Uterine fibroids

Uterine fibroids - a benign tumor composed mainly of connective tissue fibers, which is formed on the walls of the uterus. The medical literature also called uterine fibroid uterine leiomyoma. Uterine fibroids - the most common pelvic tumor. As already mentioned, the size of the fibroids can be different (from 1 mm to 20 cm in diameter).

Fibroid tumors can grow as actually in the uterus and on the outer shell. Uterine fibroids observed in 20% of women of childbearing age and 40% of women older than 30 years. Fibroid tumors do not occur in young girls before the start of the menstrual cycle, as well as in post-menopausal women. By the way, the likelihood of fibroid tumors in representatives of blacks is higher than that of Caucasian women.

Growth accelerated fibroid tumors during pregnancy, when a woman's body increases the production of estrogen.

Fibroid tumor growth also contributes to the pills with a content of estrogen to prevent or treat pregnancy menopause. The probability of occurrence of climacteric age fibroma negligible because menopausal estrogen levels naturally decreases, which prevents the growth of fibroid tumors, so that even existing tumors may gradually decrease and disappear.

Types of fibroid tumors

• Submucosal fibroids: uterine lining grows under, inside its cavity, most likely to cause severe bleeding. The growth and the movement of submucosal fibroids cause pain and cramping.
• Podseroznaya fibroma: formed on the outside of the uterus, and sometimes even on the growing of other small fibroids. Podseroznye fibroids did not have an effect until the start to grow and hinder the normal functioning of other organs.
• Interstitial fibroids: fibroids the most common type, is formed in the wall of the uterus. Interstetsialnye fibroids grow, thereby causing an increase in uterine The increase in the uterus - when the rate goes into pathology .
• Mezhsvyazochnaya fibroma: growing towards localization between the ligaments that support the uterus in the abdominal cavity. This fibroid tumors are difficult to remove without damaging other organs or blood vessels.
• Stalked fibroids: formed when the tumor appears podseroznoy leg. During the growth of fibroids stalked twisted and cause severe pain.
• The parasitic fibroma: The most common type of fibroids rarely occurs when fibroid tumors attached to any other body.

Symptoms of fibroid tumors

• Excessive or abnormal bleeding
• Severe pain during menstruation
• Abdominal cramps and pain in the abdomen Abdominal pain: when to sound the alarm?   menstruation
• The feeling of pressure or heaviness in the abdomen
• Because of pressure on the bladder frequent urination
• Feeling of fullness or bloating
• Soreness in the intimacy.
• Heavy menstrual bleeding and / or allocation of bloody clots
• Sudden or severe pain, indicating the presence of stalked fibroids
• Frequent urination, or pain when urinating
• If the fibroid tumor grows in the direction of the back, there are strong pain and constipation.

Treatment of uterine fibroid tumors

Treatment fibroma determined depending on the size and growth rate of the tumor.

• Women suffering from severe cramps and pain associated with menstruation, receiving prescribed painkillers.
• To slow tumor growth and reduce menstrual bleeding by receiving contraceptives.
• Women suffering from heavy menstrual bleeding, prescribed iron supplements to prevent anemia.
• In rare cases, prescribe hormone therapy reduces the level of estrogen Estrogen - the key to bone health   in the body. However, hormone replacement therapy has a number of side effects such as decreased bone density, which may lead to osteoporosis, vaginal dryness and hot flushes.
• Removal of fibroid tumors in the uterus used Hysteroscopic resection. In the uterus through the cervix introduced microchamber and surgical instruments, in which the tumor and remove.
• Hysterectomy - a radical way to treat fibroids, because in the process of surgery, the uterus is removed completely.
• Embolization (occlusion of the vessel) to stop blood flow fibroid tumor, which prevents further growth.
• Myomectomy - fibroid tumor removal procedure without removing the uterus Hysterectomy (removal of the uterus) - a terrible need . Myomectomy is recommended for women who are going to conceive and give birth to a child after removal of fibroids.

How to conduct a survey and treat

When an internal endometriosis was widespread method of diagnosing an ultrasound scan TVS transvaginal probe. This study has great diagnostic capabilities, allows us to refine the localization process. Can effectively evaluate the treatment on the basis of the dynamic monitoring of the uterus, which is clearly seen using Doppler blood vessels of the uterus.

