Fibroids size at 5 weeks pregnant. Indications for removal of uterine fibroids by size in weeks or centimeters - how the operation is performed

Myoma is a benign neoplasm that grows in muscle layer uterus. The main age of patients affected by this disease is 20–60 years. The main cause of cervical fibroids is hormonal failure. When diagnosing fibroids, its size is determined. Depending on how many neoplasms were found, their type and size in weeks, treatment is prescribed.

When prescribing treatment, the doctor starts from the size of the fibroid

To accurately determine the size of fibroids, it is necessary to do an ultrasound. It is generally accepted that with a large neoplasm that exceeds 60 mm or 6 cm (12–16 obstetric weeks), surgery is necessary. Benign neoplasms are dangerous for a woman's life when there are a lot of them. Fibroids 20–60 mm or 2–6 cm (10–11 weeks) are treated with medication, diet, and physical therapy. That is, conservative treatment is carried out.

Classification

The size of a benign neoplasm is determined in centimeters, weeks or mm on ultrasound. With the growth of fibroids, an increase in the uterine cavity occurs. This process is similar to the growth of a fetus. Therefore, the size of cervical fibroids is compared with the weeks of pregnancy.

Myoma is divided into 3 types:

1. Small swelling of the cervix. It does not exceed 2 cm (20 mm) - 4 obstetric weeks.
2. The average neoplasm is 10-11 weeks, varies from 2-6 cm or 20-60 mm.
3. Large myoma of the cervix. The size exceeds 6 cm (60 mm), which equates to 12-16 obstetric weeks of pregnancy.

Large fibroids can reach the size of a 4-month pregnancy

Size and symptoms

Neoplasms at an early stage (20 mm or 2 cm) do not bother a woman. But as soon as the tumor begins to grow and reaches 10-12 weeks (50 mm or 5 cm or more), the corresponding symptoms appear.

1. Menstrual bleeding accompanied by pain. Painkillers do not help relieve pain.
2. If the fibroid has reached 12 weeks (6 cm or 60 mm), then the cervix increases and bloating occurs.
3. With a diagnosis of pedunculated fibroids with torsion, sharp pains begin in the abdomen. This means that in the body of the neoplasm, the blood flow is disturbed, and entails peritonitis. You need to do an ultrasound.
4. Large fibroids (10–20 weeks) compress nearby organs, leading to improper defecation and urination. There is pain in the lower back and heart muscle. The legs begin to go numb when the nerve endings near the rectum are crushed.
5. Large fibroids (more than 12 weeks), grow on the outer part, form adhesions with nearby organs and tissue layers.

The symptoms of fibroids vary depending on its location and size.

Size diagnostics

The woman is examined bimanually to determine the size of the benign neoplasm. Further, appropriate tests are given and ultrasound is performed. Ultrasound with accuracy allows you to diagnose the size of the neoplasm.

To properly prescribe treatment, you should constantly do an ultrasound of the uterus. It will help determine how many benign formations, size and growth rate.

The faster the neoplasm grows in size, the greater the likelihood of its transition to oncology. In such situations, an ultrasound is performed to determine how many neoplasms are present and exclude cancer.

Regular ultrasound is a must. Since small fibroids (up to 12 weeks) can be localized in dangerous parts. MRI is also used to obtain detailed information about the type, structure and size of a benign neoplasm.

Ultrasound is a common method for diagnosing fibroids

Pregnancy

The tumor is small (less than 1 cm), does not particularly affect the growth of the fetus in the womb. But the obligatory observation of the doctor for the condition should be.

Large nodules (12 weeks or more), which in the submucosal part of the uterus, prevent the normal development of the fetus, forming a variety of pathologies.

Neoplasm more than 12 weeks and located at the back wall, increases the likelihood of preterm labor. In some situations, oxygen starvation of the child occurs. Doctors are sure that with a small neoplasm, maintaining a pregnancy and giving birth to a baby will not be a problem.

Treatment

It is carried out using a variety of techniques. It all depends on the size in obstetric weeks and type:

hormone therapy

Assign if the size of the tumor has reached 12 weeks. Medical treatment aimed at stopping growth and reducing size. Such treatment is carried out for women who are going to become mothers after surgery to exclude the appearance of new tumors.

Medicines reduce the size and prevent the recurrence of fibroids

Symptomatic treatment

1. antispasmodics and painkillers (tumors up to 3 weeks cause severe pain during menstruation);
2. hemostatic drugs are used for small neoplasms, if prolonged and heavy menstruation and at the time of ovulation occur bloody issues.

Surgery (fibroids more than 13 weeks old)

1. laser resection of the tumor;
2. myomectomy;
3. vascular embolization;
4. complete resection of the uterus.

Alternative treatment

1. hirudotherapy;
2. folk remedies;
3. physiotherapy procedures;
4. gymnastic exercises.

Treatment with leeches is effective for myoma

Indicators for surgical intervention

1. A benign neoplasm exceeds 12 weeks.
2. The woman is planning a pregnancy.
3. If there is a risk of formation malignant tumor.
4. A benign formation causes severe pain. The use of painkillers does not work.
5. Myoma presses on the rectum, urinary system and nerve endings.
6. Regular severe bleeding is observed, due to which anemia develops.
7. If the tumor is located on a long thin stalk, then there is a torsion factor and the onset of peritonitis.
8. If normal urination does not occur, then there is stagnation of urine.
9. If a large myomatous node presses on the rectum, then the woman has a rare stool, which leads to intoxication of the whole organism. With intoxication, bloating occurs and severe pain is felt when pressed with fingers.

If, when contacting a doctor, a benign formation of the cervix was diagnosed, then:

1. On examination, it is determined how many neoplasms and their size.
2. Ultrasound must be done on a certain day, because cervical neoplasms change under the influence of estrogen levels.
3. A qualified doctor will never claim that the formation is of an average size and talk about the rules for determining them.
4. The gynecologist determines the stage of the disease using the ratio of size to gestational age and ultrasound results.
5. Dimensions are determined in weeks, cm, mm.
6. Full diagnosis and control of the doctor will help determine the development of cervical fibroids.

Myoma itself appears benign tumor in the muscular structure of the uterus. Despite the fact that small uterine fibroids occur in patients from twenty to seventy years old, the main risk group is in the middle age category. It is generally accepted that main reason the formation of fibroids lies in the hormonal background, its fluctuations. Treatment of small uterine fibroids occurs only after diagnosis. One of the main indicators is its size - the degree of tumor development in the patient. The volume of the detected tumor and its size directly affect the upcoming treatment, which will be prescribed by a specialist.

For diagnostic purposes, an ultrasound machine is used. Methods of elimination are divided into surgical and medical. The first option is used only if the size of a benign tumor reaches six centimeters. Typically, these sizes are fixed for a period of twelve to sixteen weeks. Tumors that are smaller than the above size do not require surgery and are able to resolve. For these purposes, a variety of physiotherapy and special diets are prescribed.

Due to the fact that the tumor has its direct effect on the size of the uterus, increasing it, it is customary to classify it in the medical community according to weekly terms. The first period at which it is possible to successfully diagnose the presence of the disease is 5-6 weeks. It is at this point that the uterine cavity begins to expand like the growth of a child inside the womb. For a period of 7 - 8 weeks, the height of the fundus of the uterus can reach eighty millimeters. One of the favorable terms for treatment is also considered 9 weeks, in the case of diagnosing such a disease in the early stages, the complexity of the upcoming elimination measures decreases. As mentioned earlier, special complications are caused by dimensions that overtake after a period of twelve weeks, which may require an operation in a hospital.

Various tables are freely available, indicating the correspondence between the term and size of fibroids, however, professional diagnosis is possible only in specialized medical centers by competent doctors.

Narrow classification

Based on tabular data, it is customary to distinguish three sizes of fibroids:

• small (up to four weeks);
• medium (ten to eleven weeks);
• large (from twelve weeks).

Symptoms and scope

Small uterine fibroids in no way make themselves felt, that is, the formation of a tumor is asymptomatic. The first signs of a problem appear closer to the tenth week:

• unbearable pain during menstrual cycle, profuse discharge;
• bloating of the lower part of the abdominal cavity was recorded, which is noteworthy, the patient's weight does not change;
• if a benign formation has a leg, then its twisting is fraught with the appearance of severe pain, this indicates a violation of normal blood circulation;
• neglected large fibroids also have a direct effect on the nearest internal organs, so problems with stool and urination can be added to the symptoms,
• as for the presence of formations on the outer layer, the formation of adhesions with neighboring organs is possible here.

Diagnostics

Before prescribing treatment, the specialist must necessarily conduct an initial examination using gynecological instruments. Then the patient is prescribed a referral for an ultrasound, which will accurately determine the size of the tumor, from which it will be possible to calculate its age. For further complete cure, ultrasound is required in a systematic manner. Small-sized uterine fibroids are capable of developing at an accelerated pace, in 3 months, and developing into a malignant formation. This course of events is the most unfavorable, but no one is immune from it. The passage of ultrasound will also help to identify the exact number of formations. Only after all diagnostic actions by a specialist can treatment be prescribed.

Myoma during pregnancy

A separate topic for consideration is the treatment of fibroids during the patient's pregnancy. The nodes that appear due to the formation of fibroids, which do not reach a size of ten millimeters, do not carry a significant risk for the child. At the same time, do not forget to undergo regular examinations in order to prevent the development of a tumor. Cases have been recorded when pregnancy contributed to the accelerated development of fibroids, in which case urgent medical intervention is required. As for the formations of a large volume, they are definitely able to exert their direct influence on the development of the child in the womb, which means that you should not hesitate either. There is an opinion that has not found official confirmation that a small fibroid will not hurt during childbirth, and will not cause complications. However, the presence of this kind of problem is definitely worth considering in more detail - in a personal consultation with a specialist doctor.

Ways to overcome fibroids

Myoma should be treated immediately after all examinations and diagnostics. Treatment options depend on the size and age of the tumors.

