Why is it dangerous and how to treat uterine fibroids? Causes and symptoms
One of the most pressing problems is such a gynecological disease as uterine fibroids.
However, you do not need to panic if you are diagnosed with this:
- First, one should calm down and understand that fibroids are not a malignant neoplasm, and that there are reliable methods of treatment;
- Secondly, it is important to undergo a thorough examination using hardware techniques. Then the diagnosis will be either refuted or confirmed for certain.
Here we will consider the most important questions about uterine fibroids, talk about the likely causes of its occurrence, symptoms and methods of treatment.
- Uterine fibroids - what is it?
- Symptoms of uterine fibroids
- Causes of uterine fibroids
- Why are uterine fibroids dangerous?
- How to treat uterine fibroids?
- Medicines used in treatment
- Prevention of uterine fibroids
- Answers to popular questions
Uterine fibroids - what is it?
Myoma of the uterus is a disease of the female genital area, characterized by the formation and growth of a benign tumor in the myometrium - the muscle layer of the uterus. Most often, women in the age category from 30 to 40 years and older face the problem of uterine fibroids. However, at present, fibroids are significantly "younger", and cases of the disease are not uncommon in young women aged 20-25.
A uterine myoma is a tumor (formation, node) located inside the body of the uterus (in 95% of cases, less often in the cervix - 5%). Myoma can develop from cells of both muscle and connective tissue.
Doctors obstetricians-gynecologists indicate the size of the fibroids either in centimeters (the size of the node itself) or in weeks. The phrase "myoma 12 weeks" means an enlargement of the uterus with a myomatous node to the same size as at 12 weeks of pregnancy.
By location relative to the muscle layer - myometrium - fibroids are classified as follows:
- Intermuscular (or intramuscular, or interstitial, or intramural) - the node is located inside the myometrium;
- Subperitoneal (or subserous) - the node is located under the mucous membrane of the outer layer of the uterus, near the peritoneum;
- Submucous (or submucous) - the node is located under the inner mucous membrane of the uterus, in the organ cavity;
- Interconnection (or intraligamentary) - the node is located between the wide uterine ligaments.
There are fibroids on the pedicle, but their localization is exactly the same as we listed above.
Sometimes a diffuse form of fibroids is diagnosed, in which the node as such is absent, but a diffuse growth of the myometrium occurs.
What is the difference between fibroids and uterine fibroids?
All types of fibroids are formed from two types of tissue: muscle and connective tissue. The predominant composition of the tumor determines its belonging to the myoma type. If muscle fibers predominate in it, then this is a fibroid. If connective fibers predominate, which mix with muscle fibers, then this is fibroids. And if the tumor consists entirely of connective tissue, then it is called a fibroma.
Symptoms of uterine fibroids
Symptoms of uterine fibroids depend on the age of the node, the woman's age, the size and location of the tumor, the growth rate of the myoma node and the presence of other chronic diseases. Sometimes fibroids are almost asymptomatic and are detected only during the next medical examination.
The most common and characteristic symptoms of uterine fibroids:
- Pain in the intermenstrual period, varying in duration, arising in the lower abdomen, sometimes radiating to the lumbar region, upper abdomen or legs;
- Menstrual dysfunction. These can be changes in the duration of the cycle in the direction of reduction or increase, increased soreness of menstruation, an increase in the volume of blood loss during menstruation (menstrual uterine bleeding), intermenstrual spotting;
- Problems in the reproductive sphere (possible development of infertility).
With the rapid growth of uterine fibroids or with large sizes of the myomatous node, the volume of the abdomen can increase without adding body weight, as well as discomfort and constant aching and pulling pains in the lower abdomen, which intensify after physical exertion and emotional and psychological experiences.
When the nearby organs are compressed by the myomatous node, persistent constipation occurs, as well as frequent, sometimes painful urination.
When the legs of the myomatous node are twisted, necrosis (necrosis) of the myoma body develops, and then the clinical picture of "acute abdomen" is observed: sharp pains in the lower peritoneum, palpitations, cold clammy sweat, fainting. This situation requires urgent surgical attention.
