How to stop the growth of fibroids after surgery. Rapid centripetal growth of uterine fibroids. Symptoms of uterine fibroids

July 31, 2018 2714 0

Uterine fibroids are a reaction of a woman’s body to the effects of damaging factors, which is manifested by the rapid growth of cells in the muscle layer of the female reproductive organ. In most cases, doctors identify volumetric education in the wall of the uterus during ultrasound examination when a patient contacts about symptoms gynecological diseases. The diagnosis of uterine fibroids puts women in a state of stress. They have heard that if fibroids grow rapidly, doctors remove the uterus.

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If you are faced with the problem of uterine fibroids, you should not be unduly worried. Contact us and arrange treatment in the best. Online expert consultation. In case of rapid growth of fibroids, our doctors offer patients an innovative method of treating fibroids, which allows them to preserve the uterus and get rid of the symptoms of the disease - uterine artery embolization.

Reasons for the rapid growth of uterine fibroids

Most gynecologists believe that fast growth Uterine fibroids begin when there is a hormonal imbalance. For this reason, the tumor is formed mainly in women of reproductive age. The tumor undergoes reverse development with a significant decrease in estrogen levels during menopause.

According to modern views origin of fibroids, the rudiments of myomatous nodes are laid or during intrauterine development female fetus, or under the influence of traumatic factors. During menstruation, myometrial cells undergo changes that lead to the formation of fibroids. Uterine fibroids develop from a single clone of a cluster of cells. She is sensitive to the effects of hormones. The neoplasm consists predominantly of changes in outwardly smooth muscle cells.

The formation of myomatous nodes and the rapid growth of fibroids occurs under the influence of the following factors:

early onset of sexual activity by girls;
frequent change of sexual partners;
infectious diseases that are sexually transmitted;
poor nutrition;
excess body weight;
disharmony in intimate relationships.

The risk of developing uterine fibroids increases in women who suffer from arterial diabetes mellitus, arterial hypertension, mental imbalance.

With the rapid growth of fibroids, the potential for malignancy is the same as that of the normal muscular layer of the uterus. This has been proven by numerous studies. Gynecologists at our clinics have abandoned the high level of oncological alertness regarding uterine fibroids that has existed for many years. If fibroids grow rapidly, the doctor will rule out the presence of a malignant tumor using modern methods diagnostics and perform embolization of the uterine arteries.

Symptoms of uterine fibroids

Depending on the location of the fibroid nodes, gynecologists distinguish the following types of uterine fibroids:

subserous fibroids grow from the outer muscular layer of the uterus towards the abdominal cavity;
submucosal nodes are located under the mucous membrane of the uterus, with rapid growth of fibroids they increase towards the organ cavity, deforming it;
interstitial or interligamentous formation develops from the middle muscular layer of the uterus, increasing its size.

Small myomatous nodes do not manifest themselves for a long time clinical symptoms. With the rapid growth of uterine fibroids in women, the menstrual cycle is disrupted, periods become heavy and prolonged, and uterine bleeding occurs in the middle of the cycle. If fibroids are accompanied by large blood loss, the patient develops iron deficiency anemia. Shortness of breath, weakness appear, the pulse quickens, and the rhythm of cardiac activity is disturbed. The skin becomes dry and pale, nails become brittle.

With the rapid growth of submucosal fibroids, large formations deform the uterine cavity. This leads to infertility or miscarriage. If the subserous node is pressing on the rectum or bladder, the act of defecation or urination is disrupted. With the rapid growth of subserous fibroids, the volume of the abdomen increases. After uterine artery embolization performed in our fibroid treatment clinics, all symptoms of the disease disappear.

Diagnosis of rapidly growing fibroids

On early stages formation of fibroids clinical diagnosis not always possible. In order to establish a diagnosis for initial stage diseases, when treatment is most effective, gynecologists of the clinics with which we cooperate perform a bimanual manual examination during a gynecological examination. Rapid growth of fibroids is determined using endoscopic, ultrasound, x-ray examination. The following endoscopic diagnostic procedures are used:

hysteroscopy;
cervicoscopy;
colposcopy;
culdoscopy;
laparoscopy.

In order to effectively detect the rapid growth of fibroids, a vaginal probe is used during an ultrasound examination. At the same time, the condition of the endometrium and ovaries is assessed. If fibroids grow rapidly, differential diagnosis formations with tumors of the uterine appendages, material is collected for histological and cytological examination.

If there are signs of fibroids, the following algorithm for examining patients is used:

identify groups at risk of developing fibroids;
carry out early diagnosis using ultrasound data;
determine pathogenetic factors for the rapid growth of fibroids based on the detection of urinary tract infections, oncocytological studies, assessment of neuroendocrine-metabolic status and the state of the immune system;
determine the level of tumor markers.

For the purpose of early detection of rapidly growing fibroids, women under 30 years of age at risk and all patients over 30 years of age undergo an ultrasound scan once a year.