Most the easy way overcoming small fibroids is the use of hormone therapy. With the help of the introduction of medications, the development of the tumor is suspended, then its size decreases until it disappears completely. Often this method is assigned to young girls who hope to have their own children in the future. It follows from this that hormone therapy does not leave the consequences of treatment and the use of this method is quite harmless.

The next way is to eliminate the symptoms. It consists in the timely use of drugs in order to reduce the consequences of education. There are cases when fibroids already in the second week brought significant pain during the menstrual cycle. Hemostatic agents are also actively used in cases where small fibroids cause heavy bleeding.

The following methods of eliminating the tumor are surgical and are performed on the operating table. laser removal tumors, myomectomy, vascular embolization, total or partial removal of the uterus, if other means do not bring complete recovery. Some folk remedies are also known, but their use must also be discussed with a specialist.

You can sum it up. You can get rid of the benign formation of fibroids, but it is better to do this at an early stage of the development of the disease, because neglect of the symptoms that appear can cause significant complications, up to surgical intervention. Operability and method of removal depend on the degree of complexity and the number of fibroids. Systematic examinations, examinations and passage of an ultrasound machine are necessary for a favorable course of treatment. All actions taken must be strictly mandatory discussed and agreed with a certified medical specialist.

This video discusses in detail (but understandable and accessible) the method of uterine artery embolization: history, features and myths. In 12 minutes you will get a complete understanding of the method and find answers to most questions.

Uterine fibroids - for many women, this diagnosis sounds like a bolt from the blue, and it often happens that a misconception about this diagnosis dooms the patient to difficult experiences and completely unjustified surgical interventions.

What I would like to talk about below are the main theses:

• uterine fibroids - it's not scary at all (again dispelling myths)
• there are modern techniques to avoid surgery and organ loss
• uterine fibroids cannot be treated with Duphaston
• there is a prevention of the development of uterine fibroids
• with uterine fibroids, you can get pregnant and give birth

Some statistics:

• about 80% of all operations in gynecology are performed for uterine fibroids - 90% of these operations are removal of the uterus
• every third woman after 55 years of age had her uterus removed due to a diagnosis of uterine fibroids
• the average age of women who have their uterus removed because they have uterine fibroids is 42 years

Why everyone is offered to operate on myoma?

If all operations for uterine fibroids are removed from the work of the gynecological department, then in fact doctors will sit without work and categorically not carry out the terrible plan of “surgical activity”. “Surgical activity” reflects how many patients were operated on from among those admitted. This indicator should be high - otherwise they swear very much ...

And some of the doctors are simply not interested in new technologies and do not know that they can be treated differently.

So to myoma...

What is uterine fibroids and why is it so scary?

Uterine fibroids have long been considered as a true benign tumor that can transform into a malignant neoplasm. And since any tumor must be removed, and preferably together with the organ in which it grows, there was no alternative to removing the uterus for this disease. The only compromise was organ-sparing fibroid nodule surgery – this womb-sparing option was mostly reserved for nulliparous women to give them a chance to have a baby. Sooner or later, these women, having fulfilled their reproductive plan, found themselves on the operating table for removal of the uterus due to a relapse of the disease.

Attitudes towards the nature of fibroids began to change in the mid-1990s. New opportunities scientific research showed that although it is similar, it is not a benign tumor. It became known that fibroids degenerate into a malignant tumor so rarely that, in general, this probability is comparable to the development of a malignant tumor in the uterus, without the presence of myomatous nodes in it. And finally, in terms of their characteristics, fibroids were compared with a common wen on the skin, an atherosclerotic plaque in a vessel, and a keloid scar, which made it possible to significantly reduce oncological alertness in relation to this disease.

As a result of special studies, it was possible to show that myoma has a greater prevalence than previously thought. If earlier it was thought that it occurs in 30% of women over 35 years old, now it is known that fibroids develop in more than 80% of women, but in most women this disease is asymptomatic.

At the moment, uterine fibroids appear to be a kind of reaction of an organ (uterus) to damage. The main damage to the uterus is menstruation, or rather a large number of periods.

There is an ancient Russian proverb “If you don’t give birth to Yerema, you will give birth to fibroids” - and the ancients, as usual, were right, but they could not explain it from a scientific point of view.

The body of a woman was conceived by nature for procreation. It was supposed to be in the reproductive cycle from the moment of maturity. Pregnancy, breastfeeding, one or two periods and again pregnancy. So for the life of a woman it was supposed to survive 30-40 menstruations, and most likely the uterus is adapted to this. In practice, it happens that a woman gives birth to 1-2 children, usually by the age of 30 and rarely breastfeeds for more than 1 year. In this mode, a woman experiences about 400 menstruations in her life.

Like any frequently repeated process, menstruation negatively affects the woman's body in general, and her genitals in particular. Think about it: how could it be provided by nature that every month you have to experience a whole set of negative sensations, in their effect on the body, comparable to a disease. Headaches, pain in the abdomen and body, bleeding, bad mood, decreased performance, changes in appetite, etc. This list can be continued for quite some time. This is how the body responds to its unfulfillment.

Every month, the whole body of a woman tunes in to pregnancy, all organs and systems are prepared. In the second phase of the cycle, these processes accelerate, the uterus increases slightly in size, preparing to quickly begin to grow in response to the onset of pregnancy. Pregnancy does not occur and again the whole body begins to return its “settings” to its normal state.

Obviously, repeated repetition of a complex multilevel process begins, on the one hand, to wear out the entire system, and on the other hand, “to form errors”, the number of which increases many times when combined with various diseases, infections and medical interventions. This is how the majority gynecological diseases including uterine fibroids.

A monthly maturing follicle in the ovary will sooner or later form into an ovarian cyst, a constant increase and rejection of the uterine mucosa - polyps or hyperplastic processes; endometriosis - there is no menstruation at all.

Myoma is formed at the beginning in the form of tiny rudiments located in the muscular membrane of the uterus. These are groups of ordinary muscle cells of the uterus, but in their properties they correspond to cells that are in the period of pregnancy. As one American scientist said, “uterine fibroids are a single-cell pregnancy.” Indeed, each myomatous node grows from one cell.

Under conditions of repetitive menstrual cycles, accompanied by fluctuations in hormones, the rudiments of myomatous nodes begin to grow. At the same time, some grow faster, others slowly, and others may even regress and disappear. Various damaging factors accelerate the growth of the rudiments of myomatous nodes, which include:

• abortions
• inflammation
• medical interventions (curettage, traumatic childbirth benefits, operations)
• endometriosis

After all, it is known that after inflammation or abortion, myomatous nodes begin to grow.

There are also juvenile fibroids that occur in young girls under 25 years old. It is believed that damage to the cells of the uterus, which leads to the growth of these nodes, occurs in them during intrauterine development. The progenitor cells of the muscular membrane of the uterus take a very long time to develop during pregnancy and have a long unstable period. In this unstable state, they are most susceptible to various damaging factors. Thus, if cells receive a defect in the prenatal period, then they only need a hormonal stimulus in the future to start growing. This hormonal stimulus is the onset of menstruation.

Diagnostic approaches

At a time when ultrasound was practically unavailable, and the quality of the devices left much to be desired, it was almost impossible to detect small myomatous nodes. Basically, doctors had to deal with already large nodes that could be found by hand or with patients who complained of heavy menstruation. In fact, these were already running cases. It was then that indications for the removal of the uterus were formulated, which exist to this day. In these indications, apart from other items, there are two very subjective criteria: "the size of the uterus corresponding to more than 12 weeks of pregnancy" and " fast growth fibroids"

When myomatous nodes begin to grow in the uterus, the uterus itself increases in size accordingly. Since the uterus normally increases in size only during pregnancy, the increase in the uterus due to myomatous nodes began to be measured by weeks of pregnancy. For example, "uterine fibroids 7-8 corresponding to 7-8 weeks of pregnancy."

Estimating the size of uterine fibroids in weeks of pregnancy is an extremely subjective thing. The uterus with myomatous nodes, as a rule, increases unevenly - the nodes grow in different directions, some stretch in width, some in length. In addition, the thickness of the subcutaneous fatty tissue of the anterior abdominal wall and the height of the uterus are important in assessing the size of the uterus. All this leads to the fact that one doctor can look at a woman on a chair and say that she has uterine fibroids for 8 weeks, and another, after looking, will say that there are all 12 weeks. In fact, during the operation, it turns out that the size of the uterus barely reaches 6-7 weeks of pregnancy.

"Rapid growth" is also a very subjective criterion, as it is directly related to the desire or ability to correctly determine the size of the uterus in the weeks of pregnancy. The criterion of "rapid growth" was introduced in connection with the fear that the rapid growth of myomatous nodes is highly suspicious in relation to the malignant transformation of fibroids. This fact has been repeatedly refuted, since it has been shown that in the vast majority of cases, the rapid growth of myomatous nodes is not associated with malignant degeneration of fibroids, but is a consequence of secondary degenerative changes.

Now imagine how convenient the situation is when the indication for surgery is the subjective criterion in the form of the size of the myomatous uterus more than 12 weeks or "rapid growth" Under this "subjective sauce" the largest number of hysterectomy is performed, despite the fact that the true size of the uterus may be slightly larger norms.

Who needs it and why?

There are several reasons:

1. Dispensary registration in antenatal clinics

Each women's clinic has a dispensary record of women for various diseases. Most of the women are in the dispensary for fibroids. They are regularly invited to an appointment and observe the dynamics of the growth of myomatous nodes. The number of such women is increasing year by year. It is possible to remove a woman from dispensary registration after the disease has actually been cured, and the only radical method treatment - amputation of the uterus. Therefore, after observing for some time, at one of the receptions it is possible to write down in the card that the uterine myoma has grown up to 12 weeks of pregnancy, while “quickly” and send it to surgery. After the removal of the uterus, the woman is removed from the dispensary. Again, reporting is required.

