Small intramural uterine fibroids. Possible causes and treatment options for intramural uterine fibroids. Stages of making candles from

Uterine fibroids are a common disease among women all over the world. This is a benign tumor that can cause great discomfort. The diagnosis of “intramural uterine fibroids” indicates that the tumor is located in the middle muscle layer.

In some cases, one or more nodules form in different parts of the muscle tissue of the uterus. Another option for the development of the disease is the formation of many seals in one place, connected to each other.

The more the tumors increase in size, the more seriously this affects the condition of the uterus and neighboring organs.

Accurate diagnosis, timely and appropriate treatment play an important role in a positive outcome.

Causes

Medical science has not yet determined exactly why in a woman’s body the muscle tissue of the uterus begins to degenerate, turning into nodules. So far, scientists have agreed that in each individual case the development of pathology occurs under the influence of various factors. The main causes of uterine fibroids are as follows:

Excess estrogen. Hormonal disorders are usually placed first on such lists. While studying the disease, scientists noticed that during menopause, the nodular cells begin to gradually dissolve. In addition, hormonal drugs definitely influence the growth of uterine fibroids. If they are chosen correctly, the tumor will decrease in size.
Mechanical damage. External interference in the structure of the muscle tissue of the uterus can provoke the degeneration of these cells. It has been noticed that intramural fibroids often form after various types of operations on the female reproductive organs, including abortions and curettage.
Women's diseases. The formation of compactions in the uterus is sometimes associated with inflammatory processes. Tumor formation is also often explained by the presence of erosion, polyps and endometriosis.
Unhealthy Lifestyle. It is generally accepted that nutrition, habitat and bad habits play an important role in the development of intramural fibroids.
Chronic diseases. Scientists have noticed a connection between obesity and diabetes mellitus and the formation of uterine fibroids in women.
Stress. It is believed that overexcitation of the nervous system can give impetus to the development of fibroids.
Heredity. It has been established that a predisposition to the formation of the disease is often transmitted from mother to daughter.

Due to the last of these factors, a woman experiencing uterine fibroids should regularly check her daughter. It’s worth starting from adolescence.

Symptoms

The formation of an intramural node in the uterus is not always accompanied by obvious signs. Much depends on the number and size of tumors. A woman needs to closely monitor her reproductive system, identifying changes in its functioning. Thus, the following symptoms may indicate the presence of benign lumps in the muscle tissue of the uterus:

heavy and prolonged menstrual bleeding;
bleeding in the middle of the cycle;
feeling of tightness in the lower abdomen;
pain in the uterine area, radiating to the lower back and sometimes to the legs;
frequent urge to urinate;
stagnation of fluid in the lower extremities due to impaired lymph flow;
problems with bowel movements;
intense pain during menstruation;
inability to conceive a child.

The changes caused by intramural uterine fibroids are influenced by its location, size and growth rate.

If the disease is asymptomatic, examination using safe techniques will help identify the tumor.

A woman who does not undergo regular examination by a specialist runs the risk of encountering an advanced form of the disease and its complications.

Complications

Intramural uterine fibroids are not a malignant tumor, but treatment should not be delayed. As a rule, women do not rush into this if they do not experience unpleasant symptoms. But they must understand that uterine fibroids often progress without proper intervention. The signs described above gradually appear, and serious complications may develop.

Lack of timely treatment threatens the beginning of the process of tumor cell death. In this case, severe poisoning of the body with toxins occurs and immediate hospitalization is required. In addition, due to heavy bleeding, which is a symptom of the disease, a woman may develop anemia.

Neighboring organs suffer from compactions in the uterus, so the formation of thrombosis in the veins of the lower extremities and infertility cannot be ruled out.

Intramural fibroids and pregnancy

Women planning a pregnancy should be examined in advance to exclude the presence of uterine fibroids. If it is detected, it is necessary to take measures to cure it before conception, otherwise you may encounter undesirable consequences during pregnancy.

In some cases, a woman is able to become pregnant and carry a child with this diagnosis without problems. Sometimes after childbirth the tumor resolves. However, there is a high risk of the following complications:

bleeding;
placental insufficiency;
early onset of labor;
spontaneous termination of pregnancy.

The risk of miscarriage in women suffering from uterine fibroids is about 50%. Fortunately, the disease generally proceeds without any complications. In any case, the woman must undergo all necessary tests and prescribed therapy. If complications occur, immediate hospitalization is recommended.

Diagnosis

The initial detection of a tumor in the muscle tissue of the uterus usually occurs during a standard gynecological examination. Using a mirror, a specialist can see fibroids almost anywhere. In some cases, the lump is not visible in this simple way, even when there are symptoms indicating it. In any case, to clarify the diagnosis, additional research is prescribed using effective methods.