Treatment of fibroids

When fibroids grow rapidly, most gynecologists prefer to remove the uterus. The doctors of the clinics with which we cooperate have radically revised the tactics of managing patients with rapidly growing fibroids. If the fibroid is not a tumor, then there is no need to remove the woman’s reproductive organ. It is enough to influence the cause of the disease, deprive the nodes of oxygen supply and nutrients, and the growth of education will stop. This occurs after embolization of the uterine arteries. The procedure is performed by endovascular surgeons at our fibroid treatment clinics.

If the myomatous node small sizes, gynecologists are actively monitoring the patient:

Regularly conduct gynecological examinations;
Do the necessary tests;
An ultrasound examination is performed using a vaginal sensor.

In the case when the fibroid nodes do not grow quickly, the patient’s menstrual cycle does not change, reproductive function and intimate life are not disrupted, she is prescribed monophasic hormonal drugs. Gynecologists at our clinics consider this practice to be vicious and perform embolization of the uterine arteries in the presence of nodes, regardless of their size.

With rapid growth of fibroids, a decision is made to further method treatment: conservative, surgical or combined. Conservative therapy aimed at reducing the size of nodes. Gynecologists use it in cases where the size of the fibroids does not exceed 12 weeks of pregnancy, there are subserous or interstitial formations, there is no bleeding, pain, and or there are contraindications to surgical intervention.

Effectively eliminate the cause of the disease combined hormonal contraceptives(Logest, Novinet, Ovidon, Mercilon). Gynecologists prescribe them when the size of myomatous nodes is no more than 1.5 cm. This group of medicines includes:

With prolonged use of oral combined contraceptives Patients experience malaise and general weakness, the menstrual cycle changes and body weight increases. Hormonal drugs prevent conception even several months after the end of the course of treatment. After embolization of the uterine arteries, gynecologists at our clinics do not observe such side effects. Due to the cessation of blood flow through the vessels supplying the myomatous node, only the blood supply to the fibroids is disrupted. Pathologically unchanged uterine tissue receives a sufficient amount of nutrients and oxygen. After embolization of the uterine arteries, the menstrual cycle is restored in patients and reproductive function is resumed.

Due to the fact that the formation and growth of fibroids, according to many gynecologists, occurs due to pathology of the pituitary gland, to restore its function and reduce myomatous formations, patients are prescribed gonadotropin-releasing hormone agonists; Zoladex, Decapeptyl, Buserelin. These drugs cause abdominal pain, decreased libido and menstrual dysfunction, emotional lability. They are not prescribed during pregnancy and breastfeeding. If two or more nodes are present, the effectiveness of drugs is reduced. After embolization of the uterine arteries, all nodes with rapid growth of fibroids undergo reverse development.

If there is no effect from other medications, gynecologists resort to treating uterine fibroids with antigonadotropin drugs. They reduce the severity of symptoms of the disease, but do not affect the size of fibroids. For this reason, these medications are not effective when fibroids are growing rapidly. Embolization of the uterine arteries helps stop the growth of the tumor and prevents the formation of new nodes.

Many gynecologists use quite effective and safe method treatment of rapidly growing uterine fibroids - FUS - ablation. During the procedure, the doctor, under the control of a computed tomography scan, directs ultrasound beams to the lesions. Under their influence, the tissue of the node evaporates, the fibroid decreases in size. This procedure removes only visible tumors. Over time, new myomatous nodes may form from the rudiments.

If fibroids begin to grow rapidly, most gynecologists suggest that women perform surgery:

Myomectomy – removal of nodes using laparoscopic or laparotomy access;
Hysteroresectoscopy – removal of subserous fibroids using an endoscopic device through the vagina;
Hysterectomy – surgical removal organ.

After myomectomy and hysteroresectoscopy, the risk of rapid fibroid growth remains in 30% of cases. Removal of the uterus deprives the patient of the opportunity to give birth to children and makes the woman disabled. Doctors at our clinics are of the opinion that the only surgical intervention that affects the mechanism of formation of myomatous nodes is embolization of the uterine arteries. Gynecologists recommend performing the procedure if fibroids are growing rapidly.

After insertion into the uterine arteries through a catheter placed under local anesthesia into the femoral artery, the drug Ebol stops blood flow through the arteries that feed the myomatous nodes. The rapid growth of fibroids stops, the nodes decrease in size, undergo reverse development and disappear. New myomatous neoplasms do not form in the uterus. Thanks to this procedure, a woman retains reproductive function, its quality is improving intimate life.

If there are signs of rapid fibroid growth, contact us. The clinics we cooperate with work qualified specialists. Experienced gynecologists examine the patient, establish indications and contraindications for uterine artery embolization. The procedure is performed by endovascular surgeons. After it, patients are under the supervision of doctors for no more than one day. After some time, they completely forget about the presence of fibroids.

Article outline

Uterine fibroids are benign tumor, which develops asymptomatically and unpredictably. In some cases, a woman may not notice the pathology, having learned about it only during a routine examination by a gynecologist. But sometimes the tumor causes discomfort in the form of pain, bleeding and other unpleasant symptoms. The growth of uterine fibroids negatively affects reproductive function, so it is very important to suppress the development of the tumor at the initial stage.