2.Surgical treatment of uterine fibroids - profit for the clinic and the implementation of the "surgical activity" plan

Monitoring a patient with fibroids is a troublesome and costly task. Any operation is always more expensive, whether it is the funds of an insurance company or personal gratitude from citizens. Now, when laparoscopic operations are performed in almost every major medical institution, the removal of the uterus by this method is put on stream. The technique of the operation is debugged, the intervention is relatively well tolerated. Here is what is proposed to quickly and efficiently solve the problem. If a woman no longer has reproductive plans, then convincing her that this is the simplest and easiest way to treat fibroids costs nothing. Polyclinics honestly direct, surgeons honestly cut off. In this case, the only indication for amputation may simply be the fact of the presence of uterine fibroids, even if it does not give any symptoms, even if the myomatous node is small and does not interfere with anything.

The main idea of ​​all that I have written above is that the patient with uterine fibroids is actually being misled. Taking advantage of the fact that the patient is not versed in matters of medicine, she is not told about all the available methods of treating her disease, or they are provided with negative and false data on effectiveness alternative methods treatment - either intentionally or simply out of ignorance.

How to treat uterine fibroids?

First, I would like to list all currently available treatments for uterine fibroids:

• Drug treatment: GnRH agonists (zoladex, buserelin, diphereline, lucrine, etc.), progesterone receptor blockers (mifepristone)
• Embolization of the uterine arteries
• Conservative myomectomy (hysteroresectoscopy)
• Amputation of the uterus

Thus, in addition to removal of the uterus and passive dynamic observation, there are other methods of treatment.

Dimensions of uterine fibroids

Despite the fact that the classification of uterine fibroids by weeks of pregnancy is accepted throughout the world, in my opinion, in the era ultrasound diagnostics this approach to determining the size of uterine fibroids is somewhat outdated.

With the help of ultrasound, you can measure the size of each myomatous node, count their number and determine the localization. Such detailed description uterus, modified by myomatous nodes - more informative than the conclusion - "uterine fibroids 8-9 weeks."

In addition, the choice of treatment method, the prognosis of the disease and the conclusion about the possibility of pregnancy depends on the size of the nodes and their localization.

Choice of treatment for uterine fibroids

Before describing each of the treatments listed above, let's discuss in what situations it is possible to allow a simple observation.

A very important thought! The myomatous node appears in the uterus not immediately large, it grows from the rudiment and at the very beginning it cannot be detected even with ultrasound. Further, it increases in size and then the paths of all nodes diverge. Some nodes reach a certain size and stop growing, others slowly but surely continue their growth, and others can grow rapidly.

If there was only one node in the uterus, besides this node, new nodes may not appear. But there is another situation when the number of nodes increases.

No one knows how the node will behave - whether it will grow, stabilize, or disappear altogether. But you need to understand that fibroids have a staging, and small nodes are actually the earliest stage of the disease, and large and very large fibroids are already advanced forms of the disease.

As you know, any disease is easiest to treat at an early stage - the treatment of uterine fibroids is no exception. Therefore, even if a woman accidentally discovers small myomatous nodes (no more than 2-2.5 cm) during ultrasound, let such a patient go with the words: “we will observe, if fibroids grow, we will treat” - it is equivalent to a situation when a patient goes to a doctor with complaints of coughing, and instead of treatment, the doctor says: “we will observe, pneumonia will develop, then we will treat.” Absurd, isn't it?

It has long been known that modern hormonal contraceptives are able to inhibit the growth of small myomatous nodes, the size of which does not exceed 2-2.5 cm. body).

Thus, when small myomatous nodes are detected, even in the absence of symptoms of the disease, the patient should be offered to take modern monophasic contraceptives. In the same case, if they are contraindicated to her, or the patient categorically objects to taking them, dynamic monitoring of the growth of myomatous nodes can be allowed, but ultrasound should be performed at least 1 time per year. If the nodes began to grow, then treatment should be started immediately and not wait for their further increase, even if there are no symptoms of the disease.

Reception of oral contraceptives can be replaced with a special intrauterine hormonal system "Mirena". This is actually an ordinary intrauterine device, but containing a container with a hormone that is released into the uterine cavity in small doses for 5-6 years. It is for this period that this system is put. She, as well as oral contraceptives, inhibits the growth of myomatous nodes.

In what other cases can you observe myoma and do nothing?

There is no single answer here, the decision must be made individually. Too many criteria should be taken into account when making such a decision (and the localization of the node, its size, the age of the patient, the degree of blood supply, the presence of reproductive plans, the presence of other diseases, etc.)

Thus, it is possible to allow dynamic monitoring of uterine fibroids only by evaluating many facts.

Before proceeding to describe the methods of treatment of uterine fibroids, it is necessary to tell what nodes are and what is the main idea of ​​treating this disease.

What are uterine fibroids?

Myoma nodes can be located in different parts of the uterus.

• Actually outside the uterus, "grow on a stalk"
• Part of the node outside the uterus, and part in the wall
• In the wall of the uterus
• In the wall of the uterus, but grow towards the cavity
• And nodes that protrude into the uterine cavity to varying degrees, some nodes can be completely in the uterine cavity "on a leg"

There are also other localizations, but they are extremely rare.

The closer the node is to the uterine cavity, the more likely it is to cause symptoms of the disease in the form of heavy long periods, pain and interfere with the development of pregnancy. Accordingly, the more external the node, the less it manifests itself, except when the node is large enough and squeezes neighboring organs (bladder or rectum)

Further, the closer the node is to the uterine cavity, the more significant its size. To clarify, even a small nodule in the uterine cavity can cause prolonged heavy menstruation, while a large nodule outside the uterus can remain asymptomatic for a long time.

Therefore, the choice of treatment method depends not only on the size and number of nodes, but also on their localization.

What is the main idea of ​​the treatment of uterine fibroids

The uterine fibroid nodule can be reduced, fixed in size, and removed.

Reduces the size of fibroids two types of treatment - medical preparations and uterine artery embolization (indirect, focused ultrasound)

Each node has its own limit, below which it cannot decrease. In other words, "dry residue". I often give the example of an apple that is turned into a dried fruit - the larger the apple initially, the more dried fruit it will turn out, the juicier it was, the more it will decrease when dried.

With a myomatous node also. Large nodes, as a rule, decrease worse and mainly due to the fact that the content of connective tissue begins to prevail in their structure, which is practically not amenable to regression. However, there are also small nodes, almost entirely consisting of connective tissue - fibromyomas. Fibromyomas also shrink poorly, with juicy large ones regressing to more than 80% of their original size.

On average, after the treatment, the myomatous node decreases by 40%. When choosing a treatment method, this should be taken into account. It is not rational to medically reduce the size of the 8 cm node, since the remainder will be a 5 cm node, which will also remain clinically significant, especially if this node grows towards the uterine cavity.

Medical treatment of uterine fibroids

Important! Uterine fibroids cannot be treated with Duphaston. Progesterone (duphaston is its analogue) is the main factor in the growth of fibroids (this has been proven more than 10 years ago) - who does not believe, see Western scientific publications.

Despite this, Duphaston continues to be prescribed everywhere for patients with uterine myoma - well, how can you? Below it will be said about the drug Mifepristone (progesterone receptor blocker) - this drug reduces the size of uterine fibroids only due to the fact that it does not allow progesterone to exercise its effect on uterine fibroids. That is, no progesterone - no growth of fibroids.

Duphaston is categorically contraindicated for the treatment of uterine fibroids! Duphaston grows fibroids, and after you are sent for an operation under the sauce “treatment did not help, the nodes grow, it is necessary to cut it off, no matter how bad it is.” Some Paleolithic...

GnRH agonites

These drugs (Zoladex, Buserelin, Diferelin, Lucrin-depot, etc.) introduce a woman into artificial menopause, against which a decrease in myomatous nodes occurs. In addition, they have a direct effect on uterine fibroids. GnRH agonists block the local production of hormones in the nodes (supporting the growth of nodes) and the synthesis of connective tissue (the accumulation of which also leads to an increase in size).

The drugs are administered intramuscularly once every 28 days. Usually the course of treatment is from 3 to 6-7 months. Side effects develop differently for everyone - from mild "hot flashes" to relatively severe conditions. After the end of treatment, the myomatous nodes may begin to grow again, therefore, such drugs should not be prescribed in isolation. To stabilize the results achieved after a course of therapy with GnRH agonists, hormonal contraceptives are prescribed or the Mirena spiral is introduced.

It is advisable to use GnRH agonists for only small myoma nodes up to 3-5 cm, then after reduction, the size of the nodes will remain clinically insignificant, and it will be easier to stabilize them with the help of contraceptives or Mirena. Prescribing GnRH agonists to large nodes is not rational; there are other treatments for such nodes.

GnRH agonists should not be given at all before surgery to remove fibroids. It is believed that after such preparation, the volume of surgical blood loss decreases and the reduced node is easier to remove. In fact, the volume of blood loss is indeed reduced, but at the same time, the myomatous node is, as it were, “soldered” into the surrounding muscle tissue of the uterus, which makes it difficult to exfoliate. The most negative consequence of the preoperative administration of GnRH agonists is that, during treatment, small myoma nodes become even smaller and cannot be detected during surgery and, accordingly, removed. It is from these left small nodules that new nodes are subsequently formed and the disease recurs.

GnRH agonists should be given after fibroid surgery to allow the uterus to fully recover and suppress any remaining fibroid buds.

Progesterone receptor blockers

Currently, there is only one drug from this group - mifepristone. It is known that it is the female sex hormone progesterone that is the most powerful factor in the growth of uterine fibroids. Mifepristone blocks all binding sites of this hormone on uterine fibroid cells, thus preventing it from realizing its effect.

Against the background of taking this drug, the size of myomatous nodes decreases in the same way as with the use of GnRH agonists. The drug is better tolerated. It is also advisable to prescribe mifepristone only in the presence of small myomatous nodes.

Embolization of the uterine arteries

In fact, a unique method of treating uterine fibroids. His appearance actually gave rise to a new era in the treatment of this disease.

The term "embolization" means blockage of the blood vessels that feed the organ, which leads to the cessation of its blood supply.

The essence of the technique of uterine artery embolization (UAE) is as follows: the uterus is mainly supplied with blood by four arteries: the right and left uterine arteries and the right and left ovarian arteries.

