferative processes, untimely cessation of ovarian hormonal activity (late menopause) and severe obesity, carbohydrate metabolism disorders or liver disease.

Conservative treatment of uterine fibroids:

Conservative treatment, carried out immediately after the detection of small and medium-sized myomatous nodes, in some cases makes it possible to slow down the further growth of the tumor, prevent operations to remove the uterus, and preserve the ability 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 location of myomatous nodes
• relatively slow growth of fibroids
• no deformation of the uterine cavity.

Conservative treatment consists in the normalization of systemic disorders characteristic of patients with uterine fibroids, among them:

• chronic anemia,
• inflammatory processes of the uterus and appendages,
• violation of the blood filling of the pelvic organs with a predominance of venous stasis and a decrease in arterial blood supply,
• violation of the functional state of the nervous system and vegetative balance.

Methods for correcting systemic disorders include the following:

• compliance healthy lifestyle life (normalization of sleep, rational nutrition, physical activity, rejection of bad habits, control of body weight);
• normalization of sexual life;
• periodic intake of vitamins and microelements in the winter-spring period;
• anemia treatment;
• neurotropic effects, if the patient shows features of a disharmonious personality.

If a pregnancy occurs, not even planned, it is necessary to preserve it, because. postpartum reduction of the uterus, breastfeeding a child for at least 4-6 months contribute to a change in the composition of fibroids, its transition to a simple one and, in some cases, the cessation of its further development.

To prevent the inevitable removal of the uterus during tumor growth great importance has the preservation and maintenance of reproductive function up to 40 years.

The effectiveness of hormonal therapy varies greatly depending on the nature of hormonal disorders, the presence and density of receptors in the myomatous nodes and myometrium. in fibromas, where connective tissue, as well as in nodes of large sizes, hormonal receptors, as a rule, are absent. Therefore, hormonal therapy in these patients is not very effective.

Nevertheless, it is used in the correction of a disturbed menstrual cycle. For this purpose, progesterone and its derivatives (dydrogesterone, cyproterone acetate), as well as androgen derivatives, 19-norsteroids (levonorgestrel, norethisterone acetate) are used. The latter are undesirable young age, with obesity, diabetes mellitus, cardiovascular diseases.

The most promising drugs in the treatment of patients with uterine fibroids are antigonadotropins (gestrinone, danazol), which have antiestrogen and antiprogesterone effects, causing temporary amenorrhea (cessation of menstruation), as well as gonadotropin-releasing hormone agonists (triptorelin, goserelin, buserelin), which cause a state of reversible hypogonadism.

The following antigonadotropins are registered in Russia:

• Depo-goserelin 3.6 mg s.c.; triptorelin 3.75 mg i/m and s/c; leuprorelin 3.75 mg IM The drug is a ready-made kit with different ways introductions. Treatment begins on the 2nd-4th day of the menstrual cycle: 1 injection every 28 days.
• Endonasal spray - 0.2% solution of buserelin acetate 0.9 mg per day. Treatment begins on day 1-2 of the menstrual cycle: 0.15 mg in each nasal passage 3 times a day at regular intervals.

Preparation for surgical intervention with the help of antigonadotropins in the presence of uterine fibroids allows for sparing organ-preserving operations using endoscopic techniques.

To date, several strategies for long-term antigonadotropin therapy have been described to avoid significant side effects while maintaining high clinical efficacy:

• Add-back mode - a combination of antigonadotropins with small doses of estradiol.
• On-off mode - therapy 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 lower doses of the drug for 18 weeks.

The likely response to treatment can be predicted in most cases 4 weeks after the first injection.

The drugs are well tolerated, do not have antigenic properties, do not accumulate, do not affect the blood lipid spectrum. Side effects: hot flashes, sweating, vaginal dryness, headache, depression, nervousness, changes in libido, seborrhea, peripheral edema, deterioration in prospective memory, decreased bone density.

Termination of therapy leads to the restoration of the normal menstrual cycle and estrogen status approximately 60-100 days after discontinuation of the drug and the rapid re-growth of uterine fibroids to its original size (during the first 3-4 menstrual cycles) with all clinical symptoms(although some authors note that these symptoms are less pronounced).

Prevention of uterine fibroids

In addition to general recommendations on maintaining a rational lifestyle, preventing common diseases in childhood and adulthood, the exclusion of abortions, timely correction of hormonal disorders, and adequate treatment of gynecological diseases play a role.

There is also a specific prevention of uterine fibroids. This is a timely implementation of the reproductive function. The first birth is recommended at 22 years old, the second at 25 years old, subsequent planned births up to 35 years. Late first births lead to premature aging of myocytes, a decrease in the adaptive ability to stretch and contract. Abortions and inflammation damage the structure of the myometrium.

It should be taken into account that the most frequent period of detection of uterine fibroids falls on 30-35 years, when the effects of damaging factors are summed up.

