Symptoms and signs of uterine fibroids: how to recognize the disease. What symptoms and signs will indicate that it is uterine fibroids? How does fibroid manifest itself in women? Symptoms

Uterine fibroids are a disease that is classified as benign neoplasms. The disease manifests itself in the form of single or multiple nodes and has a strict dependence on changes hormonal levels in the female body.

Not all women know what kind of disease uterine fibroids are. According to statistics, this disease is found in no less than 20% of women of reproductive age. In most cases, it is an incidental finding during a gynecological examination.

With regular visits to the gynecologist, the formation is detected in the initial stages and can be treated conservatively. With a small size of the formation, symptoms and signs of fibroids may be absent, but in some cases the tumor can reach a mass of more than a kilogram and is determined by palpation of the anterior abdominal wall.

To judge the size of the tumor, it is customary to compare the formation of smooth muscle tissue with the size of the uterus at different stages of pregnancy. This allows you to objectively judge the stage of the disease and monitor the dynamics of the process.

Treatment can be conservative or surgical. The choice of tactics depends on the size of the tumor and changes in its size over time.

Uterine fibroids in women - symptoms

Uterine fibroids in women, which are small in size, usually do not manifest themselves for a long time and do not cause concern. If education grows at a slow pace, it may not be known for many years.

As the tumor grows, the first signs and symptoms of uterine fibroids in women appear. Symptoms on early stages:

• increased bleeding during menstruation;
• allocation large quantity blood clots;
• bleeding in the middle of the menstrual cycle;
• increased duration of menstruation
• aching pain in the lower back and lower abdomen;
• cramping pain in the lower abdomen;
• irritation of the bladder and rectum;
• chronic constipation;
• difficulty urinating.

These signs of uterine fibroids are nonspecific and may be present in other diseases, but if they appear, you should urgently make an appointment with a doctor and undergo an examination. In any case, the presence of the listed symptoms signals a malfunction in the body; the sooner their cause is identified and treatment is started, the greater the chances of avoiding surgery and normalizing function reproductive system.

What symptoms of uterine fibroids are present during menopause?

In premenopause, the disease usually manifests itself as cycle disorders. Often women attribute this to age-related changes in the body, so don't worry. But in this case, periods become irregular not due to a drop in hormone levels, but due to changes in the endometrium. As the disease progresses, discomfort may appear during sexual intercourse, uterine bleeding, not related to the cycle, nagging pain lower abdomen. Usually these manifestations force a woman to consult a gynecologist.

A characteristic symptom of uterine fibroids during menopause is bleeding associated with the menstrual cycle. They resemble regular periods, but last from a week to 10 days. Many women mistake them for menstruation, and their duration is associated with the approach of menopause.

With the end of the body's restructuring, the symptoms and signs of uterine fibroids during menopause may disappear, but you should not refuse treatment and dynamic monitoring, since there is a risk of disease progression and degeneration into a malignant tumor.

Treatment of uterine fibroids without surgery

When a tumor is detected, the doctor will determine the tactics and tell you how to cure uterine fibroids without surgery in a particular case. During the entire course of treatment, it is necessary to dynamically assess the size of the tumor. If the tumor does not decrease, much less increase, the question of its surgical removal is raised.

Small uterine fibroids are usually treated with drug therapy. Since the tumor is hormone-dependent, it is necessary to diagnose hormone imbalances and eliminate disruptions in the body. Treatment of uterine fibroids without surgery consists of prescribing hormonal drugs containing progesterone. Hormonal therapy helps not only to reduce the size of fibroids, but also eliminates unpleasant symptoms, if any. The earlier therapy is started, the greater the likelihood of a favorable outcome of the disease.

Conservative therapy is usually used in middle-aged women approaching menopause. The fact is that it is possible to reduce uterine fibroids without surgery, but it is impossible to completely eliminate the problem. Therefore, the task of hormonal therapy is to restrain the growth of education until the onset of menopause. After the onset of menopause, in many women it completely resolves. However, the neoplasm cannot be completely ignored. If you do not take special medications, it can begin to grow rapidly even during menopause.

You can treat uterine fibroids without surgery using injections of GnRH agonists. This is a long-acting drug, so injections are given once a month. The course of treatment lasts at least 6 months. Using the drug for a longer period of time is also not recommended, since the risk of developing osteoporosis increases. Clinical studies show that suppression of secretion gonadotropic hormones reduces the size of fibroids by more than 50%.

Treatment of uterine fibroids - surgery

Large uterine fibroids, as well as those with severe clinical symptoms, are treated surgically. The decision on the volume of intervention is made individually and depends on the patient’s age and reproductive function. Surgery for uterine fibroids is a method of radical treatment to avoid relapses.

Surgery to remove uterine fibroids is needed in the following cases:

• suspicion of degeneration of the neoplasm into cancer;
• large nodes;
• torsion of the leg of the knot;
• necrotic changes;
• severe pain;
• dysfunction of the pelvic organs;
• submucous fibroids;
• concomitant endometriosis;
• ineffectiveness of conservative therapy;
• rapid tumor growth.

The cost of surgery to remove uterine fibroids depends on the chosen surgical tactics. In young women, preference is given to myomectomy - isolated removal of nodes. This intervention allows you to save reproductive function. After the operation, you can become pregnant and give birth to a child. But in this case there is a risk of relapse, so after surgical treatment Hormone therapy is indicated. The least traumatic operation is performed using the endoscopic method.

Myometrectomy also refers to organ-saving operations, but the intervention is more extensive than myomectomy. The method is used for the growth of nodes in the wall of the uterus. The affected areas are removed and the organ is reconstructed. It is also possible to become pregnant after this operation.