The share of uterine arteries in the supply of the uterus with blood is the main one. Now imagine that you drastically reduce the watering of your favorite ficus to a minimum - it is obvious that very soon it will simply dry out. Similarly, an organ that has lost a significant share of its blood supply gradually begins to decrease in size, only there is one nuance here. Uterine fibroids also feed from the uterine arteries, but since it was formed later than the uterus grew, the system of blood vessels in it is not perfect and vicious (“made hastily and not thought out in case of any violations”).

Thus, the cessation of blood supply to the uterus through the uterine arteries becomes “lethal” for fibroids, but not for healthy uterine tissue, since the presence of a normal circulatory network in it allows it to “exist” due to blood flow through the ovarian and other small arteries. In other words, the cessation of blood flow in the uterine arteries leads to the “shrinkage” of fibroids, but practically does not affect the functioning of healthy uterine tissue.

As a result of this procedure, already after three months, the volume of fibroids decreases by an average of 43%, and in a year - by 65%. Abundant long painful periods with clots by the second or third month after UAE in 90% turn into short moderate or even meager, painless periods. Most importantly, after this procedure, uterine fibroids rarely recur. EMA is a self-sufficient method. After this procedure, there is no need to take any medications and procedures - you solve the problem of uterine fibroids once and for all.

How does this procedure take place?

It is interesting!

How uterine artery embolization works in the Perinatal Medical Center (video from the operating room). Now you can see everything with your own eyes.

Under local anesthesia (this is more than enough), a puncture of the right femoral artery is performed (the same as an intravenous injection only on the leg), and a catheter is inserted.

Then, under the control of a special X-ray machine, they alternately enter the right and left uterine arteries, and a suspension of microparticles (balls with a size of 300-700 microns) is injected into each of them. These particles will block the blood flow in the uterine arteries.

This procedure usually takes from 15 to 40 minutes and occurs without anesthesia - as it is simply not needed. Throughout the procedure, the patient does not experience any pain.

After the procedure is over, the patient returns to her room, where she remains until the morning. Some time after the procedure, pain (drawing character) appears, resembling pain during menstruation. The severity of pain is different - from mild to moderate, sometimes quite strong. For removal pain syndrome painkillers are prescribed. By morning, the pain usually disappears completely. In the next 5-7 days, a condition resembling a mild cold may be observed, that is, fever, weakness, drowsiness. Most often, women spend this time at home and after it they can go to work. Already after one menstrual cycle, you can feel the effect of the procedure.

Embolization of the uterine arteries can be performed for any size and localization of myomatous nodes. It is advisable to perform this procedure and in the presence of small nodes, in fact, with preventive purpose not to take contraceptives and not to worry that one day the nodes will begin to grow. For large nodules, embolization alone may be enough (the nodules in the uterus may remain large enough, but they will not grow further and there will be no profuse bleeding) or embolization will be the initial step before surgery to remove fibroids, especially in women planning a pregnancy.

The combination of uterine artery embolization with subsequent removal of the remaining nodes is an approach that allows you to restore reproductive function in women with the most complex variants of uterine fibroids.

These are situations when the uterus is actually “stuffed” with fibrous nodes of various sizes and it is not possible to remove all the nodes without risk for the uterus and the patient. 6-8 months after embolization of the uterine arteries, the number of nodes decreases, the remaining nodes are clearly delimited from the surrounding myometrium, the contour of a normal uterus begins to be drawn, and the cavity is leveled. It becomes easier to remove nodes from such a uterus, blood loss is sharply reduced, after removal of all nodes, the uterus quickly acquires its original size.

Is it possible to get pregnant after uterine artery embolization and is this procedure performed on nulliparous women?

Yes, you can! And this is proved by the increasing number of children around the world every year, born to women who have undergone uterine artery embolization.

Already within a few months after embolization, the blood flow in the uterus is restored in full. Ovarian function in young women does not suffer, despite the fact that during embolization, emboli enter the bloodstream of the ovary.

A decrease in ovarian function can be observed in women mainly over 45 years of age. The radiation dose during the procedure does not exceed the allowable values ​​(this has been shown in large Western studies)

Of course, after embolization of the uterine arteries, not so many children are born, but this is due to the fact that the vast majority of women with uterine myoma are over 35 years old, and many have already given birth to children or by this age they have additional factors of infertility (for example, obstruction of the uterine tubal or male infertility).

Uterine artery embolization and submucosal uterine fibroids (submucosal)

The effect that uterine artery embolization has on submucosal myoma nodes can be called unique. Submucosal nodes are nodes that grow into the uterine cavity and deform it to varying degrees.

Before the advent of uterine artery embolization, such nodes were removed using hysteroresectoscopy (a large operation that is performed through the vagina - with a special tool, the myomatous node is cut in small pieces from the wall of the cavity). This operation is still being carried out. The maximum node size for the possibility of this operation is 5 cm. For large sizes, they most often insist on removing the uterus. Hysteroresectoscopy is most justified in the presence of small nodules that grow in the uterine cavity, as if "on a leg".

After embolization of the uterine arteries, the myomatous node or nodes begin to gradually move into the uterine cavity, where it begins to disintegrate. The disintegrating myomatous node gradually flows out of the uterine cavity and then is completely pushed out of the uterus. Thus, the uterus, as it were, rejects the knot from itself, while already a few weeks after that it is impossible to find a single sign that this knot was in the uterus - complete healing occurs without a trace.

Against the background of such a disintegration of the node, a woman, as a rule, has an increase in temperature, weakness, malaise, periodic pulling pains in the abdomen. This condition can last for several weeks (depending on the size of the node or nodes), but in general it is relatively easy to tolerate. After removing the knot, the woman's condition becomes normal within one day. In my practice, the maximum size of the node that was cured in this way was 12 cm. Who and why speaks badly about uterine artery embolization?

As a rule, bad reviews about uterine artery embolization are:

• from doctors who have only heard about this method and have never seen it (well, rumors are different)
• for doctors who are engaged in operations to remove the uterus and fibroids - this is their main income and embolization acts as a competing method
• from extremely conservative doctors who like to treat "the old fashioned way"
• in doctors who had to deal with complications after uterine artery embolization (they happen extremely rarely with the correct operation and proper management after)
• in patients who underwent this procedure poorly or had complications (as you know, there is no medicine without complications, but they are often silent about the successes of doctors, but I always talk about complications)

Thus, uterine artery embolization is a very successful self-sufficient method of treating uterine fibroids, which has already saved many women from hysterectomy and allowed them to give birth to full-fledged children.

Remember! Every time you are offered to remove the uterus for fibroids, do not rush to agree, you will always have time to remove the uterus. Embolization of the uterine arteries is a worthy alternative to this operation.

Removal of uterine fibroids or conservative myomectomy

This operation was proposed about a hundred years ago and so far the possibility of this operation is hushed up. Technically, this is a rather complicated operation, and not all gynecologists are proficient in it. Removing the uterus is much easier.

Most often, this operation is performed to realize the reproductive function. You can get pregnant 6 months after this operation. With a large number of nodes and a high risk of losing the uterus during the operation, embolization of the uterine arteries is performed six months before this operation. Then the outcome of the operation is almost always successful. In order to prevent recurrence of the disease and allow the uterus to recover better after surgery, a course of therapy with GnRH agonists is prescribed for 3-6 months.

What is the best method for removing fibroids?

There are two options for conservative myomectomy - laparoscopic and laparotomy. In the first case, the operation is performed using special instruments inserted into the abdominal cavity under the control of a video camera; in the second, the operation is performed by the surgeon's hands in the abdomen.

Laparoscopic myomectomy requires a very high skill of the surgeon, as he must sew the uterus well so that it can withstand pregnancy and childbirth. This is not an easy task. Many cases of uterine ruptures during pregnancy and childbirth after poorly performed operations have already been recorded. Laparoscopic access is most indicated in the presence of nodes growing outside the uterus "on a leg".

The advantages of laparoscopic access include a quick recovery period, less likelihood of adhesions, less blood loss during surgery. But I repeat once again, in Russia there are only a few dozen surgeons who have sufficient experience and qualifications to fully perform this operation in the presence of several nodes in the uterus and when they are located in the wall and closer to the cavity. The names of these surgeons are usually widely known. You may be offered to do such an operation in any clinic, but just remember that you can only check the quality during pregnancy and childbirth, and it may be too late there.

Still, the uterus must be sewn by hand. Neatly, layer by layer, matching all the layers. This allows you to do an abdominal operation. In addition, during abdominal surgery, there is a more complete opportunity to feel the entire uterus with your fingers and find small myomatous nodes and remove them. The tool doesn't work that well.

Therefore, I believe that the removal of myomatous nodes, if these nodes are located in the wall of the uterus, they are large or there are a lot of them, should be done with an open operation. This will allow with greater confidence to guarantee the complete removal of myomatous nodes and better and more reliable suturing of the uterus.

When should the uterus be removed for uterine fibroids?

Only in very advanced cases, when the size of the uterus is very large and the uterus is completely stuffed with knots, so that it is impossible to find healthy uterine tissue in the uterus. And a few more situations that do not occur so often.

It's a shame, because many women themselves run their disease to such an extent. They see that their belly is growing, they do not visit a gynecologist for 10 years, and some even more, and actually come when their disease reaches a stage when organ-preserving treatment is no longer possible. Some women avoid going to the doctor because they are offered to remove the uterus from the very beginning without being told about the available alternatives. Afraid of losing their uterus, these women grow fibroids for years and only come to an appointment when a huge uterus in their stomach does not allow them to lead a normal life. They come to surrender - doomed, sad and with a strong longing in their eyes. And the worst thing is that if they knew that there were other treatments, and came to the appointment a few years earlier, they could have used them and saved the uterus.

Why should you not remove the uterus and fight for it to the end?

The attitude to the uterus, as an organ that is intended only for childbearing, actually makes it so easy to make a decision to remove it. In fact, the uterus is an organ integrated into the entire reproductive system of the body and its removal does not go unnoticed.

It is known that after removal of the uterus, the risk of breast cancer and thyroid gland. In addition, during the removal of the uterus, there is a violation of the blood supply to the ovaries, which entails the development of the so-called "posthysterectomy syndrome". This syndrome is similar to that observed in women in menopause. It often happens that after the removal of the uterus, a woman begins to “age” quickly, her body weight increases, and the quality of life changes for the worse.