It is necessary to save the first pregnancy, especially in young women with so-called hereditary fibroids. Abortion causes the growth of myomatous nodes and growing fibroids are intensively formed from microscopic nodes.

Avoid excessive ultraviolet exposure, high temperature exposure, especially after 30 years. If there is a hereditary risk (uterine fibromyoma in the mother and close relatives), the tumor develops 5-10 years earlier, i.e. at 20-25 years old. Continuation breastfeeding within 4-6 months after childbirth, it normalizes the content of prolactin, which affects the change in the growth of fibroids.

Myoma is a benign tumor of muscle tissue. Fibroids that develop from smooth muscles (uterus, stomach, intestines, skin) are called leiomyoma, from the striated muscles of the skeleton or cardiac muscle - rhabdomyoma. Usually in myoma, along with muscle fibers, there is also connective tissue and the tumor takes the form of fibroids. Fibroids are the most common fibroids) uterus. Tumors are often multiple, representing separate nodes of various sizes and shapes. Uterine fibromyoma develops as a result of hormonal disorders associated with ovarian function. Most often formed in women after 30 years. May cause prolonged bleeding.

Body oxidation

It is necessary to oxidize the body with enzymes and acetic tinctures. They begin with the oxidation of celandine, tansy, mullein, acacia, mandrake, periwinkle, colchicum, Japanese Sophora, sea buckthorn with enzymes. Prepare two enzymes from separate plants. Take from 1 tablespoon to 1 cup 3-4 times a day half an hour before meals. The first two weeks one enzyme is taken, the second two weeks another. In the future, an enzyme is selected that seems to taste more pleasant. Douching is carried out with enzymes or infusions of plants - celandine, thistle, burdock, marya root. Plant infusions should be diluted with vinegar (2-3%). You can douche with infusion of chamomile.

Camomile tea:Take a tablespoon of crushed chamomile grass in a glass of boiling water, insist 3 hours. Nice results are obtained by douching with calendula tea or 2-3% acetic infusion of calendula.

Calendula tea:1 tablespoon of the plant is brewed for 20 minutes in a glass of boiling water.

Vinegar infusion of calendula:In 1/2 l of 9% vinegar, pour 1/2 cup of calendula herb. Insist at least 5-10 hours.

Douching at bedtime with enzymes of celandine, thistle, and marya root is effective.

Celandine Enzyme: Take 3 liters of whey, 1/2 cup of celandine grass (can be dry), a glass of sugar, a teaspoon of sour cream. The enzyme ferments in heat for 2-3 weeks. Drink 1/2 cup 15 minutes before meals.

They also douche with a weak solution of potassium permanganate (light Pink colour) and soda-saline solution with the addition of ATP (adenosine triphosphoric acid).

Soda saline solution:Mix a glass of water, a teaspoon of salt, a teaspoon of soda and 1 gram of ATP.

At night, they take a bath, to which a strong decoction of oat straw is added.

Straw decoction bath: Boil one hundred grams of straw in a bucket of water for 20 minutes, pour the whole broth into a hot water bath. After the bath, drink tea. Be sure to acidify the tea with apple cider vinegar and sweeten with lemon honey. The honey mass is made from the same proportions of honey and lemon, and must ferment for at least a week.

Warm the uterus with water heaters only!!! after sufficient oxidation of the body by enzymes and kvass.

Place litmus paper in the urine, if it turns blue - the body is not yet oxidized, reddish-orange - the body is oxidized. If the paper has not changed color, it is oxidized.

Fibromyoma is a common gynecological disease in which specific nodes are formed in the patient's uterus, consisting of muscle and fibrinous tissue.

To the question "how to treat uterine fibromyoma?" Only a specialist gynecologist can answer after a thorough examination.

That is why it is important not to neglect preventive examinations, and also to consult a doctor at the first appearance of unpleasant symptoms. Timely diagnosis and early treatment can prevent complications and achieve a successful recovery.

Uterine fibromyoma is a disease that may be subject to conservative therapy and surgical treatment. In some cases, such as the small size of the formation and its slow growth, surgery can be dispensed with.

In this case, the woman is prescribed conservative therapy, which includes:

• GnRH analogues - Buserelin, Zoladex- means that cause a decrease in the synthesis of estrogens in the body, which leads to a decrease in nodes. These drugs can be used both for treatment and as a preoperative preparation for large fibromyomas.
• Gestagens- Norkolut, Duphaston - drugs that suppress the release of gonadotropins, which leads to a decrease in estrogen production by the ovaries.
• Combined oral contraceptives- Novinet, Yarina, Jess, which, in addition to a pronounced therapeutic effect in fibroids, have a rebound effect. After their cancellation, the chances of a long-awaited pregnancy in a woman increase.
• As hormone therapy, an intrauterine device (Mirena) is used.