If degeneration into a malignant tumor is suspected, as well as in women who already have children and are not planning a pregnancy, the uterus is completely removed. This operation is more traumatic, but there is no risk of disease relapse when using this tactic. The cost of surgery to remove uterine fibroids using the laparoscopic method is higher than classical surgery, but the recovery time after endoscopic removal is much shorter.

Treatment of uterine fibroids during pregnancy

Is it possible to get pregnant with uterine fibroids? Yes, you can. The neoplasm reduces the ability to conceive, but usually does not lead to complete infertility. That is why the disease is often diagnosed along with pregnancy.

Are uterine fibroids dangerous for mother and baby during pregnancy? In most cases, the process of bearing a child and giving birth to patients with this diagnosis goes smoothly. Small fibroids usually do not cause problems in the first trimester of pregnancy. However, if the fibroids are large, the likelihood of miscarriage increases significantly. For more later Also, the likelihood of miscarriage or premature birth is high, especially if the fibroid is in contact with the placenta. If the tumor is voluminous, it puts pressure on the fetus, which can cause congenital skeletal deformities.

For large fibroids, a cesarean section is often indicated; for small formations, physiological labor is possible, but they are often protracted and there is a high risk of premature placental abruption.

Uterine fibroids during pregnancy can cause postpartum hemorrhage, incomplete involution of the reproductive organ.

During pregnancy, uterine fibroids grow very slowly or retain their original size; in some cases, degeneration associated with necrosis is noted.

Treatment of neoplasms in pregnant women is symptomatic; hormonal therapy can be prescribed only after childbirth. Prevention of iron deficiency anemia is indicated for pregnant women, folic acid, vitamins A, B, E and C, a diet that allows you to maintain a stable body weight.

Constant medical supervision allows you to control the situation and prevent undesirable consequences. After pregnancy, the issue of further treatment is decided. Hormonal therapy is prescribed, and if there is no effect, surgery.

• 1. Kantemirova Z. R. et al. Steroid hormones, uterine fibroids and liver dysfunction: pathogenesis and treatment prospects // Materials of the XVIII Russian National Congress “Man and Medicine. – 2011. – P. 14-17.
• 2. Tkachev V.N. et al. Organ-preserving operations on the uterus and reproductive health of women // Siberian medical journal. – 2010. – T. 25. – No. 4-2. pp. 52-54
• 3. Optimization surgical treatment uterine fibroids: abstract of thesis. Ph.D. honey. Sciences: 01/14/01, 02/03/03 / E. S. Nikitina; scientific director: A. N. Rymashevsky, Yu. L. Naboka; GBOU VPO Growth. state honey. University of Healthcare of the Russian Federation Federation. - Rostov n/d, 2014. - 24 p. - Bibliography: P. 23.
• 4. Kozachenko V.P. Modern treatment of patients with uterine leiomyoma //Russian Medical Journal. – 2003. – T. 11. – P. 2.
• 5. Legenis N. E., Koren N. A. Differential approach to hormonal treatment of uterine fibroids, taking into account the determination of the content of estrogen and progesterone receptors // Obstetrics and Gynecology. – 2004. – No. 2. – pp. 21-23.

Uterine fibroids are a tumor that is quite common in middle-aged women. However, the disease is not oncological and can be treated quite successfully if diagnosed in time.

What do you need to know about uterine fibroids in order to recognize the pathology in time and prevent the development of complications?

What is uterine fibroid

As a result of uncontrolled and rapid division of uterine cells due to increased secretion of estrogens, nodular neoplasms of various sizes appear on the external or internal surface of the reproductive organ.

Such neoplasms are called uterine fibroids, and they can be of various sizes - from a pea to huge tumors weighing more than three kg. In this case, either a single neoplasm or several small ones, called multiple uterine fibroids, can occur.

Important! A benign tumor (uterine fibroids) does not develop into cancer. Cancer can develop only as a complication of the disease, and even then in rare cases.

The disease is quite common and occurs in 30-35% of cases in middle-aged women (especially in the period before).

How does uterine fibroid develop?

1. Active growth and division of uterine cells begins in the area of ​​small vessels, which is a predisposing factor for the development of a tumor.
2. The tumor consists of fibers that are indistinguishable from neighboring tissues. Such a nodule can be detected only when certain diagnostic measures are carried out.
3. The tumor already has the appearance of a clear, dense, formed node, with a formed capsule.

The size of fibroids is determined in centimeters, millimeters or weeks. For example, “fibroids 10 weeks” will mean that the uterus with the tumor has reached the same size as it was in the tenth week of pregnancy.

Based on the nature of their growth, benign neoplasms are divided into several types:

• Intramural, interstitial, intermuscular fibroids are completely hidden in the thickness of the muscular layer of the uterine walls. This type occurs in most cases (more than 60%) and is characterized by a feeling of pain and heaviness in the pelvic area, and menstrual irregularities.
• Submucosal (submucous uterine fibroid) – the neoplasm increases in the direction of the endometrium.
• Subperitoneal (subserous) - partially or completely located under the peritoneum, under the outer (serous) membrane of the uterine wall. The second most common type of fibroid. With it, you can rarely notice disruptions in the menstrual cycle, but with severe large sizes neoplasms
• Retroperitoneal - the node grows from the lower parts of the uterus or from the cervix outward - where there is no peritoneum.
• Interligamentous (intraligamentary) - a node is formed between the sheets of the broad uterine ligament.

There is also a separate variety - “pedunculated” fibroids, a neoplasm growing on a narrow (or wide) base that connects it to the uterine walls. Usually located inside or outside the uterine cavity, less often on the cervix.

Causes

Spontaneous division of uterine cells occurs most often due to hormonal imbalance or external intervention in the uterine area (abortion, curettage, installation of spirals).

Other causes of fibroids include:

• Pathological growth of the internal mucous membrane of the uterus (endometrium);
• Hereditary predisposition;
• Lack of children;
• Inflammation and infections of the genital organs;
• Chronic stress, mental;
• Endocrine (including obesity and);
• Physical inactivity;
• Lack of regular sex life;
• Early onset of menstruation.