There may be changes in sexual life. On this occasion, Western scientists have conducted a number of studies, and their results were controversial. It was noted as an improvement in sexual life after amputation of the uterus (apparently these are those women who were exhausted by the disease they had) and those who completely lost the pleasure of sexual life. There is no reliable data and this is most likely due to the fact that the formation of sexual sensations in a woman is extremely complex and it is very difficult to evaluate it from all positions.

If you still decide to remove the uterus, then you need to remember that in order to prevent the development of post-hysterectomy syndrome (early aging), from the next day after the operation, you must start taking a special preparation Livial, which will level the development of this pathological condition.

Other treatments

High Frequency Focused Ultrasound

This method has appeared relatively recently. The meaning of this method lies in the fact that, under the control of MRI (tomography), a stream of ultrasound is aimed at the myomatous node. In the center of the knot tissue is heated up to high temperature and the node dies.

On the one hand, this method is very good. The impact is through the skin, that is, generally contactless, but there are several nuances:

• the method is very expensive (this is due to the fact that the equipment for its implementation costs many millions of euros and this must be paid back)
• it is possible to act on one or at most several nodes of fibroids
• at the same time, there should not be a lot of fat, scars and scars on the anterior abdominal wall
• at the same time, the nodes should be well located - that is, there should not be large obstacles on the path between the node and the beam flow
• uterine myoma nodes have different sensitivity to this effect, some nodes do not decrease at all after this procedure
• During the procedure, the patient must lie motionless on her stomach for several hours.

Thus, the method has many limitations and inconveniences. At a time when there is uterine artery embolization, in which all myomatous nodes are affected at once, there are not so many restrictions and this method costs half as much - the use of focused ultrasound is only advisable for scientific purposes.

I don’t believe in homeopathy, dietary supplements, etc.…..

Conclusion

Can uterine fibroids stop being one of the most pressing problems in gynecology? - MAYBE!!! How? - everything is very simple!

It is necessary from the very early youth regularly do an ultrasound scan - once a year, and if a myomatous node is detected - immediately take measures (take contraceptives, do embolization) It is absolutely unacceptable to observe how the fibroids grow.

Regular examination by a gynecologist with ultrasound is the best prevention of problems associated with uterine fibroids.

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Sizes of uterine fibroids for surgery

Uterine fibroids are among the most common pathologies of the female reproductive system. The disease is detected in every third woman of reproductive age. Uterine fibroids have several names. In the medical literature, you can also find the terms "leiomyoma" or "fibromyoma" of the uterus.

Uterine fibroids are tumor-like formations of a benign nature, localized in the uterine myometrium. Uterine fibroids are formed in the wall of the muscle layer, and when they reach a significant size, they can change their location.

The uterine wall consists of several layers. The outer layer is the perimetrium and the inner layer is the endometrium. The myometrium is the middle layer between the perimetrium and the endometrium.

Uterine fibroids often develop in the form of nodes, which can have a different number and size. Uterine fibroids may have:

• small size;
• the average size;
• big size;
• gigantic size.

Uterine fibroids are measured in weeks, as is the increase in the organ during pregnancy. Knot size can also be measured in millimeters. Small formations are up to 25 mm in size, medium tumors are 50 mm in size, large and giant nodes are 80 mm or more. The size of uterine fibroids is essential for the choice of treatment tactics.

With an average size of leiomyoma over 30 mm, surgery is often necessary.

The development of a myomatous tumor consists of several stages:

• formation of an active growth zone;
• the formation of a nodule a few millimeters in size;
• definition of a neoplasm, which has a size sufficient for visual diagnosis.

Formations are often localized in the body of the uterus. In a small number of cases, pathology can be detected in the cervical part. As a rule, gynecologists identify several nodes at the same time, which may have a different appearance, location, age and size.

The tactics of treatment is also determined not only by the size of the fibroids, but also by its ability to grow. Simple tumors grow the slowest, while proliferating formations progress somewhat faster. It's connected with histological structure fibroids. Simple and proliferating tumors are benign pathologies. In presarcoma, giant cells with multiple nuclei are found.

With rapidly growing fibroids, surgery is often necessary, since such tumors can reach several tens of millimeters in size in a short period.

Uterine fibroids can have the following localization options:

• submucosal;
• subserous;
• retroperitoneal;
• intraligamentary;
• intramural.

Submucosal nodes quickly reach large sizes due to rapid progression.

The reasons for the growth of uterine fibroids are hormonal in most cases. There are also factors that can provoke the disease:

• metabolic disorders;
• early onset of menstruation;
• late first birth;
• disharmony in intimate relationships, leading to the phenomena of venous stasis;
• high blood pressure;
• heredity.

There are two main theories regarding the etiology of the disease. Uterine fibroids may be congenital due to the peculiarities of intrauterine development of the myometrium. In some cases, tumors occur as a result of multiple surgical interventions.

Often, uterine fibroids progress asymptomatically. Doctors say that the severity of the clinical picture is influenced not so much by the size of the neoplasms as by their localization.

Leiomyoma, which has a size of several millimeters, may practically not manifest itself in any way. The absence of symptoms often accompanies intramural nodes, while in the submucosal variety, signs are present even with small fibromyomas.

In general, large uterine fibroids have the following manifestations:

• profuse bleeding during menstruation;
• increase in the duration of critical days;
• acyclic bleeding;
• pelvic pain;
• infertility;
• miscarriages, premature birth;
• complications during childbirth.

Usually, symptoms appear with uterine fibroids over 3 cm. If the size of the leiomyoma exceeds 80 mm, compression may occur. internal organs. When squeezed Bladder and intestines with a large tumor, there is a constant urge to urinate, constipation.

In case of violation of the functioning of the internal organs, it is necessary to perform an operation.

Indications and contraindications for surgical treatment of uterine myoma

Surgery, in particular, surgery, is the main way to treat fibroids. With uterine myoma, the dimensions for the operation are important, although not of paramount importance.

Indications for surgery for leiomyoma include:

• the rapid growth of the neoplasm to large values, which contributes to the compression of the internal organs and disrupts their functioning;
• bleeding due to fibroids of considerable size;
• anemia that cannot be controlled by drug therapy;
• tumors over 3 cm;
• pedicle torsion and fibromyoma necrosis;
• severe pain;
• concomitant pathologies of the ovaries or the body of the uterus;
• reproductive dysfunction due to leiomyoma;
• cancer awareness.

Despite the large size of the nodes, it is not always possible to perform the operation. Doctors identify the following contraindications to having an operation:

• inflammatory diseases in acute form;
• some cardiovascular diseases and liver disease in the stage of sub- and decompensation;
• unrealized reproductive function (radical methods);
• drug intolerance.

When choosing a type of operation, the doctor must take into account:

• fibromyoma size;
• localization of education;
• the age of the patient;
• type of tumor;
• results of histology and other tests;
• the presence of comorbidities.

Many women are interested in what size of uterine fibroids undergo surgery. However, doctors note that the choice of surgery is influenced by both the size of the leiomyoma and its localization. Usually the operation is done with fibromyoma from 3 cm.

A few decades ago, the discovery of pathology could mean not only surgery, but also the removal of the uterus. In modern gynecology, sparing techniques are used to effectively eliminate fibroids while preserving the uterus.

Types of operations for uterine myoma

In the presence of uterine leiomyoma, doctors perform operations of both organ-preserving and radical nature. Surgery to remove uterine fibroids includes:

• myomectomy;
• UAE or uterine artery embolization;
• FUS-ablation;
• hysterectomy and extirpation.

Myomectomy means removing the leiomyoma by one of three methods.

• Laparoscopy. This operation is done using a laparoscope and small punctures to place equipment and a video camera into the abdominal cavity. The advantages of the operation include the absence of a pronounced adhesive process and adhesions. However, it is quite difficult to stop the bleeding that can occur during laparoscopy. Laparoscopy is more often done with subserous leiomyomas of medium size.

• Laparotomy. The operation is performed through an incision in the lower abdomen. This is one of the most traumatic and outdated methods.
• Hysteroscopy. The operation is a minimally invasive intervention in which a hysteroscope is inserted into the uterine cavity through the vagina for manipulation. The method is suitable for the removal of submucosal fibromyomas.

Uterine artery embolization can be done for submucous fibroids. In the process of minimally invasive intervention, the patient is injected through the femoral artery with a substance that disrupts the nutrition of the leiomyoma. As a result of circulatory disorders, the node disappears or decreases in size over time.

FUS ablation involves a minimally invasive procedure that is done using ultrasound waves. Manipulation is carried out under the control of MRI and is indicated for medium-sized leiomyomas. Treatment has certain contraindications, for example, signs of malignancy of the tumor.

Hysterectomy and extirpation of the uterus are done with an associated risk of malignant pathology or uterine prolapse. Gynecologists often recommend this operation for women who have large fibroids after menopause.

Such an operation has many long-term complications, and therefore it is performed only in exceptional cases.

The operation is complemented by conservative therapy, including the use of hormonal drugs.

An integrated approach minimizes the risk of relapse.

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What to do if the uterine fibroids are large

Uterine fibroids is one of the most common diseases of the genital area in women. Uterine fibroids is a growth of tissue in the muscle layer, which is predominantly benign.

Uterine fibroids can have different sizes: from the volume of a pea to large formations. Of particular danger is a neoplasm of large size. Large fibroids can have a negative impact on neighboring organs, disrupting their functioning.

Uterine fibroids are usually measured in weeks as during pregnancy. Education is considered large if its volume exceeds 14 weeks.

Varieties and stages of uterine fibroids

Uterine fibroids are represented by different forms and intermediate options.

During their development, myomatous nodes go through several stages:

1. A growth zone is formed. As a rule, these are areas where vessels that are not too large in size are located. Rather small vessels have increased permeability and the level of metabolic processes, which can make tumor growth faster.
2. The formation of a microscopic nodule.
3. The presence of a formed myomatous node, which is characterized by a relatively large size.