Other symptoms of uterine fibroids can be expressed in dysfunction of organs indirectly affected by pathogenesis:
- Development of anemia (with frequent bleeding);
- Frequent headache;
- Chest pain;
- Neuroses and neurosis-like states due to thoughts of tumor growth, the danger of the disease.
Symptoms of uterine fibroids in the early stages
The first signs of uterine fibroids are usually observed when a woman has a myoma node 2-6 cm in size or more:
- The appearance of sharp pains of a cramping nature not associated with menstruation in the lower abdomen;
- Soreness of menses, although this was not the case before;
- Increased menstrual bleeding;
- The appearance of spotting during the intermenstrual period;
- Heavy bleeding between periods;
- Lengthening or shortening of the menstrual cycle;
- Inability to conceive a child.
Causes of uterine fibroids
Research in the field of medicine allows us to identify several possible causes of the development of uterine fibroids:
- Genetic factor (hereditary predisposition);
- Imbalance in the hormonal sphere;
- Pathological growths of the endometrium (inner lining of the uterus);
- The consequences of multiple or frequent abortions and the use of intrauterine devices;
- Infectious and inflammatory processes of the female genital area;
- Chronic stressful conditions;
- Diabetes mellitus and other endocrine diseases, including obesity;
- The presence of chronic diseases of various internal organs and body systems;
- Lack of regular sex life and sexual satisfaction.
Let's consider some of the reasons in more detail.
Excess estrogen, lack of progesterone. Myoma of the uterus is considered a hormone-dependent disease - a tumor is formed against the background of an imbalance in female sex hormones. Therefore, the development of fibroids is typical for women of childbearing age. Fibroids do not occur in girls before the onset of the first menstruation and in women in the menopausal and postmenopausal period. Studies have shown that the onset, growth and development of a tumor is affected by an imbalance in the production of female sex hormones - estrogen and progesterone.
Violation of the menstrual cycle, in which increased production of estrogen, can lead to the development of uterine fibroids. Obesity exacerbates the risk of developing the disease. adipose tissue also produces estrogen. An increase in estrogen levels leads to a violation of the ratio of hormones estrogen-progesterone in a woman's body.
In addition to increased production of estrogen, metabolic disorders of its synthesis and the balance of its fractions (estrone and estriol) are often observed in different phases of the menstrual cycle. Therefore, if fibroids are suspected, it is important to conduct a hormonal status study.
The number of pregnancies, childbirth, abortion. An important factor in the examination is to find out the total number of pregnancies in a woman, as well as their outcomes - childbirth, miscarriage (abortion). Abortions and miscarriages increase the risk of fibroids. Pregnancies ending in childbirth, especially with subsequent breastfeeding, are reduced.
Traumatic, difficult childbirth, diagnostic curettage of the uterine cavity, frequent and multiple medical abortions (including "mini-abortions") can become the root cause of the development of fibroids.
Woman's nutrition. Unhealthy nutrition also leads to hormonal imbalance. The predominance of refined foods, trans fats in the diet, an insufficient amount of fiber can cause an increase in the formation of female sex hormones and their imbalance. Unhealthy nutrition also leads to obesity, which, as we have already indicated, is a risk factor for the development of fibroids (Read more about what you can and cannot eat with uterine fibroids).
If a woman's diet is balanced, contains a large amount of plant products, seafood, complex carbohydrates (cereals), little fat and sugars, the risk of developing fibroids is significantly reduced. Outwardly, women who eat healthy look young and attractive, they are full of health, strength and energy.
Lack of orgasm during sexual intercourse. The occurrence of uterine fibroids is also influenced by the usefulness of a woman's intimate life. Irregular or rare sexual intercourse, lack of orgasms leads to stagnation of venous blood in the small pelvis. The chronic condition of venous stasis can provoke hormonal instability and the appearance of a tumor.
Diabetes mellitus and hypertension. The risk of developing fibroids is increased by diseases such as diabetes mellitus (a violation of the production of the hormone insulin) and hypertension. The risk increases if a woman becomes ill at a young age, before the age of 35.