Factors that provoke the occurrence of the disease also include: decreased, chronic diseases internal organs.

Pay attention! Women who do not experience orgasm and have disharmony in their sexual life, as well as those who have irregular sex life, most often develop fibroids.

According to the observations of specialists, women who have given birth are less susceptible to the occurrence of neoplasms. However, fibroids can also develop during pregnancy, especially if it is late.

First signs and symptoms

The clinical picture and manifestations of the disease are influenced by how long ago the tumor appeared, its size, location, and the rate of growth of the node. In half of all cases of fibroids, women do not experience any symptoms of the onset of the disease, and it is discovered by chance during an examination or during an examination.

The first signs of uterine fibroids usually appear in a woman if the myomatous node measures 2-6 cm or more. These include:

• , not related to ;
• Appearance;
• Shortening or lengthening the menstrual cycle;
• Increased bleeding during menstruation;
• The appearance of discharge mixed with blood in the period between menstruation;
• Inability to conceive a child.

The “pedunculated” fibroid is especially dangerous - when it twists, an acute inflammatory process and the tumor ruptures. In this case, the strongest is observed, which poses a danger to life and can result in death.

Main symptoms and signs of fibroids:

1. Pain. They can occur in the intermenstrual period and differ in nature and duration. They mainly occur in the lower abdomen, but can also radiate to the lower back, leg, and upper abdomen. Submucous uterine fibroids cause pain of a cramping nature (occur during or before menstruation) or aching in nature. With intramural – long-term pain of aching nature, which intensifies during menstruation. Pain in the pelvic organs and disruption of their functioning may occur, which causes difficulties in diagnosis (women turn to or).

   With subserous pain, pain occurs extremely rarely.

2. Menstrual irregularities. These include changes in the duration of the menstrual cycle, an increase in the volume of blood loss, and the occurrence and intensification of pain. The following symptoms should alert you:

• Your periods are so heavy that you have to change your pad more often than once an hour;
• Irregularity of the menstrual cycle;
• During menstruation, severe fatigue and weakness occur;
• There are a lot of blood clots in the discharge.

1. Reproductive dysfunction (possibly infertility).

With the rapid growth of nodes or with a large size of the tumor, the abdomen may increase (with a general normal weight body), there is a feeling of discomfort and pain in the lower abdomen, which intensifies with anxiety and physical activity.

When the pelvic organs are compressed by a myomatous node, the following are observed in the functioning of the organs: painful, frequent, frequent.

Also associated symptoms, which appear as a result of dysfunction of organs affected by pathology, may include dizziness, headaches, and a neurotic state.

The symptoms that appear are similar in clinical picture to others gynecological diseases(, cancer), therefore, to establish an accurate diagnosis, you should visit a specialist.

Treatment methods

There is no clear algorithm for the treatment of uterine fibroids - the choice of treatment method depends on the manifestations of symptoms, concomitant diseases, the patient’s age, and the size of the tumors.

Three main treatment principles apply:

1. Conservative treatment;
2. Surgical intervention;
3. Expectant treatment.

The choice of method is made after diagnosing the disease - usually fibroids can be noticed already during a visual gynecological examination, after which additional studies are performed: hyteroscopy, pelvic organs, etc.

Expectant treatment

Used in rare cases when a woman lacks bright severe symptoms diseases, the size of the nodes does not exceed 10-12 weeks, pregnancy is not planned in the future.

Patients are under constant supervision, periodically undergo testing for tumor markers, cytological examination of the mucous membrane and endometrium.

Recommendations include a ban on physical activity(especially on the abdominal area), prolonged exposure to the sun, visiting saunas and solariums, abdominal massage and thermal baths, strenuous sports, self-selection, abortion.

Conservative treatment

Therapy with conservative measures is aimed at reducing the size of the tumor, stopping its growth, and preventing the development of complications.

Treatment of uterine fibroids without surgery has the following indications:

• The size of fibroids is about 12 weeks;
• Interstitial and subserous uterine fibroids;
• Absence of pronounced clinical picture, pain;
• There are contraindications to surgical treatment.

The basis of the conservative method is the use of hormonal drugs:

• Androgen derivatives (Gestrinone, Nemestran, Danazol), course 6-8 months - effectively reduce the size of tumors;
• Oral hormonal (Zhanine, Marvelon, Yarina, Novinet, Regulon) - effective in reducing and reducing pain;
• Gestagens (Premolut, Duphaston), course 4-6 weeks - prescribed for small nodules;
• Mirena intrauterine device (with gestagen), for a period of 5 years - blocks tumor growth;
• gonadotropin releasing hormone (Zoladex, Goserilin, Tripotorelin, Prostap, Buserilin), course 3-6 months. The drugs create a temporary “artificial menopause” in a woman’s body, but after stopping treatment, new nodes may appear, so they are usually prescribed before surgery.

At the same time, measures are being taken to stimulate and strengthen nutritional correction, sanitation of sexually transmitted infections, normalization of the psycho-emotional state and metabolism, treatment, and normalization of the menstrual cycle. Immunomodulatory drugs, homeopathy, physiotherapeutic procedures, and herbal medicine are prescribed.

Pay attention! Conservative therapy cannot eliminate uterine fibroids, but only stops the growth of the tumor.

TO conservative therapy include the method of FUS-MRI ablation, which consists in heating and destroying the tumor using ultrasound. The procedure is painless and has no side effects. However, it is used only when nodes are localized on the anterior wall of the uterus and on its fundus, and it cannot be carried out when the size of nodes is less than 2 cm and more than 9 cm, as well as when the reproductive function is unrealized, with subserous fibroids “with legs”.