Distinguish uterine fibroids:

• single;
• multiple.

Most fibroids are multiple.

There are the following types of uterine fibroids, depending on its location.

• Intermuscular. Such a node is otherwise called interstitial or intramural and is localized in the thickness of the myometrium.
• Submucosal. Another name for this node is submucosal. Myoma is located under the lining of the uterus.
• Subserous. This variety is also called subperitoneal and is localized under outer sheath organ or peritoneum.
• Retroperitoneal. The tumor grows from the cervix or body of the uterus.
• Intraligamentary. This is an interligamentous fibroid, which is located between the sheets of the broad ligament of the muscular organ.

Myomas are distinguished:

• on a leg, on a wide base;
• body of the uterus, isthmus, cervix.

In addition, myoma happens.

• Simple. This form is characterized by good quality and lack of cell division.
• Proliferating. There is a greater number of cells in the muscle layer.
• Presarcoma. Multiple tumors with atypical cells and large nuclei can be found.

Uterine fibroids is a serious pathology. Doctors believe that a large tumor over 14 weeks can pose a threat to a woman's health.

Many patients would like to know what to do when uterine fibroids are found. If we are talking about a tumor that has a volume of 14 weeks of pregnancy, such a fibroid is considered large and is subject to mandatory observation and treatment.

Signs and symptoms of large fibroids

Early onset of pathology clinical picture missing. As the formation grows and reaches the size of 12-14 weeks, characteristic symptoms and signs join.

Symptoms and signs of large uterine fibroids over 14 weeks:

• pain of varying degrees of intensity and localization, occurring mainly in the lower abdomen and lower back;
• violations of the processes of defecation and urination;
• copious discharge during menstruation;
• breakthrough bleeding;
• shortening or lengthening of the cycle;
• hydronephrosis;
• discomfort during sexual intercourse;
• mucous secretions with bad smell from the genital tract;
• disorders of the gastrointestinal tract;
• anemia

Anemia can result from chronic blood loss. Symptoms of this condition are weakness, fatigue, dizziness, shortness of breath, tachycardia, excessive sweating. If you find such manifestations, the first thing to do is to consult a doctor.

It should be remembered that a large fibroid, which corresponds to a volume of 14 weeks or more, affects the functioning of the whole organism and can cause serious complications.

Causes of uterine fibroids

The mechanism of occurrence of pathology is not fully known. Therefore, it is difficult to draw a definitive conclusion about what factors cause the growth of the myometrium.

Modern gynecology identifies several main causes of tumor formation:

• the role of heredity;
• adverse environmental impact;
• chronic stress condition;
• various endocrine disorders;
• chronic infections of the genitourinary system;
• diabetes;
• chronic tonsillitis;
• metabolic disorders and obesity;
• excessive physical activity;
• mechanical trauma of the uterine cavity during surgical interventions;
• long-term use of combined oral contraceptives;
• the influence of ultraviolet rays;
• violation of the production of certain sex hormones.

In the absence of adequate treatment, myomatous nodes can reach large sizes from 14 weeks and above.

Complications of large uterine fibroids over 14 weeks

Many women are interested in the answer to the question of what should be done when a relatively large tumor is found. Often in such cases, the formation reaches a volume of 14 weeks or more, causing a potential danger to the internal organs of a woman.

For the growth of a neoplasm, its intensive nutrition is necessary, which is carried out thanks to other body systems.

Uterine fibroids provoke the following complications:

• pathology of the pancreas, as well as the liver and kidneys;
• squeezing of the bladder and intestines, which is manifested by frequent urination and constipation;
• the occurrence of endocrine disorders, diabetes, obesity;
• development of infertility, miscarriage.

Uterine fibroids with a volume of more than 14 weeks, which refers to the formation of large sizes, often become the cause of spontaneous abortion.

• the degeneration of the neoplasm into a malignant tumor, which necessitates the removal of the uterus;
• anemia associated with regular blood loss with large fibroids;
• twisting of the leg of the node.

This is one of the most dangerous complications, leading to necrosis of the formation. With such a complication, emergency surgical intervention is necessary.

Diagnosis of large uterine fibroids and methods of its treatment

Determination of a neoplasm with a volume of 14 weeks can be carried out using the following examination methods.

• Gynecological examination on the armchair. The doctor can palpate the enlarged uterus to a large size, feel the myoma nodes and determine the correspondence of the volume to the week of pregnancy. And also with the progression of the disease, the uterus changes its position.
• Study and analysis of anamnesis. The gynecologist carefully evaluates the complaints and symptoms of the patient. Of particular importance are mechanical injuries of the uterus, the absence of pregnancies, and a burdened family history.
• Ultrasound examination of the pelvic area;

• Hysteroscopy. This is a minimally invasive technique performed using a hysteroscope. During the study, pathology can be diagnosed and some surgical interventions can be performed.
• Laparoscopy. This diagnostic method is the most accurate and informative. During the study, surgical treatment can be carried out simultaneously.

Large uterine fibroids from 14 weeks can only be treated surgically.

The choice of the method of surgical intervention depends on the patient's history, her reproductive plans, the location and size of the tumor.

In modern gynecology, the following types of intervention are used:

• hysterectomy;
• myomectomy.

A hysterectomy involves the complete removal of the uterus. This is a radical operation that can be performed on patients after 45 years of age in the presence of serious complications.

Doctors try to do organ-preserving operations, since the removal of a muscular organ causes a serious hormonal imbalance in a woman's body.

Myomectomy refers to the removal of the myoma node directly, which can be carried out using the following methods:

• hysteroscopy;
• laparotomy;
• laparoscopy.

In modern gynecology, sparing laparoscopic operations are most often used.

If a woman has been diagnosed with large fibroids over 14 weeks of pregnancy, the first thing to do is to see a doctor. Self-medication is unacceptable, as the disease can cause serious complications.

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Removal of fibroids

Uterine fibroids is a benign tumor that is located in the muscle layer, isthmus or cervix. The prevalence of the disease is quite high, since most women of reproductive age suffer from this disease.

It is not known for certain whether uterine fibroids are a tumor or a form of endometrial hyperplasia.

Causes, varieties and symptoms of the pathological process

Despite the prevalence, uterine fibroids is a poorly understood disease.

The reasons for its appearance can be identified:

• hormonal imbalance;
• endocrine and immune disorders;
• impact of negative environmental factors;
• traumatization of the uterus by surgical interventions;
• lack of harmony in intimate life;
• chronic stress and concomitant somatic pathologies.

As the etiology of uterine fibroids, the congenital and acquired nature of the pathology is considered.

Uterine fibroids have many varieties, as well as intermediate options.

Types of tumor depending on its location:

• submucosal;
• subserous;
• intramural.

Varieties of pathology depending on localization:

• uterine cavity;
• isthmus;
• cervical part.

Forms of the disease depending on the number of nodes and their size:

• single and multiple myoma;
• small, medium, large knot.

Symptoms depend on the stage of the disease, the location and size of the nodes.

The symptoms are:

• change in the duration of the menstrual cycle and critical days;
• profuse spotting with clots and breakthrough intermenstrual bleeding;
• pains of various localization and intensity;
• violations of urination and defecation;
• infertility.

The early stage of the disease is characterized by an asymptomatic course. As it progresses, various symptoms may appear, indicating a pathology.

Methods of treatment

Modern gynecology uses various methods of treating pathology.

All methods can be divided into two groups:

• conservative;
• surgical.

Conservative therapy is advisable to apply at an early stage with an unexpressed clinical picture of the pathological process.

Apply the following ways conservative therapy:

• hormonal drugs;
• immunostimulating and immunomodulatory drugs;
• anti-inflammatory drugs;
• physiotherapy and phytotherapy.

Medical therapy has a number side effects and is not always effective.

With small nodes, doctors try to use medicinal methods therapy. However, there are certain clinical cases when it is appropriate to use surgical methods.

Indications for the use of surgical intervention for uterine myoma:

• large neoplasm;
• concomitant endometriosis or oncological process;
• pedicle torsion and necrosis;
• violations of the functions of neighboring organs;
• a pronounced clinical picture of the disease with the ineffectiveness of drug therapy;
• regular bleeding and development of anemia;
• features of the location of fibroids that prevent the onset of pregnancy.

Methods of surgical treatment

Intervention in pathology involves the removal of uterine fibroids. In modern gynecology, predominantly organ-preserving methods for removing fibroids are used. Such methods of removing formations are especially relevant for patients of reproductive age.

Many women who have been properly diagnosed want to know how fibroids are removed.

The choice of method of treatment depends on the patient's history and her reproductive plans. The location and size of the formation to be removed are of great importance.

In modern gynecology, the following methods are used to remove formations.

• Hollow operation. Such removal is justified when other methods are impractical, for example, with pedicle torsion or necrosis.

During the operation, tumors are removed through incisions in the abdomen. Such removal is indicated for large fibroids and severe deformation of the uterus. Recovery period after the intervention lasts up to a month.

Doctors remove fibroids by abdominal surgery rather rarely, due to the difficult postoperative recovery period and the risk of possible complications.

• Laparoscopy. This method of removal involves the use of a laparoscope and is optimal in gynecological practice. Doctors remove the tumor through small punctures in the abdomen, which heal quickly. It is recommended to remove several fibroids up to 1 cm in size of the interstitial and subserous variety.

The recovery period passes quickly enough, since this method of treatment is less traumatic and virtually eliminates the formation of adhesions.

• Hysteroscopy. Removal is carried out using a hysteroscope. In this way, you can remove one fibroid located in front or behind the wall of the uterus. The procedure does not require hospitalization. Removal is performed on an outpatient basis in the first days of the cycle.
• Hysterectomy. This method of radical removal involves amputation of the uterus and is used in extreme cases.

Removal can be performed if there are certain indications, for example, if the fibroids are large or rapidly progressing, and the patient is in menopause. In addition, the suspicion of an oncological process is a direct indication for the radical removal of the organ.

There are also minimally invasive ways to remove uterine fibroids.