Transvaginal examination

This type of diagnosis is performed using ultrasound radiation. During the procedure, the patient sits in a gynecological chair and a device sensor is inserted through her vagina. This technique is more effective in examining fibroids than an examination that involves moving a probe across the abdomen. As a result, the exact location, size and density of the tumor is determined.

Ultrasound is a highly informative diagnostic method, often used in gynecology. It is available to every patient, as it is inexpensive and is carried out in many hospitals. Ultrasound radiation is absolutely harmless to humans, so examinations with its participation can be carried out at any frequency. There are no contraindications to the technique. In addition to initial diagnosis, ultrasound is used to monitor changes during treatment.

Hysteroscopy

Hysteroscopy is an additional diagnostic method. This is an invasive procedure that has a number of contraindications. It is carried out using a hysteroscope equipped with a camera, which is inserted into the uterus through the vagina. The method determines submucosal uterine fibroids with 100% accuracy.

An anesthetic drug is injected into the cervix before the examination. The image from the camera is immediately transferred to the monitor. Having noticed a suspicious area, the doctor can perform a biopsy, that is, take a piece of tissue using a hysteroscope for a detailed examination. Thus, diagnosis and treatment of uterine fibroids in some cases can be carried out simultaneously.

Magnetic resonance imaging (MRI)

MRI often plays an irreplaceable role in the study of intramural uterine fibroids. This diagnostic method is prescribed at the final stage of the examination, when previous methods did not provide a clear description of the disease. MRI allows you to determine the exact location, size and type of formed nodes. Even compactions several millimeters in size are detected.

To check the health of the uterus using magnetic resonance imaging, an MRI of the pelvis is prescribed. Additionally, it becomes possible to assess the condition of the urinary, lymphatic and circulatory systems, intestines, ovaries and vagina.

This examination method is highly informative, as it shows organs in layer-by-layer sections. A computer program stitches the individual frames together into a single image, creating a three-dimensional model. The disadvantage of magnetic resonance imaging is the use of x-rays. This limits the frequency of diagnosis and the number of those for whom it can be indicated. Thus, MRI is not prescribed to pregnant women and children unless absolutely necessary.

Treatment of intramural fibroids

A woman with intramural uterine fibroids should rely entirely on the experience of her doctor. When creating a treatment strategy, he will definitely take into account the following features of the disease:

size, localization and intensity of compaction development;
symptoms of pathology;
accompanying illnesses;
woman's age.

The patient’s age is of interest to the doctor due to the fact that some treatment methods do not make it possible to preserve reproductive function. The woman’s own view on this issue is also important.

Hormone therapy

Having carefully studied the patient’s hormonal background, the doctor can prescribe medications to correct it. This treatment is considered classic; it can stop the growth of intramural uterine fibroids and even begin the process of reducing it. The method is effective in cases of small tumors.

Hormonal therapy must be carried out very carefully, since additional disruptions in this system can lead to aggravation of the problem or the occurrence of other disorders in the body. The main goal in most cases of treatment for uterine fibroids is to suppress the production of the hormone estrogen.

Surgical methods

Surgical treatment of intramural uterine fibroids is prescribed in extreme cases, when it is of a threatening size or does not respond to hormonal treatment. These methods include:

Embolization- is not a full-fledged operation and consists of depriving the fibroids of blood supply. Special balls are inserted into the vessels feeding the tumor to stop the blood flow. Myoma, without receiving nutrition, reduces its size by half. The procedure does not affect the condition of the entire uterus. No additional treatment is necessary.
Myomectomy- removal of a uterine tumor while preserving organ function. The operation is performed in several ways: through the abdominal cavity using a special instrument (laparoscopic method) or manually (laparotomy method) and through the cervix. After a year, you can plan a pregnancy.
Hysterectomy- complete removal of the uterus. Such an operation is resorted to in the case of a large size node (more than 5 cm) or bleeding of fibroids, or the likelihood of the tumor becoming malignant. The consequence of hysterectomy is loss of reproductive function. In the future, the woman’s health is constantly supported by hormonal drugs.

Physiotherapy

Some physiological procedures help stop the growth of intramural uterine fibroids, cope with heavy bleeding, normalize hormone levels and improve well-being. Among them:

electrophoresis- effective in the presence of a small tumor in the uterus with slow growth;
magnetotherapy- reduces estrogen levels and helps cope with stress, which play a large role in the increase in uterine tumors;
iodine-bromine and radon baths- designed to improve hormonal levels and strengthen the immune system.

Folk remedies

You should not completely rely on traditional methods of treating uterine fibroids. But as an addition to the main therapy, they are quite applicable. People use many means to combat tumors in the uterus, the most popular of which are:

flax decoction;
potato juice;
motherwort tincture;
propolis tincture;
decoctions of boron uterus, burdock;
celandine tincture.

Each product has a proven dosage regimen and a list of contraindications. Before using traditional recipes for the treatment of intramural uterine fibroids, you should consult your doctor.