Other possible causes of uterine fibroids:
- Apple-type obesity;
- Oral contraception with hormonal drugs;
- Injuries and diseases of the female genital area;
- Prolonged exposure to the ultraviolet spectrum of direct sunlight and in solariums.
Why are uterine fibroids dangerous?
Uterine fibroids pose a danger to a woman's health in terms of the development of complications of the disease. With regular observation by the attending gynecologist and careful attention to her health, a woman can significantly reduce the risk of complications.
Therefore, you should be aware of possible potential problems:
- Massive uterine bleeding is dangerous both in itself as a threat to life and in the development of anemia;
- Torsion of the myomatous node on a thin pedicle. It is fraught with the development of the picture of "acute abdomen". Requires immediate operational assistance;
- Myoma node necrosis. Death of fibroid tissue. More often occurs with involution (contraction) of the uterus after childbirth, before the 40th day. Also requires immediate surgical attention;
- Malignancy of the myomatous node is the degeneration of a tumor from benign to malignant. According to research data, it occurs in 1.5 - 3% of all cases, which does not diminish the danger of complications;
- The birth of a myomatous node with submucous myoma - occurs with inversion of the uterus;
- Violation of a woman's reproductive activity - the development of an ectopic pregnancy, spontaneous miscarriages, premature and complicated labor, infertility;
- The development of purulent processes in the myomatous node and surrounding tissues. Inflammation without medical attention can lead to severe septic complications.
Women diagnosed with uterine fibroids should be monitored regularly by a gynecologist. At the slightest change in your state of health, you need to seek medical help in order to avoid all the listed complications.
On the subject: Uterine fibroids during pregnancy - why is it dangerous? How to treat?
How to treat uterine fibroids?
There are two main treatments for uterine fibroids:
- Conservative treatment - with medications and non-invasive procedures.
- Surgical treatment - through surgery.
The choice of treatment method depends on the severity of the clinical symptoms of uterine fibroids, the size of the myomatous node, the woman's age, and the intention to have children in the future.
The conservative method is based on the use of hormonal drugs by mouth and injection, as well as symptomatic therapy (pain relief, treatment of anemia, reduction of blood loss, etc.).
Conservative therapy is effective only for curbing tumor growth. It is impossible to eliminate uterine fibroids conservatively. Therefore, the non-surgical method of treatment is used mainly in women of older childbearing age. At the same time, the growth of the tumor is inhibited until the onset of the menopausal period. At this time, the likelihood of self-resorption of the tumor is high.
Basic principles of conservative therapy of fibroids
Non-surgical treatment of uterine fibroids is a complex of measures, including adherence to an appropriate diet, the use of immunomodulators, herbal medicine, permitted physiotherapy procedures, and hormonal drugs.
The course of treatment consists of the following stages:
- Anti-inflammatory therapy of infectious processes in the gynecological sphere;
- Activation of the immune system with special drugs;
- Correction of diet and diet;
- Normalization of the endocrine system;
- Formation of an even psycho-emotional background;
- Elimination of bleeding;
- Treatment of anemia;
- Bringing the menstrual cycle back to normal.
When is the operation to remove the uterus for fibroids indicated?
- Tumor sizes from 12 weeks (a bulky tumor squeezes adjacent organs, blood vessels, interfering with their normal functioning);
- Rapid growth of the myomatous node (from 4 weeks per year);
- Myoma is the cause of massive bleeding;
- Severe pain syndrome;
- Torsion of the legs and necrotization of the myomatous node;
- The birth of a submucosal myomatous node;
- The combination of endometriosis and fibroids;
- Suspected malignancy of fibroids.
On the subject: Surgery to remove uterine fibroids - is it needed? Complications and consequences
Embolization of uterine arteries is a modern unique method of treatment of fibroids
In the future, without blood supply, the tumor decreases in size and completely disappears. No relapses were observed after such treatment.
MRI-guided FUS ablation of myomatous nodes is a non-invasive method for treating uterine fibroids. The essence of the method: heating the cells of the myomatous node with the help of a directed ultrasound pulse with the aim of their death.