• Laser therapy. This is the most gentle way to remove formations. During the procedure, the doctor removes the nodes using a dosed and directed laser exposure. Healthy tissues are not damaged, respectively, there is no bleeding and scarring.

The recovery period takes place as soon as possible and is about three days.

• Embolization of the uterine arteries. This method of removal can be classified as highly effective, modern and relatively expensive. During a minimally invasive intervention, a doctor, under local anesthesia, passes a catheter through an artery in the thigh. Then a special substance is introduced, which clogs the vessels that feed the fibroids. Over time, the fibroid dies.

This method of removing uterine fibroids is quite painful and is not used for subserous varieties. After the manipulation, complications may occur, leading to amputation of the uterus. Some patients develop amenorrhea after treatment.

• FUS-ablation. The removal method involves evaporating the contents of the node with ultrasound under MRI control. Doctors remove uterine fibroids in this way quite rarely, due to insufficient knowledge of the method.

FUS-ablation does not remove subserous formations on the leg. It is not recommended to remove fibroids with unrealized reproductive function.

Preparation for the removal of fibroids

Surgery is recommended when conservative therapy fails. Removal implies a certain risk, since there is a possibility of postoperative complications. If the neoplasm is removed, its recurrence is not excluded.

Before removing the tumor, preparation is carried out, which includes.

• The study of anamnesis.
• A study of the general condition of a woman, including laboratory diagnostics blood, urine and smears from the vagina, ultrasound of the pelvic organs, colposcopy.
• Determining the method of removal and the volume of surgical intervention. Of great importance is age, as well as the size, location and type of tumor.

In modern gynecology, it is customary to use organ-preserving operations. Patients after menopause, or not planning a pregnancy, are more often recommended a radical method of removal.

Features of the recovery period

After surgical removal uterine fibroids, certain complications are possible:

• the development of inflammation due to infection;
• recurrence of pathology;
• oncological tumor of the breast.

The rehabilitation period is most difficult if the body of the uterus is removed during a radical operation. The patient may be disturbed by pain, hormonal disorders and depression.

In general, recovery after removal of uterine fibroids lasts up to two months. In order for the body to recover as quickly as possible and without consequences, it is necessary to adhere to a certain lifestyle.

• refusal of sexual activity for the entire recovery period;
• dieting;
• limitation of straining movements during bowel movements to avoid the possibility of rupture of the seam;
• lung performance exercise, gymnastics;
• observance of the regime of work and rest.

After removal of uterine fibroids, a woman is shown therapy, which includes taking hormonal, anti-inflammatory drugs. The intervention seriously weakens the immune system, therefore, as a rule, the patient is prescribed immunomodulating and immunostimulating agents. The methods of physiotherapy and herbal medicine have a good effect. Possible spa treatment.

Despite the removal of the tumor, cases of recurrence of the pathological process are not uncommon. This is due to the fact that the development of neoplasms is based on hormonal disorders, which cannot always be eliminated by conservative methods.

To avoid recurrence of the disease, after removal of neoplasms, patients are advised to take appropriate therapy. It is very important to monitor weight and pressure, as obesity and hypertension contribute to the progression of the disease.

If only pathological formations are removed during the operation, reproductive function is preserved in most cases. After some time, the woman is allowed to become pregnant.

When pregnancy occurs, a woman is under special control by the attending physician in order to avoid the occurrence of relapses and complications.

Uterine fibroids is a rather complex disease. Exists different ways her treatment is both conservative and surgical. However, the only way to completely get rid of the neoplasm is to remove it surgically.

ginekola.ru

2018 Women's Health Blog.

Article plan

Uterine fibroids is a benign neoplasm that is found most often in patients aged twenty to forty years.

In this article, we will describe in detail what symptoms accompany the development of the tumor by weeks, at what sizes of uterine fibroids surgery is performed, and also what are the indications and contraindications for certain methods of curing this disease.

Features of the pathology

Most often found nodular fibroids, it does not pose a threat to life and cannot degenerate into a malignant oncological tumor. The formation consists of smooth muscle cells and differs in volume, number of nodes and localization. A feature of the pathology is its susceptibility to changes in the hormonal balance in the fair sex. So with small formations, you can cope with the disease with hormone therapy, or simply wait for the onset of menopause, then there is a high probability that the tumor will resolve itself. And such expectant tactics are the norm for small fibroids.

But if gynecologists talk about the size that needs surgery, then its value has already reached critical volumes, and in order to normalize the condition, mandatory surgical removal of the formation is required.

What kind of disease

This is a formation that is found in 95% of cases in the uterus itself and in 5% in its neck. It can develop in the form of knots in the musculature or connective tissue. The magnitude of education is measured in centimeters, millimeters or weeks. If the gynecologist speaks of a value of 16 weeks, then he means that the organ with has become the same as during pregnancy at 16 weeks.

Symptoms

With a small size of the formation, it is almost impossible to determine its presence symptomatically. By ultrasound, the doctor can see a nodular tumor when its volume becomes from 7 mm. Symptoms of fibroids will appear with a submucous type of neoplasm, even if its size has not yet reached 15 mm. The disease is characterized by the following manifestations:

• pain in the lower back, heart muscle, if there are adhesions, then it can be localized in the area of ​​\u200b\u200bthe nearest organs;
• limbs may become numb if there are problems with blood flow;
• the process of defecation is disturbed and trips to the toilet “in a small way” become more frequent, the reason is the pressure of the neoplasm on the internal organs;
• the lower abdomen may increase in volume while the patient's weight remains the same.

Some can be confused with symptoms of other diseases:

• pain in the lower abdomen, radiating to the sacrum and leg;
• bleeding between periods;
• anemia due to massive blood loss;
• problems with conception, miscarriages.

Classification

Classification of education is carried out according to different criteria. Depending on the location in relation to the uterine cavity, the tumor is submucosal, and subserous. is diagnosed most often, progresses rapidly, and its nodes grow to a size of 11 weeks (4-5 cm).

Usually fibroids are formed in the body of the uterus, 5-8% of cases occur in the cervical location. Posterior cervical, near and precervical, interligamentous and retroperitoneal localizations are rare.

By size

It is also very important to know how many weeks in size the tumor has developed. It can be measured in mm and cm. There are such types of fibroids:

• small. The size of the nodules is a maximum of 30 mm, while the uterine myoma is 6 weeks, a maximum of 8;
• medium. The size of education from 40 mm to 70 mm (or 4-7 cm), is equal to 12 weeks;
• large. It grows more than 8 cm, while the size of the uterus starts from 13 weeks.

Is there a danger

Any disease that causes profuse blood loss is life-threatening for the patient, and intense bleeding just characterizes the presence of fibroids. There are a number of other reasons why this disease should be taken very seriously:

• if the nodes are on thin legs, this can cause torsion and the need for an instant operation;
• necrosis of the tissues of the myoma node. This phenomenon is possible with a sharp contraction of the uterus, for example, after childbirth. In this case, the patient must be operated on;
• delay in the treatment of fibroids contributes to the development of a malignant neoplasm, such an outcome is possible in 1.5-3% of cases;
• ectopic pregnancy, spontaneous abortions, complex and premature births, infertility may develop;
• inflammatory and putrefactive processes in the formation itself and in the tissues of nearby organs.

Diagnostics

The first stage of diagnosis is a bimanual examination, in which the doctor visually and manually, using special equipment for examination, assesses the size of the uterine fibroids. Then sent for testing and ultrasonography ultrasound. It can accurately determine the magnitude of education. It is best when the examination is carried out in dynamics, in order to know the rate of growth or regression of the disease. This diagnostic method allows you to determine not only the size of the nodes by weeks in millimeters, but also the speed and their development. If in a year from ten weeks the fibroid has grown to 14 weeks or more, then such growth may indicate the degeneration of the tumor into cancer. To clarify the diagnosis, MRI and transvaginal examination are prescribed.

Forecast

It doesn’t matter if surgery is needed to treat fibroids or hormone therapy is enough, the prognosis for life is favorable. When the nodes are small and appeared before menopause, it is highly likely that they regress on their own during menopause.

If the tumor was removed along with the uterus, then the patient is removed from the register no earlier than after 5 years. After laparoscopy, observation is carried out for life, since there is a possibility of resumption of growth of myomatous nodes. The possibility of recurrence after UAE is 50%.

Leakage during gestation

During pregnancy, nodes with a diameter of 9 mm, 10 mm, a maximum of 11 mm do not pose a danger to either the mother or the fetus, but require constant monitoring by the gynecologist. If their sizes in weeks exceed 12, and at the same time they are localized in the submucosal region of the uterus, they can cause various pathologies in the fetus.

If the tumors are in the region of the posterior wall of the uterus and are larger than 12 weeks, then there is a high probability of early birth, as well as oxygen starvation of the baby.

Prevention

In a woman’s body, everything is subject to the hormonal background, so when it changes, it can develop various diseases uterus, including fibroids. The nature of the occurrence of these formations has not been fully studied, but statistics show that women who have given birth and breast-fed are twice as likely to suffer from this disease. Also, to reduce the likelihood of getting sick with fibroids, you need to refuse abortions, treat diseases of the genitourinary system in time and not expose yourself to stress.

What is the treatment depending on the size

What to do with a benign education, only a doctor can decide. Depending on the size of the formation and plans for pregnancy, both conservative and surgical treatment can be used. In turn, the operation can be low-traumatic or abdominal, if, for example, it is necessary to remove a completely affected organ. Consider which method is used depending on the size of the tumor.

conservative technique

If the fibroid has a miniature size, then use such medications as combined oral contraception (). For sizes up to 2 cm hormone therapy is the most effective, with fibroids reaching a diameter of three centimeters, it is necessary to initially use gonadotropin-releasing hormone agonists or antigonadotropins. These medications are used throughout the year. Then maintenance therapy is prescribed, but if the nodes do not decrease in size, the doctor may again prescribe hormonal drugs.

Laparotomy

If the neoplasm in the uterus has grown to a size of 12, a maximum of 15 weeks and presses on the nearest organs, a cavity laparotomy is performed, after which sutures are applied to the abdominal wall. After the intervention, the patient must stay in the hospital for about a week, and the rehabilitation period will take about 2 months.