Surgical treatment

When choosing a surgical intervention method, the patient’s general and reproductive health, her age, the degree of possible risk, and planning for future pregnancies are taken into account.

Depending on this, minimally invasive or conservative treatment is selected. surgery(with preservation of the uterus) or radical (complete removal of the organ).

Surgery to remove uterine fibroids is prescribed in cases where there are indications:

• The size of the nodes is more than 12 cm;
• The presence of other gynecological diseases;
• Menorrhagia and metrorrhagia (lead to anemia);
• Rapid growth of the tumor is observed;
• Submucosal fibroids;
• Infertility, miscarriage (if caused by fibroids);
• Cervical fibroids;
• Necrosis of nodes;
• Subserous uterine fibroids “pedunculated”.

Removal of uterine fibroids is carried out using the following surgical methods:

1. Laparoscopy is an operation through small holes made in the abdomen;
2. Abdominal surgery - through an incision in the lower abdomen.
3. Hysteroscopy – myomatous nodes are removed through the vagina;
4. Hysterectomy – complete removal of the uterus;

Important! For women of reproductive age, hyteroscopy or laparoscopy of uterine fibroids is preferable. Such measures allow you to give birth to a child in the future, preserve the organ, do not require rehabilitation and do not leave traces.

The most modern and progressive method of surgical treatment of the uterus is embolization of uterine fibroids. In this operation, a catheter is inserted into the uterine artery through the femoral artery, through which the blood flow is blocked using embolization material, and the fibroid nodes are replaced with connective tissue.

Consequences and prevention

Myoma is dangerous to a woman’s health and life due to its complications.

Why fibroids are dangerous:

• Massive uterine bleeding (threat of anemia);
• Torsion of fibroids “on a stalk” (requires surgical measures and can be fatal);
• Necrosis of nodes;
• Development of purulent processes in surrounding tissues;
• Degeneration from a benign tumor to a malignant one;
• Reproductive dysfunction ( ectopic pregnancy, infertility);
• Development and hydronephrosis.

Women with fibroids should be regularly examined by a gynecologist and consult a doctor at the first signs of a pathological process.

If symptoms are detected in time and treatment is carried out with adequate measures, the prognosis is favorable. After removal of the myomatous node with preservation of the woman’s organ in reproductive age They may well become pregnant and carry a child to term.

There are no special preventive measures to prevent the formation of fibroids. It is enough to visit a gynecologist regularly, lead a harmonious and regular sex life, monitor your immunity, refuse frequent abortions, and promptly treat pathologies of the reproductive organs.

Frequently asked questions to the doctor

I am 50 years old, I have uterine fibroids, but I no longer have periods. Will myoma grow? In the absence of menstruation, fibroids do not grow, because This is a hormone-dependent tumor.

Do uterine fibroids grow during pregnancy? During pregnancy, the growth of nodes stops, but in the 1st and 2nd trimester a slight increase in the tumor is possible.

Is uterine fibroid dangerous with a small subserous node (2-4 cm) and does it need to be treated? Myoma needs to be treated in any case; for small nodes, expectant therapy is used or conservative treatment.

What method of treating fibroids is the safest and most harmless? Any therapy has its own side effects and contraindications, you need to choose the most suitable method individually.

Is it possible to use a coil for fibroids? The usual spiral is not. Only the Mirena hormonal IUD.

Is it possible to get pregnant with uterine fibroids? Pregnancy is possible - it all depends on the location of the nodes and their size.

Is it possible to give birth with uterine fibroids? This possibility exists - the issue is resolved in each individual case by the attending physician.

Is it possible to cure fibroids with folk remedies? Traditional treatment fibroids comes down to douching and inserting tampons with medicinal solutions. Reviews from doctors about such treatment methods are unfavorable, it is impossible with the help of any folk remedy cure the deep internal causes of fibroids.

This article is posted solely for the general educational purposes of visitors and does not constitute scientific material, universal instructions or professional medical advice, and does not replace a consultation with a doctor. For diagnosis and treatment, consult only qualified physicians.

When a doctor diagnoses a woman with uterine fibroids, she certainly panics.

What is this? What is the threat? Why is fibroid so scary? Could it burst? What to do? These questions run through almost everyone’s head.

There is no need to despair and be upset; uterine fibroids are no longer a death sentence, but a disease that can be treated in various ways.

It is not at all necessary to remove the uterus - doctors practiced this method of treatment several decades ago. Now doctors have at their disposal a lot of minimally invasive and conservative ways to combat myomatous formation, which allow them to preserve the woman’s reproductive organ.

What is fibroid

Uterine fibroids are certainly not oncology, and even calling this formation a tumor is not entirely correct.

Uterine fibroids are a tumor benign education, the development of which occurs in the walls of the reproductive organ or in its neck.

As a rule, fibroids are multiple in nature, but a single form of the disease often develops.

A tumor-like myomatous formation develops from connective and muscle tissue cells. Many doctors attribute this disease to hyperplastic changes in the endometrium.

There is a theory that the rudiment of fibroids is formed during the development of the embryo, and at the moment of hormone imbalance it begins to grow. In case of violation hormonal regulation the process of active division of muscle fibers starts, and some cells are destroyed.

The immune system reacts to this by provoking hyperplasia. This is how the tumor begins to grow.

In addition, the growth of fibroids is influenced by the structure of the uterine arteries, near which the tumor grows.

A number of provoking factors, which will be discussed below, also have their effect negative impact on the walls of the uterus, which leads to the growth of a myomatous node.

After the doctor has made the initial diagnosis, it is recommended to undergo an ultrasound examination with a vaginal probe to ensure that the previous examination is correct.