Prevention

Preventive measures against intramural uterine fibroids are closely related to the causes of its development. A woman should avoid abortions, which negatively affect hormonal levels. Experts advise giving birth between the ages of 20 and 30. If possible, reduce the negative influence of the environment and stress.

In addition, every woman should be careful about her health - undergo regular examinations and promptly treat inflammation in the genitourinary system. Women over 30 need to listen especially carefully to themselves.

The intramural subserous node is a benign tumor-like neoplasm on the muscular uterine wall, formed by connective and smooth muscle structures. At its core, this is one of the types of fibroids, occurring in a fairly mild form.

Reasons for education

The formation and development of intramural subserous nodes can be provoked by a number of different reasons. The most common of them include the following factors:

influence of hereditary factors and genetic predisposition;
abortions;
the presence of diseases of the endocrine system, overweight, obesity, hormonal imbalance in the body;
increased production of the female sex hormone estrogen;
previous curettage or surgery on the uterus
the presence of inflammatory processes in the body;
various traumatic injuries of the uterus;
endometriosis, erosion, adenomyosis;
the presence of polyps and other similar neoplasms;
uterine myometrium;
arterial hypertension.

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Signs of pathology

In the initial stages of formation, the disease can be practically asymptomatic, without showing any signs. As the subserosal intramural nodes grow and enlarge, they manifest themselves with the following characteristic symptoms:

pain above the pubis, as well as in the lumbar region, with a tendency to increase with physical exertion, overwork, hypothermia, etc.;
deformation of contractile uterine function;
increase in the duration and abundance of menstruation;
uterine bleeding;
frequent urination;
compression of nearby internal organs;
constipation

In the absence of proper treatment and a significant increase in size, it is characterized by the following symptoms:

development of anemia;
general weakness of the body;
increased fatigue;
pain and difficulty urinating;
development of hemorrhoids.

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Possible consequences and complications

The presence of subserosal intramural fibroids is not a dangerous manifestation. However, this pathology is fraught with the development of a number of complications and negative consequences that threaten not only the health, but also the life of the patient. In most cases, they are associated with intensive growth and an increase in the size of intramural uterine nodes. Let's look at this issue in more detail:

Myoma necrosis is considered one of the most common complications of the disease in question. It manifests itself in the form of general intoxication of the body with an increase in body temperature, bloody discharge and pronounced pain in the lower abdomen.
Leg torsion is a dangerous condition that leads to death of adjacent tissues, sepsis, and in the absence of timely measures, even death.
Fatty deformation of the myoma node is a pathological process leading to a rapid and significant increase in the size of the tumor. As a result, manifestations such as compression of closely located organs and tissues, pinching of nerve endings, problems with urination, disorders and disruption of intestinal activity and the process of defecation are observed. In this case, the development of a number of concomitant diseases is possible.
Rupture of the tumor, accompanied by severe bleeding and acute pain.

In addition, subserous fibroids located in the uterine angles can become a serious obstacle to the penetration of a fertilized egg, which is a common cause of pathological pregnancy or early termination. The following manifestations are also very likely:

difficult childbirth;
uterine bleeding during the birth process;
pathologies in fetal development;
premature placental abruption;
miscarriage;
premature birth;
infertility;
increase in body weight.

Therefore, when planning a pregnancy, it is recommended to undergo an examination and, if this pathology is present, to eliminate it before conception. In addition, if uterine intramural fibroids are detected, the necessary course of treatment should be completed to avoid the development of the above complications.

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Diagnostic methods

In most cases, the presence of these tumor-like neoplasms is discovered accidentally during a general gynecological examination. To clarify the diagnosis, determine the size and localization of intramural subserous nodes, the patient is prescribed a series of studies. These include the following procedures:

An ultrasound examination allows you to determine the presence and location of the tumor, its size and condition, and identify the possible presence of endometriosis.
Palpation method.
A study using a so-called transvaginal sensor, which allows you to obtain extremely accurate data on the condition of the uterus.
CT scan.
Hysteroscopy, which provides an opportunity to examine the tumor in detail and determine the possible presence of a number of complications, such as torsion of the leg or necrosis of fibroids in the initial stages.
Magnetic resonance imaging is a highly productive study that allows you to determine the size and location of the tumor formation, the condition of nearby organs and tissues, the depth of the uterine lesion, etc.
Laparoscopy. It is used primarily when there is a suspicion of the presence of a tumor-like neoplasm in the ovarian area.
In some cases, to exclude the possibility of cancer, a biopsy procedure is performed - taking suspicious biological material for further examination.

Typically, such a pathology is diagnosed without any difficulties, which makes it possible to promptly identify the presence of the disease and, if necessary, take timely therapeutic measures.

It can affect all layers, or it can be nodular, which is more common.