Why does uterine fibroid grow?

AND active development This disease has not yet been studied 100% by medicine. But predisposing factors are known that can become a catalyst for pathological processes:

hormonal collection (serious preponderance towards progesterone or estrogen if the natural balance is disrupted);
diseases genitourinary system, transferred early;
genetic predisposition;
violations menstrual cycle(causes problems with reproductive health, which subsequently leads to the development of a tumor);
damage to the uterus as a result of abortion;
adenomyosis;
irregular intimate life, problems in the intimate sphere;
obesity ( excess weight provokes an increase in the amount of female hormones);
mechanical damage to the uterine cavity with medical instruments during gynecological procedures.

The reasons for the growth of uterine fibroids (myomatous nodes) are quite banal and are associated with increased blood circulation in the pelvic area: active warming of the belt and lower abdomen using wraps, lotions, visiting the sauna, physical exercise and massage of the indicated areas.

Very often affects the growth of tumors. contraception, which contain an inappropriate dose of hormones.

Which fibroid is considered large?

Myoma can be a small node of a few millimeters, or it can reach the size of a soccer ball. The neoplasm is even classified by week of pregnancy (in this case, the size of the node is compared with the size of the fetus).

A tumor that has reached twelve weeks of pregnancy (from 6 centimeters inclusive) is considered large. This pathology negatively affects the organs located near the uterus, squeezing them and preventing normal blood supply.

A tumor up to 2 centimeters is classified as small neoplasms, and a tumor up to 6 centimeters is classified as medium.

Signs of fibroid growth

If a woman is diagnosed with a pathology, she is registered with a gynecologist. From this moment on, the patient should regularly visit a specialist to monitor trends in the development of the tumor.

The growth of uterine fibroids is accompanied by unpleasant symptoms, which should serve as a signal for the need for an unscheduled visit to the doctor. The symptoms are quite telling and, taken together, are difficult to confuse with signs of another disease:

with fibroids, the stomach grows;
unpleasant or painful sensations during menstruation or intimate relations;
dense areas are formed that are clearly visible when palpating the abdomen;
problems with bowel and bladder emptying begin;
pain begins in the lower back and lower abdomen;
unusual menstruation (in quantity or duration) is possible;
possible vaginal discharge;
fever and weakness are possible.

The main symptom of growth benign neoplasm is an increase in the abdomen. The tumor literally “bursts” the uterus from the inside. In advanced cases, the patient is visually similar to a pregnant woman carrying a fetus in her final stages.

How quickly does uterine fibroid grow?

The neoplasm goes through three stages of development:

formation of node/nodes;
maturation (the tumor grows quite quickly, gradually turning into a very tight and dense node);
old age (the rapid growth of fibroids stops, and then the tumor completely stops developing).

It is impossible to name the exact timing of the growth of a uterine tumor, since in each special case everything happens individually. But there are two types of pathology:

proliferating fibroids (its growth is considered rapid, and the symptoms are very pronounced; the presence of a large nucleus and increased concentration DNA);
standard fibroids (develops slowly and asymptomatically, can remain in a passive stage for a very long time, neither decreasing nor increasing).

Norms of fibroid growth per year

Cell division in the absence of provoking factors occurs rather slowly. Therefore, an ordinary fibroid, if left untreated, will reach “dangerous” sizes in five years. You can speed up the process by: external factors, and internal catalysts.

The normal growth rate per year is considered to be either a slight increase in the tumor (plus one week to the total period/stage of fibroid development over 12 months), or complete absence changes.

How to stop the growth of fibroids

Conservative methods of treating pathology make it possible to stop the growth of neoplasms in mild and severe forms. They, in addition to receiving special drugs, imply an absolute refusal bad habits and transition to healthy image life:

proper and balanced nutrition;
light but regular exercise;
taking minerals and vitamins;
6 or 8 hour sleep schedule;
quitting smoking and alcoholic beverages.

Such simple measures will help not only strengthen general health, but also to stop the rapid growth of uterine fibroids, creating favorable conditions for tumor suppression immune system body.

Hormonal medications, including birth control pills, can slow down the tumor. But if you want to influence the dynamics of the development of the tumor in this way, you need to undergo a series of tests and visit a doctor so that he can prescribe treatment. The specialist will determine the character hormonal imbalance and decide how best to influence the situation.

Surgical methods

What to do if the tumor grows and does not respond to conservative treatment? You will have to resort to operational methods:

uterine artery embolization (fallopian tubes are blocked to stop the blood supply to the tumor, causing the tumor to degrade);
removal of the tumor.

Removal of the tumor can be partial, when the node itself is removed, barely touching the uterine cavity. But if the fibroid is multinodular in nature or has reached a very large size, it is possible complete removal uterus and its appendages.

It is important to remember that any surgical intervention can pose a risk to a woman’s health and can also affect reproductive function. Therefore, it is necessary to prevent the growth of fibroids before they reach the 12th week of development.