Myoma develops in three stages:

• the beginning of education– formation of the active zone;
• microscopic volume of the node. If at this moment a histological analysis is carried out, then it is still impossible to distinguish normal myometrial cells from pathological ones. As already mentioned, this process occurs during the period of embryonic development, and if there is no impetus for the development of the tumor, the fibroid remains in its infancy;
• appear clear boundaries of education, which means the growth of fibroids.

How quickly it happens depends on where exactly the fibroid is located.

Symptoms of the disease

What symptoms accompany this disease?

In the early stages of the development of a myomatous node, a woman in most cases does not feel any symptoms or signs of the disease. In rare cases, an attentive woman may notice heaviness in the lower abdomen and discomfort during intimacy.

More late sign fibroids is the appearance of pain in the lumbar region. But they can be perceived as premenstrual pain.

• gynecological examination, during which the doctor can palpate the formation, or determine its presence using mirrors. The doctor also interviews the patient and draws up a general clinical picture, taking into account the woman’s medical history;
• . This is the most informative technique, the effectiveness of which is almost 100%. This study can be performed abdominally or transvaginally;
• hysteroscopy. It is carried out using special optical equipment, during which various surgical procedures can be performed. During hysteroscopic examination, the integrity of the organ is preserved. The equipment is being introduced into cervical canal and transmits the picture to the monitor;
• colposcopy. With this study, the doctor can not only confirm the presence of a tumor, but also take biomaterial for examination under a microscope;
• laparoscopy. IN abdominal cavity a small puncture is made into which a special device is inserted, which provides detailed information about the condition of the organ and collects biomaterial for research;
• X-ray, CT, MRI;
• laboratory tests include general analysis blood and urine. Curettage may also be prescribed, which provides information about the formation even when other methods turn out to be uninformative.

The photo below shows a transvaginal ultrasound of uterine fibroids.

What are the sizes?

The size of the myomatous formation can be determined by ultrasound. The uterus also increases as fibroids grow, so the results often indicate the size of the fibroids in obstetric weeks.

The classification of fibroids by size looks like this:

• small – up to 2 cm, 4 or 5 obstetric weeks;
• average – up to 6 cm, 6-11 weeks;
• large – more than 6 cm, 12 weeks or more.

After the tumor reaches a large size, it begins to interfere with the functioning of other internal organs.

How to recognize a tumor at an early stage

Since the myomatous formation is entwined a large number vessels, its first signs may be bleeding. Young girls may experience a disruption in their cycle.

Problems with the menstrual cycle are a very important symptom of the presence of fibroids, which is a good reason to contact a specialist.

Due to an increase in the amount of menstrual blood or intermenstrual bleeding, a woman experiences low hemoglobin and also develops another early symptom fibroids – iron deficiency anemia.

With the active growth of the formation, pain appears in the abdominal area, and the lower back and back also begin to ache.

In some cases, the temperature may rise, difficulty urinating, constipation, and infertility.

A persistent increase in temperature to subfebrile levels can be extremely dangerous symptom malignancy of the tumor.

Painful sensations

Pain from fibroids can be sharp or aching.

The intensity of pain depends on the location of the myomatous formation, its size, as well as the presence of possible complications.

With submucous fibroids, the lower abdomen constantly hurts. The cause of pain is compression of surrounding tissues by the tumor, which leads to disruption of their blood circulation. Cramping pain occurs before menstruation, and disappears after the end of menstruation.

With interstitial fibroids, pain occurs only when the formation reaches a large size. The pain intensifies before menstruation and can be paroxysmal.

Lumbar pain is not characteristic of all myomatous formations.

If you have any type of pain, you should consult your doctor.

Self-regression

Myoma regression is its reduction.

Since fibroids are a hormone-dependent tumor, regression is impossible without appropriate treatment.

During menopause, the level of estrogen in a woman’s body decreases, and this leads to the cessation of the growth of myomatous formation, as well as to its slight decrease, but we are not talking about the complete disappearance of fibroids during this period. In any case it will be necessary hormonal treatment neoplasms for complete relief from the disease.

Conservative treatment methods

Goals of drug treatment:

• inhibition of educational growth;
• reduction in fibroid size;
• prevention of possible complications.

Appointed:

• oral contraceptives – Regulon, Janine etc.;
• gonadotropin agonists – Zoladex, Buserelin, Diferelin;
• antiprogestogens – Mifepristone;
• gestagens – Utrozhestan, Duphaston.

FUS ablation is also a conservative method of getting rid of fibroids - in this case, the tumor is destroyed using ultrasound waves.

Drugs, their dosage and duration of treatment can only be prescribed by a competent specialist in accordance with the patient’s age, clinical picture, type of fibroid, its size and the presence of underlying diseases.

Surgery

In cases where conservative treatment of the disease is impossible, it is prescribed surgical removal neoplasms:

• uterine artery embolization– the formation degrades due to the cessation of blood supply to the tumor;
• myomectomy– organ-preserving surgery, in which only nodes are removed;
• hysterectomy– the myomatous node is removed along with the uterus.

Consequences of the disease

Once upon a time, fibroids were considered a precancerous condition, since experts believed that the risk of the formation degenerating into a malignant process was quite high. Today, this topic has ceased to be relevant, since studies have proven that the percentage of benign fibroids degenerating into cancer is extremely low.

Other risks:

• rapid growth of the tumor, as a result of which it begins to put pressure on tissues and organs located nearby. This leads to blocking of normal blood flow and decreased tissue nutrition;
• profuse bleeding that leads to anemia;
• development of hydronephrosis and pyelonephritis;
• termination of pregnancy;
• fetal malnutrition or hypoxia;
• infertility;
• endometrial hyperplasia.

Why uterine fibroids are dangerous, read also

Complications during pregnancy

If a woman with fibroids manages to become pregnant (a fairly rare occurrence), then the following risks are possible:

• leg torsion;
• impossibility of normal closure of the neck (if the node is located in the cervical region);
• rapid growth in education;
• fetoplacental insufficiency;
• thrombosis;
• uterine rupture;
• termination of pregnancy;
• low placentation;
• placental abruption;
• gestosis;
• anemia.