Types and causes of the disease

There are several types of nodes. A node that has formed in the mucous layer of the uterus is called submucosal; if the node grows towards the abdominal region, it is called subserous; interstitial is a node that has formed in the interstitial apparatus.

The intramural (transmural) node is localized in the muscle layer. With this pathology, a diagnosis may be made: myoma, fibromyoma, leiomyoma.

Intramural miasmatic node can be caused by various factors:

hormonal imbalance (predominance of estrogen)
genetic predisposition
mechanical procedures in the uterine area (curettage, operations, caesarean section)
hormone-dependent diseases (adenomatosis,)
chronic diseases of the genital organs
high blood pressure, diabetes, excess weight

Since hormonal levels have a great influence, with the onset of menopause and a decrease in estrogen levels, the nodule may resolve. But if you refuse hormonal therapy, fibroids can begin to grow. Women's health is also affected by lifestyle: physical activity, nutrition, bad habits.

The risk group includes women with irregular menstrual cycles: early puberty, early or, conversely, late menopause. When several factors are combined simultaneously, the likelihood of developing the disease increases.

How does the disease manifest itself?

During intramural fibroids, healthy muscle cells and blood vessels are replaced by connective or fibrous tissue. The nodes have a clear outline. If the fibroid grows into the muscle layer, then the clinical form is called submucosal-interstitial; if the periphery is affected, it is called the intramural-subserous form.

A small node in the uterus does not cause discomfort to a woman. As the formation increases, the following symptoms appear:

pulling
intestinal motility disorder
dysuric disorders

The latter symptoms are associated with an increase in the size of the node and its pressure on neighboring internal organs. Possible nerve pinching.

Fibroids and pregnancy

Multiple small nodes do not affect the possibility of conception and the course of pregnancy. If the cause of the disease is a lack of hormones, then their levels normalize during pregnancy and the problem goes away.

Large nodes have a negative impact on the course of pregnancy. Possible complications: miscarriages, bleeding, placental abruption, weak fetus.

Ultrasound alone does not give a reliable result if the node is located in the muscle layer. During pregnancy, the node stretches and its borders become stretched and invisible. This is the reason why the nodes come back after pregnancy.

The course of pregnancy is influenced by the size and location of the intramural node. The node located near the placenta has a negative effect. A tumor can lead to infection of the fetus, block the supply of nutrients and oxygen, and provoke a miscarriage.

Diagnostic methods

You should consult a doctor if typical symptoms appear. The gynecologist performs the following examination:

inspection with mirrors
two-manual examination

Using palpation, the gynecologist can immediately detect nodular formations. After this, it is prescribed to confirm the diagnosis. Additional diagnostic method: transvaginal sensor. It allows you to determine the location of nodes, their sizes, and condition.

Ultrasound alone is not used to diagnose fibroids, since a node in the muscle layer may not be displayed on the screen. An ultrasound will show endometriosis, which simultaneously develops with fibroids.

The next research method is hysteroscopy. It is reliable even in the initial stages, allows you to determine the size and condition of the node, and prevent necrosis.

Complications and treatment

The most dangerous complication with an intramural node is. Pregnancy is also difficult. It is possible to get pregnant with fibroids, but the fertilized egg has difficulty moving. If the node is localized in the posterior wall of the uterus, then the egg will not be able to gain a foothold for further development. If it becomes fixed in the cervical area, a miscarriage will occur.

The technology for treating small and moderately complex nodes depends on the patient’s age, location of the nodes, and size. During childbearing age, treatment is carried out with medication; doctors try to preserve the uterus to the last.

The first treatment method is embolization. The blood circulation to the node is cut off and it is anesthetized. After a few months, the node dies and the inner layers of the uterus are restored. Sometimes hormonal therapy continues.

Myomectomy involves removing the node by laparotomy or through. The technology resembles curettage, but not the entire mucous layer is removed, but only the area where the node is located. Complete restoration of the uterine cavity occurs after six months to a year. After this period, you can plan to conceive a child.

Vaporization - the node is exposed to different temperature conditions. As a result, the node becomes necrotic. The procedure is effective only for small nodes, no more than 60 mm.

In adulthood and if there is no desire to have children in the future, they resort to removal of the uterus. The organ is removed using laparotomy or the cavity method. Indications for removal:

suspected cancer
presence of endometriosis
anemia

Hormonal changes in women of childbearing age lead to the development of hyperplastic processes in the genital organs. They can be benign or malignant.

According to statistics, 30% of women over 35 years of age experience uterine fibroids, and the percentage of asymptomatic development of the disease is even higher. Its development cannot always be prevented, but it is possible to reduce the likelihood of its occurrence.

Intramural fibroids are a benign growth of smooth muscle cells of the uterus, the name is determined by the location of the nodes - in the thickness of the myometrium. In contrast, submucous nodes grow under the mucous membrane, the endometrium, and subserous nodes are located closer to the outer surface of the uterus.