Uterine fibroids are a disease that is most often characteristic of women who have reached adulthood, but with hormonal imbalances, it can also form in young girls. Women who are of an age to give birth healthy child, it is recommended to remove the fibroid. But women who have almost reached the age of menopause can wait a little longer for the operation, since fibroids can resolve on their own without outside intervention. In this case, everything must be done to stop the growth of fibroids and prevent it from growing to a size that will become a threat to human life and health.

Basic ways to stop the growth of fibroids

The question that worries many women is how to stop the growth of fibroids. ethnoscience, the effectiveness of recipes in this area has been confirmed by many years of experience in their use. Here are just a few basic recipes that will help stop the growth of fibroids.

A decoction of two tablespoons of burdock roots and leaves, poured with half a liter of boiling water, which is infused in a water bath for half an hour, is brought to a boil. After this, you need to strain it and drink about 100 milliliters at a time instead of tea to stop the growth of fibroids. If you don’t want to drink the herbal decoction in this form, you can make an alcohol tincture from the same ingredients. To do this, you need to grind 100-150 grams of dry burdock root and leaves, and pour it all with 300 milliliters of alcohol. The mixture, infused for fourteen days, must be taken approximately 40 drops four times a day. Treatment with such means is quite long, but at the same time effective.
Eating broccoli about twice a week also helps to effectively cope with the growth of fibroids. The whole point is that this vegetable has great content indole-3-carbinol, which is responsible for regulating estrogen levels and also promotes the processes of resorption of tumors. In addition, in pharmacies a large number of preparations that contain broccoli extracts. At the same time, eating broccoli, as well as taking medications containing its extracts, may be inappropriate, so before taking them, you should consult a gynecologist.
The herb Vitex Sacred is also a very effective remedy for solving the problem of fibroid growth. Alcohol tincture, which is made from two tablespoons of dried herbs, filled with one hundred milliliters of vodka, and infused for about fourteen days at room temperature and taken one teaspoon three times a day. You can also make a decoction from this herb. To do this, you need to brew a tablespoon of the herb in a glass of boiling water and take 100 milliliters twice a day. In addition, pharmacies have a large number of drugs that contain an extract from the herb Vitex Sacred.
An effective remedy To stop the growth of fibroids, douching and creolin are also used. To do this, you need to dissolve 15 drops of creolin in 200 milliliters of water. This procedure should be carried out for 20 days, after which you should take a break for one week and repeat the course.
It is also necessary to carefully monitor your health. Regular visits to the hospital and undergoing an ultrasound procedure are the basis for regulating the growth of fibroids. In cases where there is a significant growth of this neoplasm, it is necessary to consult a gynecologist and prepare for surgery.

The circumstances of the onset of the disease are different, but regardless of this, we can say that the disease itself poses a danger to women’s health. In this article, we discuss the causes, signs and growth of uterine fibroids. Is it possible to prevent the development of this disease?

Causes of uterine fibroids

Uterine fibroids can occur due to the following reasons:

Hormonal imbalance as a cause of uterine fibroids

The main cause of fibroids is a lack of estrogen with a high progesterone content. Very often, a similar phenomenon is observed when ovarian function is impaired, which, in turn, leads to the formation of nodes. The higher the estrogen level, the larger the tumor grows. Therefore, when treating fibroids, doctors almost always prescribe hormonal drugs to normalize general background.

By the way, it is interesting that women with high estrogen levels (who, according to statistics, are most predisposed to fibroids) look much younger than their age, lead active image lives and are different good health. By the way, the latter contributes to the fact that such patients rarely use the help of a doctor.

Poor diet as a cause of uterine fibroids

Very often food consumption high content refined carbohydrates and saturated fatty acids with a lack of fiber, it provokes an increase in the level of estrogen in the body, which, as we already know, affects changes in hormonal levels and the development of fibroids. In addition, under the influence of poor nutrition, excess weight occurs. It has been established that as soon as a woman loses weight, many problems associated with the sexual sphere disappear. In particular, the likelihood of developing fibroids is reduced.

By the way, the highest probability of developing fibroids exists in women with an “apple” figure.

Genetics as a cause of uterine fibroids

If a woman’s family has at least one relative with uterine fibroids, then it is likely that this disease is passed on from generation to generation. In this case, you need to regularly see a gynecologist in order to detect the disease in time.

Any gynecological interventions

Childbirth as a cause of uterine fibroids (especially C-section), abortion, unprofessional gynecological examination, insertion of an IUD - these and other procedures lead to disturbances in the functioning of the reproductive system. It is also worth noting that nodes can occur against the background of pre-existing gynecological ailments, for example, due to endometriosis.

Quality of intimate life as a cause of uterine fibroids

Frequent change partners or, on the contrary, long-term sexual abstinence negatively affects women's health. Therefore, it is very important to maintain balance in your intimate life.

Signs of uterine fibroids

Signs of uterine fibroids cannot always be identified and determined. The main danger lies in the fact that the development of myomatous nodes can be asymptomatic, and the disease is detected already at the stage when it cannot be treated only with medications. What to do? In this article we will talk about the signs of fibroids and methods for diagnosing them. This is what will help every woman do everything to maintain her health.