All pregnancy complications associated with myomatous formation are quite serious and must be treated in a hospital setting.

A woman must adhere to a diet prescribed by a doctor and undergo therapy aimed at improving placental-fetal blood flow.

In case of active growth of education, it can be carried out endoscopic surgery for fibroid removal. Pregnancy in this case can be saved.

Uterine fibroids - symptoms and treatment

What are uterine fibroids? We will discuss the causes, diagnosis and treatment methods in the article by Dr. D. M. Lubnin, a gynecologist with 20 years of experience.

Definition of disease. Causes of the disease

Uterine fibroids- This chronic disease of the uterus, manifested by the formation of single or multiple nodes of different localization in it, limited in time to the reproductive period. Uterine fibroids do not occur until menstruation and regress after menopause.

Previously, uterine fibroids were considered a true benign tumor of the uterus, but as a result of research it was found that they did not fully meet the criteria for a tumor, so fibroids began to be called a tumor-like formation.

Uterine fibroids are a fairly common disease, the incidence reaches 70-80%, but in most cases the disease is asymptomatic. Only in 30-40% of cases are observed clinical manifestations fibroids.

The causes of uterine fibroids are still unknown. Previously it was assumed that hormonal disorders lead to its development, but this theory was completely refuted. Uterine fibroids are formed in hormone-dependent tissue and are therefore sensitive to the influence of sex hormones, but its growth is not triggered by hormonal imbalance.

It is assumed that there is a hereditary predisposition to the development of uterine fibroids. It was also noted that representatives of the dark-skinned race and women with overweight, uterine fibroids are more common. Uterine fibroids never turn into a malignant tumor and have nothing to do with the development of malignant diseases of the uterus.

Uterine fibroids are most often diagnosed at the age of 30-40 years, but can occur in younger women aged 16-18 years.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of uterine fibroids

In most cases, uterine fibroids do not manifest themselves in any way. Only in 30-40% of cases can it disrupt a woman’s quality of life.

The main symptoms of uterine fibroids are:

1. Heavy menstruation
2. Feeling pressure on bladder(frequent urination), pressure on the rectum (difficulty defecating)
3. Pain in the abdomen, back, pain during sexual activity
4. Abdominal enlargement
5. Infertility (rare)
6. Miscarriage

The development of symptoms of uterine fibroids depends on the location of the node or nodes, as well as their size. The further the node is from the uterine cavity, the greater the likelihood that the disease will be asymptomatic. Even relatively small, centimeter-long nodes, deforming or completely located in the uterine cavity, can lead to heavy menstruation, while a node of this size in the wall of the uterus or outside it will make the disease asymptomatic. Large nodes of 6-8-10 centimeters or more are already beginning to increase the overall size of the uterus, that is, manifest themselves as an enlarged abdomen, as well as pressure on the bladder or rectum. In this case, there may be heavy menstruation due to an increase in the size of the uterine cavity and disruption of the processes of uterine contraction at the end of menstruation.

Pathogenesis of uterine fibroids

Uterine fibroids are round formations of various sizes, consisting of a different combination of smooth muscle and connective tissue fibers. Large fibroid nodes can reach 20 cm, and the uterus itself with nodes can be of a size corresponding to a full-term pregnancy.

Uterine fibroids can be single or multiple, that is, there may be several small nodes in the uterus or a combination of small nodes and several large ones or a single large node.

It is known that each node in the uterus grows independently of each other from a single cell, which receives a defect that triggers the division process. Female sex hormones are the main factor in the growth of uterine fibroids. Estrogens stimulate the formation of progesterone receptors on fibroid cells, while progesterone triggers cell division. In other words, two female hormone complement each other, but the main hormone that stimulates the growth of uterine fibroid nodes is progesterone.

Uterine fibroid nodes grow at an unpredictable speed: some can grow quite quickly - up to several centimeters per month, others very slowly - 5-7 mm per year. Some nodes may stop growing and not increase in size for several years. Some nodes are able to independently disrupt their blood supply and cause necrosis, as a result of which the node dies, decreases in size and no longer grows.

There is no scientific evidence that external factors influence the growth of uterine fibroids. That is, baths, saunas, massages, tanning and physiotherapy do not have a stimulating effect on the growth of uterine fibroids.

In general, the behavior of uterine fibroids is unpredictable, it is only known that some nodes begin to actively grow during pregnancy, and after childbirth they decrease in size; uterine fibroids do not grow after menopause and undergo reverse development and do not occur until the onset of menstruation (menarche).

Classification and stages of development of uterine fibroids

Depending on the location, uterine fibroids can be:

1. Intramural (intermuscular) - growing in the thickness of the uterine wall
2. Subserous (subperitoneal) - located outside the uterus;
3. Submucosal (submucosal) - growing in the uterine cavity
4. Cervical - from the cervix

There are mixed localizations, for example: intramural-subserous myoma, that is, the node grows from the wall of the uterus, but is partially displaced outward. In addition, the direction of growth of the nodes relative to the uterine cavity is described. So, uterine fibroids can have centripetal growth, that is, grow towards the cavity, or centrifugal growth, that is, outward.

Nodes of submucosal (submucosal) and subserous localization are also divided into types depending on their location in relation to the uterine cavity or the external contour. If the node is completely located in the uterine cavity - this is type 0 fibroids, 50% - type 1, less than 30% - type 2. Subserous nodes are also called similarly. The zero type of subserous node is also called “pedunculated fibroid,” and the pedicle can be either thin or quite wide.