About the organ

The uterus is an unpaired muscular organ, it is intended for bearing and giving birth to children. The inner epithelial layer creates the conditions for the attachment of a fertilized egg and the development of the embryo.

The muscle wall is formed by three layers of cells, which are located in three directions - outside and inside longitudinally, and between them in a circular manner. Their contraction during childbirth pushes the baby out.

Causes

Adverse factors affect smooth muscle cells, damaging them. This leads to the appearance of nodes consisting of myocytes and connective tissue cells.

The most likely causes of the formation of intramural fibroids:

Hormonal changes with a predominance of high levels of estrogen. This hormone causes increased division of uterine cells, its effect can manifest itself in the form of an increase in the mucous layer, then they speak of endometrial hyperplasia.

If the myometrium is affected to a greater extent, then nodes are formed. A decrease in estrogen levels during menopause leads to the reversal of fibroids.

Traumatic manipulation of the uterus– abortions, curettage, difficult childbirth, surgical interventions. There are proliferating (young) cells in the muscle layer; their damage during rough manipulation causes a gradual accumulation of such myocytes. Hormonal changes that necessarily accompany abortion and childbirth intensify the process of formation of nodes.
Inflammatory and infectious diseases of the uterus– endometritis, sexually transmitted infections. Inflammation is accompanied by swelling of the tissue, the release of the liquid part of the blood from the bloodstream, which leads to compression of microvessels and ischemia. The damaging factor in this case is infection itself and oxygen starvation of tissues.

Diseases of the endocrine organs– diabetes mellitus, damage to the thyroid gland, affect the overall level of hormones. Obesity always leads to an imbalance of sex hormones. This is explained by the hormonal activity of adipose tissue and its ability to increase the synthesis of estrogen.

Diabetes and hypothyroidism are in most cases accompanied by weight gain.

Irregular sex life after 30 years, a sedentary lifestyle leads to stagnation of blood in the pelvis, which contributes to myometrial hyperplasia.
Stress and bad habits in women can cause hormone fluctuations and increase the risk of developing fibroids.
The occurrence of fibroids in relatives speaks in favor of a possible hereditary predisposition to the disease.

Symptoms

In half of the cases, fibroids are asymptomatic. Symptoms become noticeable when neighboring organs are compressed, when the uterus increases in size due to large nodes. Some signs appear due to deformation of the organ. Symptoms:

Heavy and prolonged menstruation associated with changes in the shape of the inner surface of the uterus, worsening endometrial rejection and possible hyperplasia.
Bleeding between periods are also associated with high levels of estrogen and hyperplastic processes in the mucous membrane.
Painful menstrual bleeding due to difficulty in separating the endometrium.
Lower abdominal pain occurs when blood flow in the nodes is disrupted due to compression of the feeding vessels.
Excessive blood loss causes anemia, which is accompanied by dizziness and increased heart rate.
Large fibroids compress neighboring organs– bladder and rectum, which leads to urination and defecation disorders.
Malnutrition of large fibroids causes its necrosis. This is accompanied by severe pain, fever, intoxication, and discharge of blood clots from the genital tract.
Infertility, miscarriages, bleeding during pregnancy and after childbirth a consequence of changes in the shape of the uterus, disruption of hormonal regulation.

Clinical picture

The formation of myomatous nodes occurs under the influence of a cyclic increase in hormone levels. Presumably, with each menstrual cycle there is an accumulation of damaged myocytes, in which the mechanism of apoptosis, programmed death when damaged, is disrupted.

Exposure to damaging factors aggravates the process. But in the first stages, for the growth of fibroids, exposure to the usual concentration of estrogen, which fluctuates throughout the cycle, is sufficient.

Gradually, mechanisms for self-sustaining growth are formed in the pathological focus - the connective tissue begins to synthesize estrogen from androgens, and the level of hormones in the blood ceases to matter. The rate of development of self-regulation determines the nature of growth - the pathological focus will increase quickly or slowly, or at a certain stage it will stop increasing.

Small nodes may not manifest themselves for a long time and are discovered by chance during a pelvic ultrasound. Larger and more numerous formations are accompanied by severe symptoms and are forced to consult a doctor with complaints. A woman’s refusal of necessary treatment leads to further growth of fibroids.

The surrounding organs are compressed and the size of the abdomen increases. Frequent heavy bleeding leads to bleeding and sometimes severe anemia. Sometimes such conditions require emergency measures to remove the uterus and blood transfusion.

Deprivation of the uterus of hormonal stimuli leads to regression of the nodes. This can be achieved by taking hormonal drugs or over time with the onset of menopause.