The main cause of uterine fibroids is hormonal disbalance. Against this background, the main symptoms may occur:

Enlarged abdomen – if the fibroid grows too much, the patient’s belly may look as if she is 6-7 months pregnant! Naturally, we're talking about about too advanced cases. At the initial stage of its formation, signs of uterine fibroids can manifest themselves in the form of a slight increase in the size of the abdomen, most often on one side.

Pain in the lower abdomen, lower back, back - depending on the location of uterine fibroids, pain can be localized in different parts peritoneum and give, including to the back. Sometimes the pain resembles the onset of menstruation or even an attack of appendicitis. In any case, you need to urgently consult a doctor to rule out the presence of serious illnesses.

Problems in the functioning of other organs - as uterine fibroids grow, they begin to put pressure on neighboring organs. First of all, the bladder and intestines are affected. As a result, signs of problems with bowel movements and urination appear. It is important not to wait until it gets even worse, because myomatous nodes can cause constipation, hemorrhoids and others unpleasant phenomena.

Long and heavy menstruation, spotting - all these signs indicate a dysfunction of the reproductive system, and you need to urgently visit a gynecologist. In addition, it is important to remember that large blood losses can lead to iron deficiency anemia.

Increased temperature as a sign of uterine fibroids. In practice, this occurs as a result of rupture or twisting of the fibroid, as the body begins to inflammatory process. If antipyretics do not help you, and your temperature, on the contrary, continues to rise, go to the hospital immediately.

Growth of uterine fibroids

The growth of uterine fibroids is the first signal that you may need to resort to surgery in the future to cure the fibroids. Is it possible to stop the increase in nodes? When are they removed? How dangerous is such a procedure? Let's talk about this right now.

The uterine fibroid itself consists of a ball of chaotically intertwined fibers that form a knot. Such nodes can increase in size, reaching several kilograms in weight. It is known that the largest myomatous tumor in the world weighed 63 kilograms. This is a very advanced case - most often the size of fibroid nodes varies from a few millimeters to several centimeters, and the weight does not reach a kilogram. True, in medical practice There is information that many patients who neglected treatment brought the disease to such an extent that the nodes grew so that from the outside it seemed as if the woman was 6-7 months pregnant.

At first, when uterine fibroids first appear, no symptoms may be observed. However, the growth of uterine fibroids still causes sensations that become an alarming signal and require immediate consultation with a doctor.

The growth of uterine fibroids and its signs

Be alert if you observe the following phenomena:

pain during menstruation or sex;

problems with bowel movements and urination;

pain in the lower back and abdomen;

heavy menstruation;

vaginal discharge;

heat;

general malaise and fatigue for no particular reason;

problems with conceiving and bearing a child.

Diagnostic signs uterine fibroids

On initial stages Uterine fibroids can be diagnosed as follows:

gynecological examination;

Ultrasound of the pelvic organs;

CT scan;

urine and blood analysis.

If uterine fibroids do not increase in size, you can take hormonal medications and even plan a pregnancy. It is worse if the fibroid nodes are constantly growing - in this case they need to be removed. Depending on the severity of the disease, a specific type of operation is prescribed. They try to preserve the young woman’s uterus and remove, at most, a small part of it along with the fibroids. But sometimes it is necessary to completely remove the uterus. Unfortunately, it is impossible to get pregnant in this case. Is it even worth bringing uterine fibroids to this stage? Remember that everything is in your hands: do not neglect the plan gynecological examination, and many diseases (including uterine fibroids) can be avoided!

Uterine fibroids, or leiomyoma, is a benign hormone-dependent (estrogen- and progesterone-dependent) tumor of the myometrium (muscular lining of the uterus), which develops from smooth muscle cells and contains fibrous connective tissue in varying quantities. Despite significant progress in early diagnosis, removal of the uterus for fibroids (hysterectomy) remains a fairly common treatment method to this day.

Relevance of the topic

Myoma ranks 2nd in the structure of gynecological diseases. Its frequency is reproductive age averages 16%-20% of cases, and in premenopausal women reaches 30-35%. IN Lately, due to the increase in the number of “aggressive” gynecological and obstetric treatment methods and the improvement in the quality of diagnosis, there is an increase in the number of women with myomatosis under 30 years of age.

In general, leiomyoma growth occurs slowly - on average over 5 years. But sometimes rapid growth of the tumor is observed, in which within one year or less it increases by an amount corresponding to 5 weeks of pregnancy.

It may be the cause (if localized in the uterine region fallopian tube), spontaneous abortions, premature birth, incorrect position fetus, abundant postpartum uterine bleeding and other complications during childbirth and the immediate postpartum period.

Significant sizes of fibroids, for which surgery is indicated, correspond to 14 weeks of pregnancy. But in most other cases, radicalism in treatment (hysterectomy) is unjustified. It is based on the traditionally prevailing opinion that the uterus performs only a reproductive function, after which it can be removed without consequences for the body.