Until now, in our country, a classification of uterine fibroids is used, based on the correspondence of the size of the uterus to the length of pregnancy in weeks. For example, you can find the following conclusion: “uterine fibroids 11-12 weeks.” This classification is extremely subjective and not at all informative. A uterus with several small nodes or a small submucosal node may not increase in size. Large nodules increase the size of the uterus asymmetrically, and different doctors will estimate the overall size of the uterus differently, which can lead to misinterpretation of the growth pattern of the nodules. This classification does not describe the number and location of nodes, which determines the tactics of treating the disease.

Uterine fibroids can be single or multiple. What determines how many nodes are formed and at what speed they will grow is unknown. In general, the growth dynamics of nodes is unpredictable. Apart from the period of pregnancy, when most of the nodes begin to grow under the influence of progesterone, there is not a single scientifically proven factor that affects the growth of uterine fibroids. After menopause, uterine fibroids undergo reverse development - the nodes should begin to decrease in size, and dystrophic changes occur in them.

Some nodes may die on their own due to disruption of their blood supply. This kind of “suicide” of a node should be considered as favorable outcome diseases.

Complications of uterine fibroids

The most common complication of uterine fibroids is iron deficiency anemia, which develops against the background of a gradual increase in the volume of menstrual blood loss. Its manifestations are not always noticed by the patient in time. Against the background of anemia, weakness increases, working capacity and cognitive functions decrease, and the condition of the skin, nails, and hair worsens. Often, it is with these complaints that the patient turns to therapists, who diagnose anemia and send her for examination to a gynecologist, where uterine fibroids are diagnosed.

The presence of uterine fibroids can complicate reproductive function. When localized in the uterine cavity or significantly deforming it, fibroids can prevent conception or pregnancy. For large nodes or multiple fibroids an enlarged uterus can occupy most of the abdominal cavity, squeezing the ureters, which leads to impaired urine flow and kidney damage.

Pregnancy with uterine fibroids in some cases may be accompanied by delayed fetal development, premature birth, premature rupture of membranes, low fetal weight, and weakness of labor.

Diagnosis of uterine fibroids

Diagnosing uterine fibroids is not difficult. Already during an examination on a chair, a doctor may suspect the presence of uterine fibroids, detecting an enlargement of the uterus and its tuberosity, but a manual examination is not informative in terms of the number, size and location of nodes. The gold standard for diagnosing uterine fibroids is ultrasound. In the vast majority of cases, this method is sufficient to describe the disease. Ultrasound must be performed with two sensors: vaginal and abdominal (through the abdomen), so as not to miss subserous nodes, which may be located a short distance from the uterus. Besides detailed description sizes and localization of all nodes must be completed graphic image the location of uterine fibroid nodes relative to the walls of the uterus and its cavity; in other words, draw how these nodes are located in the uterus. This is important for choosing the right treatment tactics for the disease, since only a verbal description can be interpreted in different ways.

If the size of the uterus is so large that ultrasound does not allow it to be fully assessed, an MRI of the pelvis is recommended. This method displays the entire picture of the disease in detail and allows you to assess the size and exact location of the nodes.

In some cases, to clarify the location of the node, they resort to hysteroscopy - endoscopic method, in which a camera is inserted into the uterine cavity and the uterine cavity is visually assessed.

Treatment of uterine fibroids

Not all cases of uterine fibroids require treatment. Asymptomatic uterine fibroids do not require treatment, but only if the following criteria are met:

1. The patient has no signs of iron deficiency anemia
2. The patient is over 35 years old and has no plans for pregnancy
3. The nodes either do not grow, or the growth rate of individual nodes (subserous or intramural-subserous localization) does not exceed 1 cm per year

In all other cases, treatment is required.

Since uterine fibroids in themselves are not dangerous, I repeat once again: they never turn into a malignant tumor.

Here are the main goals in the treatment of uterine fibroids:

1. Stop blood loss during menstruation
2. Stop the pressure of the uterus on the bladder, rectum, remove the enlargement of the abdomen
3. Ensure the opportunity to become pregnant and give birth to a child
4. Stop the progressive growth of nodes.

Thus, before starting treatment for uterine fibroids, you need to clearly decide what goal you are pursuing, since the choice of treatment method will depend on this.

To treat uterine fibroids today, it is optimal to use the following methods:

1. Myomectomy (surgical removal of uterine fibroids)
2. Uterine artery embolization (a method in which the blood supply to the fibroids is cut off, causing them to die)
3. Drug treatment with ulipristal acetate - the drug blocks the receptors of progesterone, the main hormone that stimulates the growth of uterine fibroids.

All other treatment methods either do not have scientific evidence of effectiveness (leeches, homeopathy, herbal medicine, dietary supplements), or are not effective enough, that is, the effect is temporary (FUS ablation, GnRH agonists) or are completely ineffective (Mirena spiral, contraceptives).

When choosing a treatment method, it is important to consider the following data:

1. Patient's age
2. Reproductive plans: desire to become pregnant at the moment (in the near future), someday or no plans for pregnancy
3. Set goal (see paragraph 2)

Complete removal of the uterus - hysterectomy also refers to surgical methods for treating uterine fibroids. Removal of the uterus is objectively indicated only in the case of giant fibroids, when the total size of the uterus corresponds to 20-25 weeks of pregnancy, but there are exceptions. In all other cases, uterine fibroids can be cured without removing the organ using the three treatment methods described above.

Forecast. Prevention

The prognosis for uterine fibroids is favorable in most cases. Only in advanced cases is it not possible to preserve the organ or restore reproductive function. Uterine fibroids most often grow slowly. As a rule, patients themselves do not visit a gynecologist for years, which does not allow timely diagnosis of the disease at the initial stage and treatment. At the same time, doctors themselves often observe the gradual growth of nodes for a long time, without taking any measures, and then only suggest removal of the organ.