Diagnosis

Confirm the diagnosis of adenomyosis helps hysteroscopy Hysteroscopy - examination of the uterus inside . When imaging the uterus can see the characteristic features of adenomyosis:

• endometrium is uneven contours
• the presence of uneven surface of the mucosa as crypts of various cellular structures or irregularities. Even after the removal of a special instrument functional layer is no alignment surface
• the emergence of "points" or "gaps" that resemble cells from which blood flows. This is clearly seen after the test oxytocin, when administered intravenously a solution of oxytocin and pronounced blood flow occurs from "points"

If the pathological process is common, it is important to evaluate the condition of having an anatomical connection with the uterus. It is important to select the further treatment strategy when planning surgery. With high precision allows us to give a description of established pathological process method of computed tomography (CT), MRI technique. Status of the mucous of the uterus is well visualized by MRI, so it is necessary to include in the plan a comprehensive survey.

There laparoscopic diagnostic sign of adenomyosis Symptoms of adenomyosis - characteristic and recognizable   - "Marble" of the uterus. You can also find other manifestations - specific pockets of white and red color, the presence of glandular bulging or yellow-brown spots of irregular shape. Using endoscopic technology makes it possible not only to confirm or rule out the presence of endometriosis, as well as in the future to restore a woman's reproductive health.

Proven clinical cases of adenomyosis require treatment, which consists of several stages. After the relief of symptoms of the disease to restore a woman's fertility, her menstrual function, to carry out prevention of recurrence. The main method of medical treatment is hormone therapy. While receiving hormonal therapy is the development of atrophic phenomena directly in endometriosis. If the disease is characterized by widespread over, while there is a high risk of subsequent relapse, use combination therapy with hormonal and surgical treatment. It is recommended that hormone therapy as a preoperative preparation, as this will help to reduce the severity of pathological formations and makes maintenance an operation.

Preparations for the treatment of endometriosis uterus

The question of how to approach the selection of a drug, assign the appropriate procedure to be determined not only the clinical picture and age limits and the presence of comorbidities (gynecological diseases combined with adenomyosis Adenomyosis - avoid constant stress   and somatic disorders). Independent method of treatment is to use oral contraceptives, or COCs. This method is particularly recommended for young women. It confirmed the effectiveness of low-dose preparations of the last generation, "Silest" "Marvelon", "Janine", "Yasmin". The positive results of treatment can be expected only after long-term use of drugs for six months to one year. Receive Mode hormones selected individually, the standard scheme is that the patient must take pills for 21 days followed by seven days to make a break.

Effectively the appointment of hormonal agents from the group of progestogens, which include dydrogesterone, medroxyprogesterone. The daily dose of dydrogesterone may be up to 30 mg per day. In the treatment of adenomyosis Adenomyosis - treatment should be individualized   mode should be selected taking the drug from 10-11 to 25 day cycle. If injections of medroxyprogesterone deposited, they do once every two weeks at a dose of 150 mg. Optimal treatment progestogen should be at least nine months.

The first is side effects associated with the hypoestrogenic state. The developing shortage of sex hormones should be compensated for conducting hormone replacement therapy. If a woman is appointed for a long period of therapy agonists, it is necessary to pay attention to the appearance of complaints of "hot flashes", palpitations, mood changes, or urogenital disorders. To eliminate the effects hypoestrogenic appointed replacement therapy tibolone (CW one tablet per day).

For the majority of patients is the most convenient mode of application of GnRH agonists. The formulations are produced in the form of injections (intramuscular or subcutaneous injection), which are administered only once every 28 days. Intramuscularly injected "buserelin" at 3, 75 mg. Subcutaneously can be used "goserelin" at 3 and 6 mg. Results of therapy are evaluated not earlier than after 3-6 months. The duration of hormone treatment should be strictly differentiated for each clinical case.

If, after completion of a course of treatment, the patient complaints persist persistent pain, there are symptoms of neighboring organs, it is necessary to appoint a consultation of experts of related disciplines (urologist, gastroenterologist, psychiatrist) .  Severe pain that is not relieved by conservative treatments, is an indication for hospitalization and surgical intervention of .  Even after adequate removal of endometriosis there is a risk of re-development .  In this regard, it is important to promptly appoint a rehabilitation treatment in the postoperative period .  This treatment consists of physical therapy to normalize the circulatory and metabolic processes improve tissue regeneration processes, as well as immunostimulatory therapy, hormonal treatment to restore the two-phase loop .  On the success of combination therapy influences the prevalence of adenomyosis, the severity of changes .

Marina Solovyov