What is fibroid and why does it appear?
Myoma develops from one altered muscle cell of the uterine wall, which begins to divide and forms a node. Nodes can be single or multiple, ranging in size from a few millimeters to large formations that deform the uterus.
The growth of fibroids depends on female sex hormones, primarily estrogen and progesterone. That is why it develops during reproductive age, can increase during pregnancy and, conversely, usually decreases after menopause, when hormonal levels change.
- Age 35–50 years—the period of highest detection frequency
- Heredity: fibroids in a mother or sister increases the risk
- Obesity - adipose tissue produces additional estrogens
- Lack of labor and late first birth
- Early onset of menstruation
- Chronic inflammatory diseases of the pelvic organs
- Multiple intrauterine interventions and curettages
- Diabetes mellitus and arterial hypertension
Types of knots: why location is more important than size
- Submucosal (submucosal) - grows inside the uterine cavity. Even a small node of this type causes heavy bleeding and interferes with pregnancy
- Intramural (intermuscular) - located in the thickness of the wall; the most common option, symptoms depend on size
- Subserous (subperitoneal) - grows outward; does not cause bleeding for a long time, but if it is large, it compresses neighboring organs
- Knot on the leg - can twist with the development of acute pain
- Cervical node - located in the cervix, less common
Symptoms
- Heavy and prolonged menstruation, often with clots
- Bloody discharge between periods
- Anemia: weakness, fatigue, shortness of breath, pallor, hair loss
- Drawing pain or feeling of heaviness in the lower abdomen
- Abdominal enlargement with large nodes
- Frequent urination due to pressure on the bladder
- Constipation due to pressure on the rectum
- Pain during intercourse
- Difficulty getting pregnant and miscarriage
- Very often - complete absence of symptoms; the node is found by chance on an ultrasound
Diagnostics
- Examination by a gynecologist - an enlarged tuberous uterus is determined by bimanual examination
- Ultrasound of the pelvic organs, preferably transvaginal - the main method: number, size and location of nodes
- Hysteroscopy - examination of the uterine cavity from the inside; indispensable for submucosal nodes
- Hysterosonography with contrast to assess cavity deformation
- MRI of the pelvis for multiple nodes and planning surgery
- Complete blood count and ferritin - assessing anemia
- Pipelle biopsy of the endometrium or curettage in case of bleeding to exclude endometrial pathology
- Tumor markers and MRI with rapid growth of the node - to exclude a rare malignant tumor
When to treat and when to observe
Observation with control ultrasound every 6–12 months is quite justified if the nodes are small, do not grow and do not give symptoms. This is not “inaction”, but a reasonable tactic.
- Treatment is required for heavy bleeding and anemia
- With rapid growth of nodes
- For compression of the bladder or intestines
- With severe pain syndrome
- For infertility and miscarriage associated with a node
- With a submucosal location of the node
- In case of necrosis of the node or torsion of the leg - urgently
- When a node grows during menopause, it requires special attention and exclusion of a malignant process
Treatment methods
- Drug therapy - control of bleeding, correction of anemia, hormonal drugs; often used as preparation for surgery to reduce a node
- Intrauterine hormonal system - for heavy bleeding without deformation of the uterine cavity
- Hysteroscopic myomectomy - removal of the submucosal node through the vagina, without incisions; selection method for this arrangement
- Laparoscopic myomectomy - removal of nodes through punctures while preserving the uterus; main organ-preserving method
- Laparotomy myomectomy - for multiple and very large nodes
- Embolization of the uterine arteries - cessation of blood supply to the node
- Hysterectomy - removal of the uterus; discussed in case of multiple large nodes, heavy bleeding and in women not planning pregnancy
- Treatment of anemia with iron supplements is a mandatory part of preparation
Fibroids and pregnancy
- Many women with fibroids become pregnant and give birth without complications
- Submucosal nodes and nodes that deform the uterine cavity reduce the likelihood of pregnancy and increase the risk of miscarriage
- During pregnancy, nodes can increase under the influence of hormones
- Possible pain if there is a malnutrition of the node
- The location of the node influences the choice of method of delivery
- After myomectomy, pregnancy is planned after a period set by the doctor - the scar on the uterus needs time
- During laparoscopic myomectomy with opening of the uterine cavity, the method of delivery is discussed in advance
Where are uterine fibroids treated in Tashkent
High-quality ultrasound, hysteroscopy to assess the uterine cavity, and a surgical service proficient in organ-preserving techniques are required.
In Tashkent, examination and treatment of uterine fibroids, including laparoscopic and hysteroscopic myomectomy, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Take previous ultrasound reports for your appointment: the dynamics of the size of nodes over a year or two often turns out to be a decisive argument in favor of observation or, conversely, surgery. Clinic contacts are below on the page.