Since the cause of uterine fibroids is unknown, no preventive measures not offered. Some studies have shown that taking hormonal contraceptives reduces the likelihood of uterine fibroids by 24%. Abstaining from massage, sunbathing, sports and visiting baths does not reduce the likelihood of contracting uterine fibroids.

If you undergo an ultrasound of the pelvic organs once a year starting at the age of 21, you can detect in time initial stage diseases and carry out preventive treatment.

Myoma – benign neoplasm in the body of the uterus or in the cervix, which is a fairly common gynecological pathology. With this disease, specific symptoms rarely occur that could accurately determine the presence of fibroids. It is worth knowing what approximate signs of uterine fibroids exist, how to recognize this disease in initial stages until it turned into a large tumor.

Even though it is a tumor, it is quite safe for female body generally. Fibroids are benign tumors and extremely rarely degenerate into malignant ones; the risk of developing any other complications arises only when the tumors are large enough. However, it is worth noting that diagnosing the disease in time and starting its treatment or monitoring the dynamics of changes is also important for a number of reasons, especially if you plan to bear a child in the future.

Previously, it was believed that this disease was a problem for older women, but recently experts have noted that fibroids are also common in young women and girls. This phenomenon is quite difficult to explain; perhaps the statistics are influenced by improved diagnostic capabilities.

It is quite difficult to identify the exact causes of this disease; gynecologists cannot name the factors that precisely influence the development of the tumor. This usually happens due to various hormonal disorders, systemic and endocrine diseases. Infectious diseases of the reproductive system and multiple abortions can also affect the occurrence of pathology.

Sometimes the development of fibroids is accompanied by the occurrence of other pathologies of the reproductive system. Along with this pathology, endometriosis is quite common - a disorder of the development of endometrial tissue, which lines the uterus from the inside. If you have several diseases, it is extremely important to treat each one, since they can influence the development of each other.

The main problem in diagnosing this disease is the non-obviousness of the symptoms; often they are not pronounced enough to accurately speak about the presence of any pathology. The symptoms of fibroids can easily be attributed to changes during the menstrual cycle, fatigue, and side effects from taking various medications. Therefore, it is usually recommended to periodically undergo preventive examinations with a gynecologist so that you can identify various pathologies in the early stages, before the development of a serious disease.

Important! Put accurate diagnosis This is possible only after an examination, which must include an ultrasound and, if necessary, a number of other tests.

Symptoms

The main symptoms that arise during the formation of fibroids can indicate many other pathologies of the reproductive system, so when they appear, you should be wary and consult a doctor for a full diagnosis. In general, you should pay attention to the following signs:

1. Violations in menstrual cycle. It may get longer without visible reasons. The periods themselves may start to last longer, especially alarming symptom– their duration is longer than seven days. Blood volumes may also increase. Also, with fibroids and other gynecological pathologies, spotting and spotting may occur in the middle of the cycle.
2. Frequent urination, frequent constipation. These symptoms are associated with the growth of the tumor, over time it begins to put pressure on the organs genitourinary system and gastrointestinal tract.
3. The occurrence of unexplained pain in the lower abdomen, in the lumbar region, which is in no way related to the onset of menstruation, diseases of the excretory system and gastrointestinal tract.
4. Pain and discomfort during sexual intercourse.
5. Increase in abdominal circumference. Sometimes the size of fibroids exceeds 10–15 centimeters in diameter, which affects the volume of the body. It happens that a neoplasm is confused with the onset of pregnancy for this reason.
6. Infertility. With fibroids, it becomes more difficult to get pregnant; women who want to conceive a child will notice this sign.

These are the main signs indicating the development of this disease. When a tumor is detected, it is extremely important to ensure that it is not malignant, so examination is mandatory.

During pregnancy, it is especially difficult to detect signs of the development of fibroids; before conception, it is advised to undergo an examination and make sure that there are no prerequisites for its occurrence during pregnancy. It is also worth noting that during pregnancy the tumor may begin to grow faster due to hormonal changes in the body.

Important! Myoma during pregnancy can cause miscarriage and other serious complications, dangerous to the health of the unborn child and mother.

How to recognize during menopause?

During menopause, the symptoms remain the same. It is worth considering that normally during menopause, when menstruation stops, bleeding can be an extremely warning sign. If spotting occurs, you should immediately contact a gynecologist. This sign may also indicate a malignant neoplasm; it is important to make sure that there is no cancer.

Diagnostics

After detecting symptoms that may indicate the development of fibroids, you should contact a gynecologist and undergo an examination. It includes various studies and analyses.

It is always worth undergoing an ultrasound; it will show the presence of a neoplasm in the uterine area, its size and approximate nature. Other tests and instrumental studies may also be required to help determine the size, location and composition of tumor tissue. At this stage, it is important to understand whether the tumor is malignant.

After determining the nature of the tumor, treatment of the disease can begin. Each individual case of uterine fibroids requires a different approach to therapy, it all depends on many factors: possible reasons the occurrence of pathology, the presence of concomitant diseases of the reproductive system, the location and size of the tumor.

Treatment

Therapy depends on the characteristics of the tumor as a whole and its size. Small fibroids are usually treated conservatively, using various medications. In this case, it is extremely important to constantly monitor the doctor and monitor changes in the condition. The following means are usually used:

• oral contraceptives – hormonal agents, they are used for small nodes;
• gestagens, these drugs help to reduce and provoke the resorption of small tumors;
• FUS ablation, this method is quite new, its action is based on the properties of ultrasound to destroy tumor tissue.

If conservative methods do not help, for some reason they cannot be used or the size of the node is too large, the fibroid is removed surgically. Small nodes can be removed by laparoscopy, when several small holes are made; this operation is carried out quickly and without complications.

Larger tumors may be treated differently. Most often, only fibroids are removed, but if complications develop, a hysterectomy may be required - complete removal of the uterus. It all depends on individual characteristics course of the disease.