The attending physician also prescribes symptomatic therapy to patients. It includes iron preparations for the correction of anemia, analgesics and antispasmodics to relieve pain, sedatives, as well as vitamin and mineral complexes.

When treating fibromyoma and uterine leiomyoma, it is important to carefully follow all medical prescriptions, as well as adhere to a healthy lifestyle: exclude alcohol and smoking. To speed up the healing process, you need to eat right, eat protein-rich foods, fresh vegetables and fruits.

It is very important to improve blood circulation and eliminate venous congestion in the pelvic area. This requires sports (swimming, dancing), as well as regular sex life.

It has been proven that women with irregular sexual intercourse, as well as those who do not experience orgasm, are more likely to develop benign neoplasms in the uterus.

Surgical interventions for fibrous nodes in the uterus

Uterine fibroids are treated with surgery large sizes(12 or more weeks of pregnancy), rapid growth dynamics (more than 4 times per month), as well as in the presence of complications (necrosis, torsion of the leg, emerging submucosal node).

There are minimally invasive sparing and radical operations. The choice of the method of surgical intervention is carried out by the doctor. This occurs depending on the characteristics of the neoplasm, the age of the woman and the presence of concomitant diseases of the internal organs. The methods used for uterine fibroids include:

• embolization of arteries. In which, with the help of a special drug, the blood flow in the vessels supplying the uterus is blocked, as a result of which the node decreases and disappears. The recovery period for this intervention is 1-2 days.
• FUS ablation– removal of a pathological neoplasm with a directed stream of ultrasound. This method is considered one of the most effective among minimally invasive interventions.
• Laparoscopic removal of nodes.

• Supravaginal amputation of the uterus and total hysterectomy- radical operations used in complex cases with multiple nodes, profuse, intractable bleeding, as well as with malignancy of neoplasms.

Diagnosed with fibromyoma early stage, it is possible to avoid a major operation and get by with conservative therapy or gentle surgery with a short recovery period.

Home Therapies

Treatment of fibroids with folk remedies cannot replace drug therapy and surgery, but only reduces the unpleasant symptoms of the disease. The most useful and effective ways that deserve a lot of positive feedback are recognized:

• Healing is guaranteed by the infusion of the boron uterus. With regular use, this composition helps to restore hormonal balance and regulates the menstrual cycle. To prepare it, you need 2 tbsp. dry raw materials pour 1 liter of boiling water and insist for 1 hour. You need to drink the resulting drink one glass 3 times a day. Many patients drinking this decoction noted an improvement in their condition and a decrease in pain 2 weeks after the start of treatment.

• In order to remove excess estrogens from the body and reduce the size of the nodes, it is necessary to drink milk thistle, thistle, a decoction of dandelion leaves and yellow sorrel.
• With heavy, prolonged bleeding, it is necessary to drink strawberry leaf tea, which has hemostatic properties.
• Many are interested in the question "is it possible to get rid of fibroids with celandine?" in such ways - this remedy has a very strong effect, therefore, when prescribing, strict adherence to an individually selected dosage is required. To prepare an infusion from this plant, you need a 3-liter jar, 1/2 filled with raw materials, pour boiling water and leave for 5 hours in a place protected from light. The resulting liquid should be filtered and taken 1 tsp. 3 times a day.
• Popular among many patients are bee products - perga and propolis. In order to eliminate the inflammatory process and to reduce the size of the tumor, it is necessary to place propolis balls in the vagina.

• Calamus root should be grated on a fine grater. Use the resulting slurry for 1 tsp. 1 hour before meals 3 times a day.

Before starting the treatment of uterine fibroids with folk remedies, it is necessary to consult with a specialist in order to identify possible contraindications, as well as to select drug therapy.

What will help alleviate the condition

In the occurrence of hormone-dependent diseases of the uterus, the wrong lifestyle plays an important role - moral exhaustion, physical overwork or physical inactivity, bad habits.

To speed up recovery, it is important not only to play sports, give up alcohol and smoking, but also, if possible, avoid stressful situations. To this end, many patients visit a psychologist, dance, music and art therapy.

V Lately The method of working with the healing energies of Reiki has gained particular popularity. The essence of the method is psychological work on oneself, during which patients understand the subconscious causes of their problems and find ways to solve them.

This method "morally healed" and improved the psycho-emotional state of many patients, which contributed to a speedy recovery, compared with those who continued to be exposed to stress factors.

Do not rely on the treatment of folk remedies and various energy practices in the treatment of fibroids.

Only properly selected hormonal therapy and surgical interventions to remove pathological nodes.

It is important to know the symptoms and treatment of fibroids, so that at the first appearance of unpleasant manifestations, do not postpone a visit to the doctor and start therapy as soon as possible. Timely treatment will help to avoid many unpleasant and formidable complications, speed up recovery and the onset of the desired pregnancy.