Embolization for uterine fibroids treatment of uterine applied relatively recently, from the late 90s of the last century. This technique is most effective in the treatment of small submucous and intramural fibroids - uterine fibroids decrease in size and do not grow. At the same time restores woman's menstrual cycle and are in pain.

Embolization of uterine fibroids - what is it?

Correct this method is called uterine artery embolization (UAE). This method has been used for over 30 years to stop uterine bleeding Uterine bleeding outside of menstruation - a sign of a serious breach Developing after childbirth and gynecological operations. For the treatment of uterine fibroids, NASA used it more than 20 years ago, and in Russia to this end, ESA officially applied since 1998.

EMA method is that by introducing into the uterine artery occlusion special particles are those of its branches that carry blood to the fibroids. This effect is possible because the blood supply is from leiomyomata their particular network environment vessels having a larger diameter than the vessels that carry blood to the surrounding healthy tissue tumor.

Following occlusion of these vessels gradual replacement by connective tissue uterine tissue while decreasing its volume. Formed connective tissue has no tendency to sprawl, on the contrary, during the following year significantly reduced the tumor. Small tumors are quite.

How is the procedure

Carrying EMA requires special skills, so vascular surgeon carried out under the control angiography (X-rays of the arteries) and under local anesthesia. The upper thigh make mini-puncture of the skin and are administered through the femoral artery of a special catheter. Under the control of X-ray TV installation catheter is advanced into the uterine artery and through it entered mikrochastichki substance plugging the lumen of blood vessels that feed tumors. The procedure is performed, first the right and then the left, and lasts an average of no more than half an hour.

Therapeutic effect

A few days after the procedure, the women are pain and vaginal bleeding (both related and not related to the menstrual cycle). Gradually decreases and after a few weeks of fully taper off symptoms of compression fabrics - urinate is free and painless, are pain during bowel movements, symptoms of hemorrhoids, constipation, gradually improving digestion. All these symptoms usually disappear within six months after the UAE. Pronounced symptoms of compression of the tissues tested a year later, when the volume of large fibroids decreased an average of four times, and small knots disappear completely.

Recurrence of the disease after UAE, in most cases do not arise. Unfortunately, there is little experience in applying this method to the treatment of women of reproductive age. In particular, do not set the degree of risk of infertility after such treatment of fibroids, so in most cases experts are hesitant to use it to treat women who want to have children later.

Indications and contraindications for the procedure, uterine artery embolization

The procedure is indicated for embolization of uterine fibroids, which are accompanied by uterine bleeding and pain, symptoms of compression of the surrounding tissues, while asymptomatic fibroids, fibroids in women who for health reasons is contraindicated surgery, when a woman has contraindications for hormone replacement therapy Hormone therapy - is it possible to fool nature? . EMA is also carried out to reduce the size of fibroids prior to myomectomy and conservative in multiple uterine fibroids Multiple uterine fibroids - a frequent phenomenon   women who want to restore or preserve their reproductive function (if the alternative is removal of the uterus).

Contraindications for uterine artery embolization are: infectious and inflammatory processes in the uterus and pelvic organs, pregnancy, cancer, fibroids subserous on thin long leg (there is risk of falling necrotic node in the abdominal cavity). Submucosal fibroids on thin legs are a relative contraindication, as the more reliable is their removal using a hysteroscope.

Do not use if you are hypersensitive EMA radiopaque substance, impaired renal function, and increased tortuosity of blood vessels through which the catheter must penetrate into the uterine artery.

Side effects

During the procedure, the EMA side effects usually do not happen. A few hours after the procedure, there are severe pain in the abdomen Abdominal pain: when to sound the alarm? Associated with fibroid tissue death. Pain can last a few hours, but well removed pain medication. For the same reason, women may be somewhat understood the temperature, general weakness and malaise. All these phenomena take place throughout the day.

Sometimes (quite rarely) a woman for six months after the EMA appear menstrual disorders and even complete absence of menstruation (amenorrhea), but it goes with the times.