Embolization

Myoma does not always need to be operated on, one of the new loyal methods is or UAE. This technique is characterized by high efficiency and low recurrence rate. A catheter is inserted into the patient's femoral artery, and a special solution is injected through it into the arteries that feed the fibroids. The embolizing substance clogs the vessel, the node stops feeding and eventually dies.

Uterine fibroids at 7, 8 and 9 weeks allow for UAE.

Hysterectomy

This is a cardinal way to remove the formation along with the uterus. Hysterectomy is used only when the tumor is huge, grows rapidly and has a tendency to degenerate. After the operation, a woman can be prescribed antibiotics and drugs for general strengthening of the body, then hormone therapy is possible for the stable functioning of the endocrine system.

Hysteroresectoscopy

The procedure is performed using a hysteroscope, the tube of which enters the uterus through the vagina. With such a device, uterine fibroids 3 cm in diameter are removed as sparingly as possible. Most patients respond positively to this procedure.

Myomectomy

Another name is laparoscopy. During the manipulation, small incisions are made, a laparoscope (optical device) is inserted into them. Elimination of nodes using laparoscopy is carried out if the tumor is 8 weeks old, no more. After manipulation, there are rarely complications, and the rehabilitation period proceeds easily and quickly. The possibility of having a child remains.

Myoma is a benign tumor, but if it is large, then the complications are very serious. The abdomen increases, as during pregnancy, the shape of the uterus is disturbed, the volume of the cavity is reduced. It is possible to block the cervical canal. Violated physiological processes occurring in the reproductive system. The general health of a woman is deteriorating. When choosing a method of treatment, various factors are taken into account, the most reliable and sparing method is selected. An assessment of the size of the fibroid is important, since there must be good reasons for the operation.

Content:

Types of fibroids

The neoplasm originates in the muscle tissue of the uterus, gradually increases in size due to abnormal cell division. Unlike a malignant tumor, fibroids do not spread to other organs, they grow much more slowly. Initially, cells develop abnormally only in muscle tissue, and then the tumor goes beyond it. Depending on the direction in which it grows, the following types of fibroids are distinguished:

1. Submucosal - it is formed in the depth of the muscle layer (myometrium), grows towards the mucous membrane of the uterine cavity, therefore it is called "submucous".
2. Subserous (subperitoneal) originates in the outer muscle layer, grows towards the serous membrane that separates the uterus from the abdominal cavity. Knots can have a wide base or a thin stem.
3. Interstitial (intramuscular) - develops in the middle of the muscle layer, without going beyond it.

When assessing the degree of danger of a tumor and choosing a method of treatment, specialists take into account its location. In most cases, myomatous nodes are located in the body of the uterus (corporal view), but sometimes they are also in the cervix (cervical fibroids).

The tumor is single or multiple, in the form of several nodes. For a specialist choosing a method of treatment, great importance are the size of uterine fibroids.

How dimensions are determined

The growing tumor stretches the uterus, which leads to a gradual increase in the abdomen (similar to its growth during pregnancy). According to which week of pregnancy the size of the abdomen corresponds, the size of the fibroids is estimated.

The exact size of the tumor in centimeters can be determined using ultrasound. In this way, even fibroids smaller than 1 cm are detected. Ultrasound is performed either through the anterior wall of the abdominal cavity or through the vagina. This allows you to identify and measure fibroids of any localization and size.

In difficult cases, when a small tumor is located, for example, between the ligaments, the hysterography method is used (X-ray of the cavity with the introduction of a contrast fluid). To study fibroids and assess its size, hysteroscopy (examination with an endoscope inserted into the uterine cavity through the vagina), diagnostic laparoscopy (an optical device is inserted into the uterine cavity through a puncture on the anterior wall of the peritoneum) and MRI are also used.

All myomatous nodes, depending on their size, are divided into three categories:

Sometimes uterine fibroids reach a size at which the stomach is, as at 37 weeks of gestation.

In addition to size, the rate of tumor growth is also taken into account. A tumor is considered to grow rapidly if its size increases by 2-2.5 cm (or 5-6 weeks) per year. Thus, the growth of small and medium-sized fibroids is assessed. If they are small and grow slowly, then it is possible to carry out conservative treatment. At sizes greater than 8 cm (or 15 weeks), the nodes are removed.

In addition to the size of the tumor and the rate of development, when prescribing treatment, the severity of the symptoms, the age of the woman, and her intention to have children are taken into account.

The danger of large fibroids

There are uncomplicated and complicated forms of the disease. Possible complications are:

• necrosis of the myomatous node - an acute painful condition in which there is a torsion of the legs, a violation of the blood supply to the fibroids;
• the formation of cystic cavities (the threat of purulent inflammatory processes);
• compression of blood vessels and nearby organs;
• malignant degeneration (into sarcoma).

Fibroids can reach a diameter of 25 cm. A large tumor located outside, on the front wall of the uterus, compresses the bladder, which leads to difficulty urinating or, conversely, can cause urinary incontinence. In addition, the appearance of fistulas connecting the cavities of the uterus and the bladder is possible.

If a large fibroid is located on the back of the uterus, then emptying the intestines is difficult, constipation occurs.

A large knot can compress the inferior vena cava, making it difficult for blood to move from the lower body to the heart. In this case, the woman has shortness of breath and palpitations even at rest. In the presence of many medium and large nodes (myomatosis), there are constant uterine bleeding that is not associated with menstruation. This leads to anemia.

Video: Complications with large nodes. When and how is surgical removal performed?

When is surgical treatment used?

Surgery for uterine fibroids is mandatory in cases where there is a rapid growth - up to 2 cm (4 weeks) in diameter during the year, and also if the tumor has a stalk and there is a risk of its twisting.

An unconditional indication for surgical removal of fibroids is the appearance of uterine bleeding and severe anemia in a woman. This is possible due to a violation of muscle elasticity during the development of large myomatous nodes in it, deterioration of contractility.

Myoma must be removed surgically if it is the cause of infertility or miscarriage. The operation is also prescribed if a woman has severe pain in the abdomen, rectum, bladder, as they are squeezed, blood circulation is disturbed.

Video: Treatment of fibroids with hysterectomy and uterine artery embolization

What types of operations exist

When choosing a method for the operation, the size of the uterine fibroids and its localization are of primary importance. In each case, the doctor decides on the method of removing the tumor, the possibility of preserving organs and menstrual function.

Myomectomy

This is an operation in which only the tumor is removed, the uterus is preserved. Most often, this method is used to treat women under 40 who would like to maintain the ability to give birth to a child.

Removal of the tumor is carried out in this case in various ways.

Laparotomy- this is the removal of fibroids located deep in the muscle tissue or under the outer shell of the uterus by cutting the abdomen above the pubis. The tumor is excised. The risk of infection and complications is minimal. This method is especially effective when there are many nodes, there is an increased likelihood of damage to large vessels. It is much easier to prevent bleeding during open surgery. In addition, the removal of fibroids can be done quickly.

Laparoscopy– removal of fibroids through 3 small openings in the abdomen using optical instruments. Carbon dioxide is first introduced into the uterus to create conditions for more free manipulation of instruments and avoid cuts. The image is displayed on the screen, which allows you to control the process.

The advantage of the method is that the wound heals quickly, the operation is less traumatic, and there is no suture left after it. It is carried out under general anesthesia. The disadvantage is that there is still a minimal chance of internal cuts, so the woman is under the supervision of doctors for 3-4 days. Sometimes, if the myomatous node is located on the posterior or lateral outer surface of the uterus, it is removed through a puncture in the posterior wall of the vagina.

Addition: If necessary, this method can remove large myoma nodes in pregnant women. In this case, the fetus is not injured, the pregnancy proceeds normally.

Hysteroscopic myomectomy. A method that is used to remove fibroids in the cavity itself. It is carried out using an optical instrument (resectoscope) through the vagina. The method is not used if a woman has inflammatory diseases genital or cervical defects.

Hysterectomy

Removal of the uterus completely or with preservation of the cervix. Such an operation is performed in the most severe cases, when there are many large nodes, the fibroids occupy the entire cavity, there is severe bleeding. At the same time, the level of hemoglobin is critically low, the probability of tumor degeneration into sarcoma is high. Most often, such operations are performed on women after 45 years.

Removal of the uterus is performed in several ways: through an incision in the lower abdomen, through punctures in the abdominal wall (laparoscopic method), through the vagina. After the operation, a woman cannot have a period. But if the ovaries are not removed, then the rest of the symptoms of menopause may be absent. The possibility of sexual activity after the operation is preserved.

Video: Methods for removing fibroids while preserving the uterus

Minimally invasive methods for treating fibroids

When treating fibroids with these methods, no incisions or punctures are required.

Embolization of the uterine arteries. The method consists in the fact that through the inguinal artery with the help of a catheter, "plugs" made of plastic or gelatin are brought to the vessels of the fibroids, which block the flow of blood. Due to lack of nutrition, the tumor gradually decreases. The procedure is performed under local anesthesia.

FUS ablation(focused ultrasound). Removal of fibroid nodes is carried out using a directed ultrasonic flow, which causes heating and evaporation of the nodes located in the muscle. The process is controlled using a magnetic resonance tomograph. In this case, anesthesia is not required, the functions of the uterus are fully preserved. The method is effective even in the presence of large nodes.

Video: Evaporation of fibroids by FUS ablation

The possibility of pregnancy with myoma

Large fibroids (greater than 15 weeks) are the cause of infertility if they block the tubes or cervix, creating obstacles to the movement of sperm. In the presence of nodes no larger than 3 cm in diameter (that is, less than 8 weeks), pregnancy is possible. If the nodes do not increase, then their existence does not affect the course of pregnancy and the development of the fetus. Complications arise when the tumor grows in the uterine cavity, fills it, making it difficult for the fetus to develop. Often this ends in a miscarriage.

Sometimes, if the fetus is already large enough and begins to lack nutrition due to the pressure of the fibroids on the vessels, a caesarean section is performed and the subsequent removal of the uterus. C-section you have to do it even if the fibroid occurs in the neck or overlaps it.