This opinion is erroneous, since the risk of transformation of leiomyoma into malignant tumor is practically absent, but after a hysterectomy, menstrual and reproductive functions are lost, and many women develop pronounced vegetative-vascular, psychoemotional disorders and accelerated decline in bone mineral density.

In the same time, conservative treatment uterine fibroids, as well as the use of non-invasive and minimally invasive methods Treatments in the early stages of tumor development make it possible to stop its growth, cause reverse development and prevent disorders reproductive function uterus. But if the indications for surgical treatment are clearly developed and defined, then the issues of using conservative methods still remain controversial.

Causes of uterine fibroids and mechanisms of its development

Causes

There are different theories about the causes of leiomyoma. For example:

Some scientists believe that this formation is not a tumor, but a consequence focal hyperplasia(proliferation) of the myometrium. It can occur in areas where there is a complex weave muscle fibers- along the lateral surfaces of the neck, in the area of origin fallopian tubes, along the miduterine line. These areas are called risk areas for the development of dystrophic disorders.
Under the influence of any unfavorable factors hypoxia (lack of oxygen) develops in the smooth muscle fibers of the myometrium. The areas mentioned above are especially affected. Hypoxia leads to impaired differentiation of muscle cells, as a result of which they acquire the ability to divide and grow against the background of normal synthesis and release of sex hormones. This constant unregulated proliferation of undifferentiated muscle fibers leads to the formation of fibroids.
Under the influence of growth factors and sex steroids, mutation of normal muscle cells occurs, followed by their neoplastic transformation in the presence of favorable conditions. At the same time, the molecular disorders that contribute to this transformation have not been fully established.
During the embryonic period, smooth muscle fibers undergo a long stage of development - from 14 to 30 weeks. Since during this time they are still poorly differentiated, they easily undergo mutations under the influence external reasons (Negative influence environment) or maternal factors (growth factors, tropic hormones, sex steroids, etc.). Mutated tumor cells (progenitor cells) are located in the myometrium and begin to develop under the influence of estrogens after the first menstruation. Their development takes place over many years. This theory is currently the most substantiated.

Pathogenesis

Various concepts of tumor development mechanisms have also been proposed. Thus, the theory of peripheral hemodynamic disorders and water and electrolyte disturbances suggests that tumor development is based on a decrease in the sodium-potassium ratio. The reason is a local decrease in the elasticity of the vascular wall, which leads to their overflow with blood, slower outflow and accumulation of potassium ions.

Another concept for the formation of fibroids is the influence of estrogens on the mechanisms of programmed cell death (apoptosis) through the BcI-2 protein, which inhibits them. Estradiol suppresses the effect of BcI-2, and in fibroids - to a much lesser extent than in normal myometrium.

IN last years multiple interrelated mechanisms have been established. The main ones:

Changes in sex hormones (estrogen and progesterone) affecting mutated smooth muscle cells.
Increased sensitivity of tissue receptors affected by sex hormones.
Changes in the formation of new blood vessels in the tumor area.

Their principle is as follows. Progesterone, acting on mutated cells, causes their proliferation. The conditions for the implementation of its action are created by estrogens. In addition, they slow down regulated processes programmed cell death, which contributes to the proliferation of the latter.

The influence of sex hormones is not direct, but through the stimulation of certain protein growth factors, which include:

epidermal (EGF);
insulin-like-1 (IGF-1);
transforming-beta (TGF-beta);
heparin-binding epidermal (HSEFR);
vascular endothelial (VEGF-A);
fibroblast growth factor (FGF-2).

For the first four factors characteristic property is a pronounced stimulation of mitosis (division) of cells, for the rest and angiogenin - modulation of angiogenesis (formation of the vascular network) in the tumor, necessary for its development.

Recent results of studying the pathogenesis of the disease have made it possible to supplement the treatment of uterine fibroids medications, with the help of which in many cases it is possible to avoid hysterectomy or prevent relapses after minimally invasive surgical treatment.

Provoking factors

As a result of epidemiological studies, the main risk factors that trigger the development of leiomyomas have been established:

Genetic - the likelihood of developing uterine fibroids is much higher in women whose immediate relatives (mother, sister) suffered from the same diseases. Moreover, their tumors arise in more at a young age and acquire larger sizes compared to others.
Early onset of menstruation.
No children. Increasing the number of full-term pregnancies correspondingly reduces the risk. For women with three children - by 50-90%.
Excess body weight against a background of low physical activity. Obesity in childhood and adolescence influence is much less than that after puberty.
Availability up to 35 years of age arterial hypertension, accompanied by reception antihypertensive drugs for 5 years.
Long-term and chronic psycho-emotional stress, frequent and prolonged stressful conditions.
Repeated episodes of induced abortion, especially surgical method, and frequent diagnostic and therapeutic curettage.

The factors listed in paragraphs 2-5 increase the risk of developing fibroids by 2 times or more.

