Uterine fibroids is a benign hormone-dependent formation of the uterus that develops from muscle tissue in the form of a myomatous node. Uterine fibroids account for 30% of all gynecological diseases. Given the fact that the trigger for the growth of the myomatous node is the excessive production of estrogens in the female body, it is women of reproductive age who are most susceptible to the formation of uterine fibroids. The peak incidence occurs at 30-45 years, while about 20% of women who have reached the age of thirty are diagnosed with uterine fibroids. But you should not be afraid, since malignancy of the tumor occurs in less than 1% of cases. However, a large myomatous node can negatively affect the patient's quality of life.

Reasons for the formation of mymatous nodes in the uterus

The hormonal factor is the main etiological aspect of the development of uterine fibroids. Excess secretion of estrogens in the female body leads to morphological changes in the myometrium. Its mass increases due to hyperplasia of smooth muscle cells or their proliferation. An important role in the development of myomatous nodes is played by changes in the body's immune system, especially in the presence of chronic infectious diseases. Genetic predisposition and changes in pelvic hemodynamics also play a role in the occurrence of uterine fibroids. Phenotypic transformation of cells and degenerative changes play a significant role in the increase in the size of myomatous nodes, provided that microcirculation is disturbed.

Classification of uterine fibroids: main types of myoma nodes

Depending on the location and type of growth of myomatous nodes, they are divided into two types, each of which may or may not have a stem on which the tumor grows:

  • submucous (submucosal) myomatous nodes that grow into the uterine cavity, thus deforming it;
  • subserous (subperitoneal) myomatous nodes growing towards the abdominal cavity.

There are three types of uterine fibroids according to morphological features:

  • simple uterine fibroids that develop as benign muscular hyperplasia;
  • proliferating uterine fibroids - have no more than 25% of pathological mitoses;
  • presarcomas - uterine fibroids, which have the greatest tendency to malignancy.

Given the fact that growing uterine fibroids can reach very large sizes, and thus mimic pregnancy, the diagnosis must indicate which week of pregnancy corresponds to the size of the uterine fibroids.

Clinical picture of uterine fibroids: characteristic symptoms

In the early stages, with small sizes of myomatous nodes, the symptoms of the disease may be absent. As the size of the myomatous node increases, there are complaints of discomfort in the lower abdomen, a feeling of heaviness, periodic pulling or aching pain, and an increase in the size of the abdomen. Submucosal myomatous nodes deform the uterus and lead to menstrual dysfunction, patients complain of prolonged heavy menstruation, intermenstrual bleeding from the genital tract. Subserous myomatous nodes of large size can disrupt the functions of neighboring organs, there are complaints of dysuric manifestations or impaired defecation. If there is a torsion of the leg of the myomatous node and a violation of its blood supply, as a result of which the node becomes necrotic, a characteristic clinical picture of an acute abdomen appears.

Instrumental methods for diagnosing uterine fibroids

The main diagnostic method of uterine fibroids is considered to be ultrasound. With ultrasound, myomatous nodes are visualized as round or oval formations located in the uterine cavity, or beyond its outer contour. Myomatous nodes often have a layered structure and a pseudocapsule, which is formed due to compaction and hypertrophy of the myometrium. Such a diagnostic method as Dopplerography allows you to evaluate the features of blood circulation in the myomatous node. Computed and magnetic resonance imaging makes it possible to differentiate a benign uterine formation from a malignant one. Diagnostic laparoscopy is performed if non-invasive diagnostic methods turned out to be uninformative. In case of menstrual irregularities in patients with uterine myoma, hysteroscopy is performed, but on condition that

Conservative and surgical treatment of uterine fibroids

Conservative treatment of uterine fibroids is carried out in order to stop the growth of the myomatous node, to treat menometrorrhagia and, as a result, anemia. 19-norsteroid derivatives are prescribed, under the influence of which uterine fibroids can decrease by 1-2 weeks of pregnancy. Antigonadotropins and GnRH agonists are also able to stop the growth of myomatous nodes. Another effective conservative method of treating uterine fibroids with small sizes of myoma nodes is the Mirena hormonal intrauterine system, which is installed in the uterine cavity for 5 years, and provides a regular supply of a hormonal drug that produces a local therapeutic effect on the endometrium of the uterus. Surgery is indicated for large, rapidly growing myomatous nodes, as well as violations of their power when twisting the legs of the node. The volume of surgical intervention is determined individually, depending on the size and characteristics of the myomatous node, and varies from organ-preserving operations to radical extirpation of the uterus with appendages. Nevertheless, the benign nature of the formation causes a favorable prognosis for the life and working capacity of the patient.

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