Diagnostics

The following diagnostic methods are used:

Fibroids can be detected during an examination by a gynecologist. The doctor will note hardening of the uterus, changes in its shape, size, and the appearance of tuberosity. Intramural fibroids cannot be seen using gynecological mirrors. But the displacement of the cervix can suggest its presence.
Hysteroscopy– examination of the uterine cavity with a special sensor from the inside allows you to visually assess the condition of the node.
MRI and CT– X-ray methods, produce a series of layer-by-layer images. MRI is more sensitive to soft tissues, displays nodes of minimal size, clarifies their location and location relative to neighboring organs.
Informative ultrasound of the pelvis, with its help even small nodes are detected that require further regular monitoring.

In this video you can see what a node looks like on an ultrasound:

Therapy

Treatment aims to eliminate the symptoms of fibroids associated with bleeding and pressure on neighboring organs, while preserving the organ and reproductive function. Indications for conservative therapy:

small fibroids (up to 12 weeks of pregnancy);
single nodes (no more than 1-2);
slow growth of the lesion;
intramural localization of fibroids;
there is no pain or heavy bleeding.

Hormone therapy

The selection of a drug for treatment is always individual. The following groups are used:

Gestagens. A natural hormone in the second phase of the menstrual cycle, it lowers estrogen levels. For treatment, progesterone or Duphaston is used, which can be used even during pregnancy. The Mirena intrauterine device is also effective against fibroids.
Antigestagen drug Mefipristone Apply twice per cycle for small knots.
Gonadotropin-releasing hormone agonists reduce the concentration of estrogen, which leads to a reduction in the node.
Tamoxifen– a selective modulator of estrogen receptors has an antiestrogenic effect.
Antiandrogen drugs (Danazol) by reducing androgens, they influence gonadotropins, which inhibits the growth of the node.
Combined oral contraceptives will help in the treatment of small nodes up to 2 cm in diameter.

Other medicines

Other medications are used to relieve the symptoms and effects of fibroids:

Nonsteroidal anti-inflammatory drugs needed to eliminate pain. Analgin, Nimesulide, Meloxicam, Ketorolac are effective.
Iron supplements necessary for the treatment of anemia. Sorbifer, Maltofer, Totema are used.
Hemostatic agents needed for heavy bleeding, Etamzilat in injections or tablets is effective.

Folk remedies

Traditional medicine cannot be used as an independent method of treatment. It is used after consultation with the doctor as additional supportive therapy:

4 teaspoons flax seeds Brew 0.5 liters of boiling water, boil for 10 minutes. Take half a glass three times a day before meals for 2 weeks.
Freshly squeezed potato juice 100 g is taken on an empty stomach for 3 months.
Motherwort tincture Drink 30 drops twice a day for a month.
A decoction of a mixture of nettle, burdock, barberry, yarrow, cloves, shepherd's purse has a hemostatic effect.

FUS ablation

Focused ultrasound - destruction of fibroids in a non-invasive way using ultrasound under MRI control is carried out as follows:

Before the procedure, an examination is carried out to determine the location and size of the nodes. It is impossible to use the method for submucosal and subserous nodes on a stalk or sizes greater than 500 cm3.
The distance to the nodes is calculated.
The appropriate hardware settings are made.
Under the control of MTP, ultrasound is applied to the node. Anesthesia and pain relief are not needed at this stage.
After the procedure, analgesics are prescribed.

Operation

Surgical treatment is possible radical - removal of the organ, conservative-plastic - myomectomy.

Indications

Removal of the uterus is resorted to in the following cases:

There is no need to preserve fertility.
The size of fibroids is more than 15-16 weeks of pregnancy.
Rapid node growth.
Tumor enlargement in postmenopause.
Suspicion of sarcoma.
Dysfunction of neighboring organs.
Bleeding leading to the development of anemia.

Operation process

General anesthesia.
Access to the abdominal cavity laparoscopically for small fibroids. If the size of the uterus is more than 16-18 weeks, a laparotomy is performed.
The vessels feeding the uterus are ligated.
The appendages are cut off, the neck is preserved.
The uterus is freed from ligaments and removed. The ovaries are inspected for tumors.
Checking the reliability of hemostasis.
Layer-by-layer suturing of the abdominal cavity.
Apply an aseptic bandage to the wound.

Rehabilitation

After surgery, thrombosis prevention is continued for a month (compression garments, low doses of aspirin). After removal of the uterus, hormone replacement therapy is prescribed to prevent castration syndrome. After removal of the nodes, a control ultrasound is performed after 1, 3 and 6 months.

Forecast

With timely treatment, the prognosis is favorable. During childbearing age, reproductive function can be maintained and pregnancy can be achieved.

Relapse is possible if not all nodes were removed during treatment (for example, with FUS ablation).

Prevention

To avoid getting sick, you need to adhere to the following principles:

Protect yourself from infections, treat inflammatory diseases in a timely manner.
Refuse abortion.
Have a full sex life.
Have at least 2 children.
Control your weight, eat right, and avoid physical inactivity.
Treat other endocrine diseases.