Types of uterine fibroids

It arises and develops in the muscular layer of the uterus. There are 3 stages in its development:

I - zone formation active growth at the location small vessels; These zones are characterized by high permeability vascular wall and fabrics, as well high level metabolic processes, which contributes further development tumors;
II - the tumor is visible in the form of a nodule only microscopically; it consists of fibers that have no obvious signs of difference from neighboring tissues;
III - it is already defined macroscopically in the form of a formed dense node with clear boundaries, the capsule of which is formed by the surrounding tissue elements; leiomyoma consists of muscle spindle cells collected in a bundle and oriented in different directions; they already differ from normal smooth muscle fibers of the myometrium in their significantly larger sizes, high density nuclei and the content of individual thin muscle fibers (myofibrils) in the cytoplasm.

Classification

Depending on the number of nodes, multiple and single (in only 16% of cases) fibroids are distinguished.

Types of uterine fibroids depending on location

According to the nature of their growth, they are divided into 5 types:

Intermuscular, interstitial, or intramural uterine fibroids. It is completely located in the thickness of the muscular layer of the uterine wall (occurs in 60% of all cases of the disease).
, or submucosa - grows in the direction of the endometrium. If such a node is partially (more than 1/3) located in the myometrium, it is called intermuscular with centripetal growth (towards the uterine cavity).
Subserous, or subperitoneal fibroids - located completely or partially under the serous (outer) membrane of the uterine wall, that is, under the peritoneum. It is divided into three types: “type 0”, when the tumor is completely located under the serosa; “Type I” - more than half of the tumor is under the serous membrane, and the rest of its volume is in the thickness of the myometrium; “Type II” - more than half of the node is located interstitially. Zero type is divided into 2 subtypes - “0-A” (node on broad base) and “0-V” (node on the leg).
Retroperitoneal tumor - the growth of the node occurs from the cervix or lower parts of the uterus outward, where the peritoneum is absent.
Intraligamentary, or interligamentous - between the leaves of the broad uterine ligament.

The first three species differ significantly in morphological structure and degree of ability to increase. Submucosal tumor and interstitial fibroid uteri are true, since the ratio of parenchyma (functioning tissue) to stroma (connective tissue cells, nerves, vessels and extracellular substance) is 1:2, and in subserous nodes - 1:3. Therefore, the latter are called fibromyomas. The degree of activity of metabolic processes in a submucosal tumor is much higher, and therefore its growth rate is higher.

Depending on the location in relation to the uterus, a tumor is distinguished between corporal, or uterine body (94%), and cervical (16%).

Types of uterine fibroids according to cellular composition:

Simple - grows like a simple benign local growth of healthy muscle cells. There is no cell division (mitosis) in it.
Proliferating is also benign, but the number of muscle cells is significantly greater compared to the equivalent volume of simple leiomyoma. In addition, in the absence of cell atypia in a proliferating formation, their mitotic activity is determined, but it constitutes no more than 25% of all tumor cells.
Presarcoma. This type of fibroid is characterized by the presence of multiple foci of growth in the node, in which the number of mitoses is up to 75%. The cells have signs of atypia, their nuclei are heterogeneous. In some areas of the node there are cells with multiple and large nuclei with intense coloring.

Clinical symptoms of uterine fibroids and contraindications for it

In half of women with fibroids, the disease develops without any symptoms and is detected by chance during an examination by a gynecologist or an ultrasound scan of the pelvic organs. Clinical signs are quite varied. The main ones:

Pain of varying nature and intensity in lower sections belly. They can be aching or pulling (in 25-30%), which is associated with pressure on nerve plexuses and/or stretching serous membrane(peritoneum). As the tumor grows rapidly, the pain becomes more pronounced and constant. Torsion of a subserous formation on a pedicle or acute disorder blood flow in myomatous nodes with the development of their necrosis (necrosis) causes acute paroxysmal pain, which may be accompanied by weakness, vomiting, and fever. Cramping pain during menstruation usually occurs when the node is located submucosally.
Acyclic bleeding, more characteristic of intramural or subserous localization, as well as prolonged and heavy menstruation, usually occurring in the presence of a submucosal node. Blood loss leads to the development of anemia, headaches, fatigue and weaknesses, to dystrophic changes in the myocardium.
Disorders of the pelvic organs, which are manifested by frequent urge to urinate and constipation. These symptoms occur when the nodes are subserosal, cervical or interligamentous, as well as when the tumor volume is large.
The presence of a dense formation above the womb.
Miscarriage and infertility occur in 30% of women with multiple fibroids.

Principles of treatment

Despite the high prevalence of the disease, a clear algorithm for the management of such patients has not been developed. There are many different opinions and contradictions in treatment tactics, which come down to 3 main areas:

Waiting tactics.
Conservative treatment of uterine fibroids.
Active patient management.

Waiting tactics

It can be applied to a small number of patients. These include women who have no manifestations of the disease, the size of the tumors corresponds to periods of less than 10 - 12 weeks of pregnancy, the reproductive function has already been realized and pregnancy is no longer planned in the future. In addition, such patients should have the opportunity to be under constant dynamic monitoring using ultrasound, cytological monitoring of the endometrium and cervical mucosa, as well as monitoring the content of tumor markers in the blood.