At the first stage of treatment, the doctor plans the entire process with an MRI examination. At the second stage, while continuing to control the process by means of MRI, the doctor directs ultrasound pulses to the tumor node. The cells of the node are heated to a certain temperature, as a result of which they die. After that, the doctor produces targeted cooling of the tissues. There will be several such short sessions of ultrasound exposure, depending on the size of the tumor. MRI allows you to monitor the degree of tissue destruction and adjust the power of the ultrasound beam.
In general, FUS ablation can take up to 4 hours. The third stage of the procedure is a control magnetic resonance imaging scan using a radiopaque contrast agent.
Advantages of the FUS-ablation method:
- No need for anesthesia, postoperative care, intensive fluid therapy;
- No complications and side effects - blood loss, fever, intoxication;
- Conservation of the uterus and reproductive activity, respectively;
- Short terms of rehabilitation;
- Absence of recurrence of the development of myomatous nodes;
- High efficiency of the method even in the presence of multiple and large nodes;
- Significant reduction in the size of fibroids immediately after treatment;
- Quick relief from unpleasant symptoms of the disease.
During the procedure, the woman needs to lie still. Due to a long stay in the prone position, discomfort may occur in the neck, feet, knees. All changes in your condition should be reported to the nurse and the doctor who is carrying out the treatment.
These symptoms cannot be tolerated:
- Burning or stabbing pains in the lower abdomen;
- Stitching and shooting pains in the back, lower back, sacrum and legs.
On the subject: Treatment of uterine fibroids without surgery - 3 modern methods
Medicines used in the treatment of fibroids
With conservative therapy, several groups of medicines are used. Let's consider each in more detail.
Combined oral contraceptives
Combination of ethinyl estradiol and desogestrel:
Combination of ethinyl estradiol with norgestrel:
Treatment with contraceptive drugs containing a combination of 2 hormones is effective in reducing the severity of pain and reducing bleeding. From therapy with such drugs, one can expect a reduction in the size of only those tumors that initially had a size of up to 1.5 cm (for more details: COC (combined oral contraceptives)).
Gonadotropin-releasing hormone agonists
Drugs in this group:
- Triptorelin (Dipherelin, Decapeptyl, Decapeptyl-depot);
- Leiprorelin (Lukrin-depot);
- Goserelin (Zoladex).
Under the influence of AHRH, the ovaries "fall asleep", ovulation does not occur, the uterine mucosa does not change cyclically - menstruation stops. This process is completely reversible; after drug withdrawal, all functions are restored. Treatment lasts no more than 6 months. During this period, the size of the tumor can decrease by up to 50%, the symptoms of fibroids become less pronounced.
Cons of using drugs:
- Possible complete restoration of tumor size after stopping treatment;
- Long-term (longer than 6 months) drug use is prohibited due to the high risk of osteoporosis and other complications of insufficient estrogen levels.
It is advisable to prescribe AHRH before surgery for uterine myoma in order to reduce the size of the tumor.
Complete list of gonadotropin-releasing hormone agonists
Like GnRH agonists, drugs in this group are used before surgery to remove uterine fibroids. The drug is usually Mifepristone (RU-486).
Under the influence of hormone therapy, myomatous nodes decrease in size, the symptoms of uterine fibroids weaken.
The drugs used:
- Danazol (Danogen, Danoval, Danol, Vero-Danazol).
- Nemestral (active ingredient - gestrinone).
The effect of antigonadotropins is to reduce the intensity of symptoms without reducing the size of the tumor. Often, when using them, unwanted side effects occur (increased hair growth on the face and body, a change in the timbre of the voice, the appearance of rashes).
Antigonadotropins are rarely used to treat uterine fibroids, only in the absence of an effect from treatment with other hormonal drugs.
Currently, the use of gestagens is prescribed for the combination of uterine fibroids and endometrial hyperplasia.
The drugs used:
- Linestrenol (Organometrile, Escluton);
- Nor-ethisterone (Norkolut, Primolyut-nor);
- Medroxyprogesterone acetate (Provera, Depo-Provera).