To prevent relapse:

Adhere to a healthy lifestyle, and if you are obese, get rid of extra pounds.
Avoid stress.
If you need to take hormonal medications, strictly follow the instructions.
Use the Mirena intrauterine hormonal system.

Myoma, or leiomyoma, is a benign tumor of the muscular lining of the uterus, which appears by the degeneration of smooth muscle cells into connective tissue. Despite the latest methods of early diagnosis, surgical removal of the tumor currently remains one of the most common methods of therapy.

Prevalence of pathology

In the structure of gynecological diseases, intramural fibroids and other types of benign neoplasms in the uterine cavity occupy second place. In reproductive age, the incidence of pathology averages 15-20% of cases, and in the premenopausal period reaches 30-35%. Due to the recent increase in the number of “aggressive” gynecological and obstetric methods of therapy, as well as the improvement in the quality of diagnostic measures, there has been an increase in the number of patients under 30 years of age with this pathology.

Educational growth usually occurs slowly, usually over a period of five years. In some cases, rapid growth of the tumor is observed, and within one year or even faster it increases by an amount corresponding to five weeks of normal pregnancy. Doctors determine the tumor size in weeks of pregnancy.

Intramural uterine fibroids can cause infertility, spontaneous abortion, abnormal position of the fetus, heavy uterine bleeding, premature delivery, menstrual irregularities and various complications during childbirth and the postpartum period.

The operation is indicated when the size of the tumor corresponds to fourteen weeks of pregnancy; in other cases, radical treatment tactics are not justified. This technique is based on the traditional opinion that the organ performs only a reproductive function and can then be removed without negative consequences for the body.

This opinion is erroneous, since the risk of transformation of fibroids into a malignant tumor is practically absent. After removal of the uterus, a woman loses her reproductive and menstrual functions, and many patients experience psycho-emotional and vegetative-vascular disorders.

Conservative treatment, as well as the use of minimally invasive and non-invasive methods of therapy in the early stages of pathology development, makes it possible to stop tumor growth, cause reverse development and prevent reproductive dysfunction. True, the issue of using conservative methods for treating intramural uterine fibroids still causes debate in the medical community.

Main types of uterine fibroids

There are several types of neoplasm depending on location:

Subserous fibroids form in the outer part of the organ and progress into the pelvic cavity. As a rule, this type of tumor does not lead to changes in the menstrual cycle or does not manifest itself at all, but it can cause some inconvenience, since the tumor puts pressure on surrounding organs and tissues.
Intramural uterine fibroids (intramuscular) are localized in the muscle layer and lead to an excessive increase in the size of the organ. This is one of the most common types of pathology. With intramural fibroids, the menstrual cycle is disrupted, pain and pressure appear in the pelvic area.
Interstitial, or intermuscular, is located inside the walls of the uterus. The organ increases evenly, some patients complain of heavy menstrual bleeding. Pain occurs only with a rapid increase in the size of the tumor, edema or necrosis. Intermuscular fibroids have a negative impact on neighboring organs, namely the rectum and bladder.
(submucosal) grows under the layer of mucous membrane that envelops the organ cavity. Leads to an exacerbation of severe symptoms of the pathology.
Cervical fibroids form in the muscle layer of the corresponding part of the organ. This type of pathology is diagnosed in only 5% of patients.

Myomas can be single or multiple. Often, several nodes are located in different parts of the organ, which leads to the diagnosis, for example, of submucous intramural fibroids or other mixed types of pathology. In this case, treatment is often complicated by the unclear clinical picture. For example, with subserous-intramural uterine fibroids, the menstrual cycle is disrupted, which is typical for intramural fibroids, but rarely happens with subserous pathology, but at the same time, pressure is exerted on surrounding organs and tissues.

Causes of leiomyoma

There are many opinions on the causes of intramural uterus. Some scientists believe that the neoplasm is not a tumor, but the result of focal growth of the myometrium. Thus, fibroids can occur only in those areas where there is a complex interweaving of muscle fibers - these are the areas that are called risk areas for the development of dystrophic disorders. Under the influence of various unfavorable factors, hypoxia can occur in these areas, which causes muscle cells to tend to divide and grow against the background of normal release of sex hormones.

In addition, proliferation can occur under the influence of mutation of normal muscle fibers due to exposure to growth factors and sex steroids. This is possible when favorable conditions occur. Modern medicine has not yet identified the molecular disorders that contribute to such transformation.

Smooth muscle fibers may retain a tendency to proliferate from the embryonic period. They go through a long period of development - from fourteen to thirty weeks of gestation. Fibers at this time are easily subject to mutations under the influence of various external causes or maternal factors (for example, sex steroids, tropic hormones and growth factors). Mutated cells begin to develop after the first menstruation under the influence of estrogens. Currently, this theory of the occurrence of fibroids is the most substantiated.