Contraindications for uterine fibroids:

Prolonged exposure to the sun and visiting a solarium.
Lifting weights over 3 kg, heavy physical exercise, especially on the abdominals.
Any types of physiotherapeutic procedures for the pelvic area.
Wraps, abdominal massage.
Thermal baths, visits to baths and saunas.
Application of cosmetic hardware techniques to the abdominal area.
Load training on simulators.
Abortion and self-selection of oral contraceptives.

Conservative treatment of uterine fibroids

Taking hormonal medications

Conservative tactics are to prescribe hormonal drugs, among which the most effective are analogues of gonadoliberin, or gonadotropin-releasing hormone (a hormone of the hypothalamus). They are able to temporarily bind the corresponding receptors in the pituitary gland and over time suppress its gonadotropic function. As a result, the synthesis of estrogen and progesterone is reduced, the tumor volume is reduced to 55%, and bleeding and pain stop. However, these drugs, even with a short course of treatment (3-4 months), have side effects in the form of expressed vascular reactions, feelings of flushing, nausea and decreased bone mineral density.

Relatively new drug Mifepristone is a synthetic steroid with a fundamentally different action. It binds to the receptors that progesterone acts on, blocking their function. For this reason, a decrease in the production of progesterone itself does not occur, but side effects, characteristic of previous drugs, are much less pronounced with approximately equal effectiveness.

Mifepristone is used at a dose of 50 mg daily for 2-3 months in preparation for surgery: it allows you to stop bleeding, relieve a woman of pain, normalize blood hemoglobin, and halve the volume of nodes, which makes them easier to remove with minimal blood loss. As self-treatment the drug is used rarely and over a longer course.

Currently, clinical trials are being conducted on 2 drugs that block the action of growth factors. One of them, Pirfenidone, causes fibrosis of the node; the action of the second, Interferon-alpha, is based on suppressing the growth of blood vessels in the tumor.

FUS – MRI ablation

Another conservative method is a non-invasive method of focused ultrasound ablation of a myomatous node under the control of magnetic resonance imaging (FUS - MRI ablation). It is based on the passage of ultrasonic waves through biological tissues without damaging them. Focused on the tumor, they cause heating of its individual zones to 55-90 o. Already at 60 o in 1 second, cell destruction occurs due to the evaporation of water from them, damage to the vascular network, local destruction of the structure of proteins and collagen fibers.

However, this technique is not yet perfect enough and is used mainly when fibroids are localized in the fundus of the uterus and along its anterior wall. The procedure is contraindicated for nodes smaller than 2 cm and larger than 9 cm, for pedunculated subserous fibroids, infertility, unrealized reproductive function, etc.

Active tactics

It distinguishes two directions:

minimally invasive manipulations;
surgery.

EMA

Among minimally invasive manipulations, bilateral selective arterial embolization for uterine fibroids is mainly used. Its effectiveness is 98.5%, in contrast to surgical myomectomy, after which relapses are possible (up to 40%). The meaning of the procedure is to insert (under local anesthesia) a special microcatheter into the uterine artery through the femoral and internal iliac arteries. After this, polyvinyl alcohol is introduced in the form of very fine particles. It leads to occlusion (blockade) of the vessels feeding the myomatous nodes, cessation of blood flow and their further shrinkage.

After the procedure, severe pain appears in the lower abdomen, lasting several hours. Sometimes vascular embolization (rarely) can be complicated by the development of infarctions in the uterus or abscesses, which will require removal of the organ. In addition, embolization is ineffective for subserosal nodes, the long-term results of its use are still unknown, and the effect on the possibility of subsequent pregnancy has not been fully studied. In 5% of cases, the onset occurs in women of childbearing age.

Surgery

Currently, on average, 80% of women surgery for uterine fibroids remains the main treatment method. Surgery can be of two types:

conservative - removal of only single or multiple nodes (myomectomy);
radical - subtotal hysterectomy (supravaginal amputation with preservation of the cervix and appendages) or total hysterectomy (extirpation), that is, removal of the uterus and cervix.

Conservative removal of uterine fibroids laparoscopic method is preferable and is carried out when the size of nodes is less than 7-8 cm. However, the current availability of morcellators makes it possible to remove tumors up to 17 cm in size using the laparoscopic method. A morcellator is an electromechanical device that crushes a myomatous node in the abdominal cavity.

The absolute indications for surgery are:

The size of the tumor is more than 14 weeks of pregnancy or more than 10 cm (according to ultrasound).
Rapid growth during reproductive years or any growth during the postmenopausal period.
Submucosal location, accompanied by anemia as a result of prolonged and heavy menstruation.
Cervical localization.
Subserous tumor on a pedicle.
Negative effect on the function of the pelvic organs (bladder, intestines).
Combination of fibroids with diseases of other genital organs requiring surgical treatment.
Necrosis of the node, usually accompanied by pelvic pain syndrome.
Infertility, if fibroids are the cause.

Volume selection surgical intervention depends on concomitant diseases, the woman’s age and planning pregnancy in the future. The priority in the treatment of fibroids is the use of minimally invasive or conservative surgical organ-preserving methods.