Galina Romanenko

One of the important diagnostic method that is used in gynecology, colposcopy is. This endoscopy allows a survey of epithelium and detect the presence of lesions. In a specialized office that deals with problems of diseases of the cervix and other parts of the reproductive system, a woman can be counseled professional expert on the issue, which shows a colposcopy, and pass the corresponding examinations.

The objective and purpose of colposcopy

Method colposcopy refers to endoscopy. Used special binocular optical system with a lighter, whereby the objects under study can be viewed at a magnification of 30 times. As with any diagnostic method, colposcopy Colposcopy - how to prepare it properly?   It has its own goals and objectives:

• first of all a method of screening cancer pathology (primary and secondary)
• identification of pathological changes in the external parts of the reproductive system, clarification of their nature, location
• confirmation of the need for further, more in-depth study, for example, carrying out a morphological study (histological and cytological methods)
• accurate detection of abnormal area from which to take the material for the study (biopsy, conization)
• the ability to determine the further treatment tactics and choose the method of treatment
• the ability to dynamically monitor the process of treatment and evaluation of its effectiveness
• monitoring of women who are at increased risk of cancer pathology of the reproductive system, with premalignant, background diseases

During the colposcopy, the doctor is able not only to detect the presence of lesions, but also to evaluate the dynamics of their development, assess the effectiveness of remedial measures.

Diagnostic value of colposcopy method

Features colposcopy differ depending on what kind of research has been applied. During the simple colposcopy can be done only tentative conclusion. The expert determines the shape, size, surface of the neck, the border between the epithelium (the distinction cylindrical and squamous epithelium) and evaluates the vascular pattern. You can also take the material for cytological examination of the diseased area and the material for culture and microscopy studies. More extensive diagnostic capabilities of different extended colposcopy Extended colposcopy: detailed analysis of . While this method of treatment of cervical produce special "markers" that is, solutions that allow you to do a variety of diagnostic tests.

To better visualization was colposcopic pictures, it is recommended to use different color filters .  To study the state of the epithelium fit blue and yellow filters, and for studying the vascular pathology is better to use a green filter .  The use of special fluids during colposcopy is of great importance for the diagnosis of pathological conditions in the neck .  Such solutions are a solution of acetic acid and 3% Lugol .  When applied to the neck of the acetic acid solution from the observed reaction vessels are narrowed .  If the neck has a malignant process, the newly formed vessels will have the muscle layer, so they will not respond to the effects of acetic acid .  The reaction in this case is considered negative .  This diagnostic test allows you to identify the various malignant neoplasms, it is mandatory during the extended colposcopy .

The test can reliably determine the localization of the pathological process and to clarify the boundaries of destruction, while the nature of the changes can not be differentiated. Lugol solution when applied to the neck causes staining multilayered epithelium in particular a dark brown color. This is due to the rich content of glycogen in the epithelium. If the neck lesion of epithelium occurred, then there will be a reduced amount of glycogen and this will lead to a brighter staining pathological epithelium portion. The light colored area is called yodnegativnym, and the sample is considered positive. Conducting such a study makes it possible to identify areas of the epithelium affected by the malignant process, as well as areas that are typical of precancerous cervical disease. If during colposcopy were found pathological changes characteristic of cancer Breast cancer - the verdict? , It is possible to carry out a more in-depth study using dyes. In this case, the sample used hematoxylin. In the presence of malignant process will be observed staining of pathological areas in the intense blue color. This makes it possible to accurately determine the outer boundaries of a diseased area.

Using the method of colposcopy can be carried out histological examination of cervical mucous membrane in vivo. This was made possible thanks to the introduction of another species method called kolpomikroskopiey. It allows us to estimate the increase in the state under the epithelium, as well as the elements located under the epithelium. Without prejudice to the integrity of the cell composition, you can examine on the structure of tissues, which helps in the process of diagnosis.

Marina Solovyov