Provoking factors

The main risk factors that trigger the development of intramural nodes of uterine fibroids and benign neoplasms of another nature:

Unfavorable heredity. The likelihood of pathology in women whose immediate relatives suffered from the same disease is higher.
Early puberty and onset of menstruation.
No children. Increasing the number of full-term pregnancies significantly reduces the risk. In women with three full-term pregnancies - by 50-90%.
Excess weight and low physical activity. At the same time, obesity after puberty is a significant risk.
Having hypertension before age 35 and taking antihypertensive drugs for five years.
Frequent stress and chronic psycho-emotional stress.
Termination of pregnancy, especially surgically. Frequent diagnostic and therapeutic curettage of the uterine cavity.

The mechanism of pathology development

Uterine fibroids develop against the background of a local decrease in the elasticity of the vascular walls, which leads to blood overflow and the accumulation of potassium ions. According to another version, the neoplasm occurs as a result of the influence of estrogens on the mechanisms of cell death. In recent years, other interrelated mechanisms have been established:

Increased sensitivity of tissues affected by hormones of the reproductive system.
Changes in hormones affecting smooth muscle.
Changes in the formation of new vessels in the tumor area.

Stages of development of uterine fibroids

In the development of intramural fibroids and other gynecological pathologies of a similar nature, but of a different localization, three stages are distinguished:

Formation of a growth zone in the area where small vessels are concentrated. Such risk zones are characterized by a high rate of metabolic processes and permeability of the walls of blood vessels and tissues.
The tumor appears in the form of a small nodule. The neoplasm consists of fibers that clearly do not differ from neighboring tissues.
The formation is defined as a dense node with clear boundaries. The capsule is formed by the surrounding tissues. The node differs from normal fibers in its large size, density of nuclei, and the content of individual muscle fibers in the cytoplasm.

Clinical symptoms

In almost 50% of women, the disease develops without symptoms and is diagnosed accidentally during a pelvic ultrasound or during a routine examination by a gynecologist. In this case, clinical signs can be varied:

Pain of varying intensity and nature in the lower abdomen. In a third of patients, the pain is aching or pulling, which is associated with pressure on the plexuses of nerve fibers and stretching of the peritoneum. If the tumor grows rapidly, the sensations become more intense. With the development of necrosis, pain may be accompanied by fever, vomiting and general weakness.
Bleeding outside the cycle, prolonged or too heavy menstruation. Blood loss leads to headaches, weakness, dystrophic changes in the heart muscle, anemia, and fatigue.
Pelvic dysfunction. The symptom is manifested by frequent urge to urinate and constipation.
The presence of a dense formation in the lower abdomen.
Infertility (occurs in 30% of women with uterine fibroids) or miscarriage.

Methods of treating the disease

Treatment of intramural fibroids comes down to three main tactics: watchful waiting, conservative therapy, and surgery. Despite the widespread prevalence of the disease, an algorithm for managing patients has not yet been developed, so much depends on the individual doctor.

Waiting tactics

This method is suitable for a small number of patients. This group includes women who have no symptoms of pathology, and the size of the tumor corresponds to 10-12 weeks of pregnancy, the family already has children, and pregnancy is no longer planned in the future. Patients should be monitored using ultrasound and monitoring the levels of tumor markers in the blood.

Doctors recommend that patients refrain from lifting weights of more than 3 kg, heavy physical activity, heat baths, abdominal massage, body wraps, prolonged exposure to the sun and visiting a solarium, independent choice of birth control pills, the use of cosmetic techniques on the abdominal area and any physiotherapeutic procedures on the pelvic area. .

Conservative treatment

Conservative therapy involves taking hormonal drugs, the most effective of which are analogues of gonadoliberin and hypothalamic hormone. As a result of their use, the synthesis of estrogen and progesterone is reduced, and the tumor volume can be reduced by up to 55%, in addition, pain and bleeding stop. But such drugs, even with short-term use, have side effects: severe vascular reactions, hot flashes, nausea, decreased bone density.

Active therapy for fibroids

Active tactics involve minimally invasive and surgical procedures. Selective arterial embolization is used, the effectiveness of which is about 98.5%. According to reviews, intramural fibroids after such a diagnosis recur in 40% of cases. Surgery is the main method of therapy for 80% of patients. Surgical excision is especially often used in complex cases, for example, with subserous-intramural myoma.

Indications for surgery

Absolute contraindications to intervention are:

The size of the tumor corresponds to a period of more than 14 weeks of pregnancy.
Any postmenopausal progression or rapid growth during reproductive age.
Localization on the cervix.
Prolonged menstruation with heavy blood loss.
Necrosis of the node.
Infertility, if its cause is identified as fibroids.
Negative impact of neoplasms on the pelvic organs.

The choice of the method and extent of the operation is made depending on the woman’s age, the presence of concomitant diseases, and planning a pregnancy in the future.