Recent Research on Drug Treatment of Fibroids
Scientists at the University of Brussels conducted research at the Hospital of St. Luke to understand how the contraceptive drug Esmya works on uterine fibroids. As part of Esmya tablets, the main active ingredient is ulipristal acetate. And since in the process of development and growth of fibroids, the level of not only estrogen, but also progesterone matters, it was decided to study the effect of Esmya and progestogen blockers.
The experiment involved 550 women who were shown surgical treatment of uterine fibroids. All subjects were divided into two groups. One group was given placebo as a "treatment" for 3 months, and the other was given Esmya tablets.
In parallel, another study was conducted: a comparison of the action of Esmya and injections of progestogen hormone blockers.
The results of two experiments revealed the following:
- After using the drug Esmya, the size of uterine fibroids is reduced, the intensity of the symptoms of the disease decreases;
- 90% of the patients studied noted the positive effect of taking Esmya tablets;
- In 50% of patients who took Esmya, the need for surgical treatment disappeared (the effect is similar with the use of progestogen blockers injections);
- After taking Esmya tablets, there are no side effects such as when using injections of hormone blockers - hot flashes, degeneration of bone tissue;
- After 6 months of treatment, no resumption of tumor growth was observed, whereas after the termination of injections of hormone blockers, myomatous nodes began to grow again.
It is likely that thanks to the efforts of scientists, the problem of uterine fibroids will soon be solved much faster and easier than at present.
On the subject: Borovaya uterus and red brush with uterine fibroids
Prevention of uterine fibroids
Since uterine fibroids are an urgent problem, due attention should be paid to the prevention of this disease from a young age. Although there is no unified theory of the occurrence of fibroids, it is worth trying to prevent all possible causes of a tumor.
Stress. To cultivate psychological comfort within yourself is what every woman should strive for. Of course, you will not be able to completely avoid stress. However, you need to learn how to properly respond to conflict situations, not to carry grievances, unspoken claims and long-term experiences in your soul. Learn more about stress and how to eliminate it ➤
Healthy lifestyle. Balanced nutrition, optimal physical activity, sufficient stay in the fresh air, hardening procedures, adherence to work and rest regimes - at first glance, commonplace truths can really help preserve women's health.
Weight control will help avoid obesity, which, as we pointed out, is a risk factor for uterine fibroids. Every extra 10 kg of weight increases the likelihood of developing the disease by 20%.
The diet should include a sufficient amount of fresh vegetables and fruits, whole grains, replace simple carbohydrates with complex ones. Drink plenty of clean water, especially during the hot season.
Regular physical exercise helps to improve the activity of the endocrine system in general and the gonads in particular. The acceleration of blood flow improves the supply of oxygen to the pelvic organs, which improves all metabolic processes in the gynecological sphere.
After physical exertion, it is optimal to carry out water hardening measures - a contrast shower, douches, rubdowns.
Medical supervision. Every woman should be examined by a gynecologist at least once a year, or better - once every six months. If necessary, your doctor will prescribe an ultrasound examination of the pelvis. In no case should such an examination be neglected, based on the fact that “nothing bothers”. Detection of fibroids in the early stages will make it possible to dispense with a non-invasive or conservative method of treatment.
Contraception, family planning. It is imperative to organize rational contraception to avoid terminating an unwanted pregnancy. Contraceptive issues should be discussed with your gynecologist. The use of oral contraceptives is often the best choice, which is another preventive factor against uterine fibroids. You just need to choose the right drug.
With a genetic predisposition to the development of uterine fibroids in a young woman, it is necessary to maintain the first pregnancy.
Childbirth at the optimal age (first - up to 22 years, the second - up to 25, subsequent - up to 35 years) with subsequent breastfeeding reduce the risk of tumor development, and sometimes contribute to the resorption of the existing fibroids. The state of motherhood, lactation period provides not only a harmonious psychological state of a woman, but also normalizes the level of sex hormones in the body.
Harmonious intimate life. Regular, full-fledged sex life with the obligatory achievement of orgasm with each intercourse significantly reduces the risk of developing any tumors of the gynecological sphere, including fibroids. This is due to the acceleration of blood flow throughout the body and in the small pelvis in particular, a comfortable psychological state, increased work of the endocrine system.
"Climate control". All women should remember about the prevention of both general and local (pelvic, thighs, buttocks, feet) hypothermia. Long periods of time in a wet swimsuit should be avoided, as well as sitting on wet ground, stone and other cold surfaces, even on hot days in summer.
Linen should be natural, because synthetic fabrics in the cold contribute to rapid freezing, and in the heat - sweating. Clothing that is too tight and squeezing the body can also disrupt heat transfer.
If symptoms of inflammatory processes (pain, discharge, fever) occur, you should immediately consult a gynecologist to prescribe timely treatment. If you do not pay attention and expect that "everything will go away by itself," you can contribute to the development of a focus of a chronic inflammatory process.
Ultra-violet rays. Women should not abuse exposure to the sun and tanning salons, under the direct rays of the ultraviolet spectrum. Before sunbathing, you must apply a special protective cream to your skin.
Vitamins and trace elements. In addition to eating healthy foods, it is important for a woman to periodically take additional vitamin and mineral complex preparations. Specifically, this step is best discussed with your doctor, who will prescribe a complex containing iodine, iron, magnesium, copper, selenium, zinc, and vitamins A, C, E with antioxidant properties.
Answers to popular questions
Is pregnancy possible with uterine fibroids? Yes, in the presence of fibroids, pregnancy is possible. It all depends on the size of the myomatous node and its location. If the node does not prevent the fertilized egg from passing through the fallopian tube and implanting into the wall of the uterus, pregnancy occurs. The development of pregnancy should occur with regular observation of a woman by an obstetrician-gynecologist.
Is it possible to give birth with uterine fibroids? It is possible, but each case is individual. Your obstetrician-gynecologist should decide on the management of labor (natural or C-section).
Taking birth control pills for uterine fibroids. Since myoma is "younger", and young sexually active women suffer from the disease, the issue of contraception is very relevant. With fibroids, in the absence of individual contraindications, monophasic and combined hormonal contraceptives can be used. Oral contraception helps regulate your menstrual cycle and reduce bleeding.
Is it possible to do massage for uterine fibroids? With fibroids complicated by bleeding, constant pain in the lower abdomen, rapid tumor growth, or suspected malignant degeneration, massage is absolutely contraindicated! For uncomplicated myoma, massage is possible, but excluding the following areas of the body: lower abdomen, lumbar region, thighs, buttocks. Gynecological massage is also contraindicated for any uterine myoma.
Is it possible to sunbathe with uterine fibroids? No, you can not sunbathe in direct sunlight or under solarium lamps. Overheating of both the local area in the lower abdomen and the body as a whole should not be allowed - in order to avoid tumor growth and degeneration.
Is it possible to play sports with uterine fibroids ? In the absence of pain and intermenstrual bleeding, it is possible, but subject to several rules.
You should refrain from:
- Weight lifting exercises;
- Torsion of the hoop with weighting (sand, suction cups);
- Belly dance;
- Using warming belts.
Is contraception possible with a spiral for uterine fibroids? No, the usual spiral cannot be used for uterine fibroids. In the absence of contraindications, contraception is possible with a special Mirena spiral for the treatment of fibroids. A regular coil increases bleeding during menstruation. When using the Mirena spiral, pain during menstruation is completely absent, and bleeding becomes scarce.
How to confirm the diagnosis of uterine fibroids? You should undergo a two-handed gynecological examination with palpation and ultrasound with a vaginal probe. Usually these two methods are sufficient. If necessary, computed tomography, magnetic resonance imaging, biopsy diagnostics, hysteroscopy are prescribed.
Do I need to undergo treatment if there is a small subserous myomatous node of 2 cm? Yes. In any case, fibroid treatment is necessary. In such a situation, conservative methods are shown (without surgery).
Does myoma continue to grow during pregnancy? In the first two trimesters, there is little tumor growth. In the third trimester of pregnancy, the growth of fibroids stops.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.