Hysteromyoma - hormone-dependent tumor is benign (node), arising from the uterine wall smooth muscle structures.Uterine fibroids certainly has the appearance of a tumor, but also different from that, therefore correct to correlate it with tumor-like formations.Significant characteristics of uterine fibroids are its high quality, hormone-dependent and the ability to self-regress.
«Beloved" age fibroids account for 20-40 years.Rare disease called uterine fibroids is not possible, the last time she is diagnosed in 30% of patients with gynecological diseases.To the assertion of some experts that the uterine fibroids "younger" and has become increasingly apparent, should not be treated with unconditional acceptance.It is possible that such statistics is not only connected with a true increase in the incidence, but also with a change in the mentality of patients: women have become more attentive to your body, take preventive examinations.Also on the increase in the number of detecte
To have a true idea of uterine fibroids should be aware of its structure.The uterus is designed to implement unique and very important function - procreation.Its structure allows to increase during pregnancy, many times, to keep the fruit of many months and push it out when it is fully formed.
most powerful and thick middle layer of the uterine wall - the myometrium.It forms three layers of smooth muscle fibers that are intertwined and form the spiral turns.To enhance the muscular uterine carcass and to ensure its higher extensibility and elasticity in the myometrium woven fibers and elastic connective tissue elements.
From inside the uterine cavity is lined with mucous membrane - the endometrium.This is where the processes take place monthly growths and subsequent rejection of the participation of ovarian hormones - estrogen and progesterone.
Outdoor durable serosa uterine wall perimeter protects the uterus from external influences.
Fibroids uterine body is born in the myometrium as a nodule.Fibroids are both single and multiple, small or large.Most in the womb there are several units of different sizes, and sometimes location, then it is called uterine fibroids.
localization of uterine myometrium is not limited, as the nodes at growth can overcome the boundaries of the muscular wall, others grow into the uterine layers.In rare situations, fibroids becomes atypical form, lying in the tissues of the cervix, uterine ligaments between the wide and even peritoneum.
Causes of uterine fibroids continue to be studied and refined.The only reliable sign of uterine fibroids is its close relationship with hormonal dysfunction that increases the amount of estrogen.Dishormonal Like any process capable fibroids decrease symmetrically reduce the amount of estrogen and menopause when estrogen practically absent, it often disappears.
clinical manifestations of uterine fibroids do not have clear criteria.The disease often do not have subjective symptoms and are diagnosed by chance.On the severity of symptoms in uterine fibroids affect the value and the number of nodes, their location and the presence of concomitant adverse background.
relatively unfavorable situation is considered to be a combination of uterine fibroids and pregnancy.The presence of large nodules in the myometrium changes the strength and contractility of the muscular layer, which is fraught with complications during pregnancy and childbirth.Uterine fibroids small size is good "gets" with pregnancy and threatens her.
diagnosis of uterine fibroids is not difficult.It begins with the usual examination and ends instrumental methods of examination.
Although the word "tumor" in the definition of fibroids, treatment strategy is not limited to surgical methods.Small, uncomplicated myomas with a favorable localization respond well to conservative therapy.Complicated uterine fibroids are less common, particularly in recent years when the diagnostic methods have improved, and patients are examined on a regular basis, allowing to diagnose the presence of fibroids and prevent negative consequences.
patient, obtain the opinion of the presence of fibroids in the uterus should not be afraid.With due respect to the doctor's with this form you can live a lifetime or even get rid of it, since the treatment of uterine fibroids without surgery possible.
to indicate uterine fibroids using several terms that sometimes can "confuse" patients.In fact, the name is changed according fibroids its inner cellular structure.If it is formed mainly muscle fibers, say myoma.When it has a significant amount of connective tissue elements, it is called a fibroid.In fact, an important part of the clinical significance of fibroids has not, since any kind of histological it diagnosed and treated equally.
In recent years, due to the use of high-precision diagnostic equipment, began to be used frequently, the term "fibromatosis of the uterus."It is the presence of precancerous changes in the uterine wall, that is the initial stage of the formation of uterine fibroids, which are not always transformed into the actual fibroids.
Causes uterine fibroids
Hormone nature of uterine fibroids is recognized as the most accurate, it is confirmed by numerous clinical cases of simultaneous diagnosis of the presence of fibroids and hormonal dysfunction.When there is hormonal balance throughout the cycle, with the constant increase of FSH and LH and persistent anovulation, the amount of estrogen is stored permanently high and progesterone concentration becomes lower.This means that most of the causes of hormonal disorders may also be a source of uterine fibroids.
Proper hormonal balance in the body is maintained by a complex interaction of brain structures, ovaries, uterus, immune and endocrine systems.Therefore, conventionally mechanisms of fibroids can be classified into:
- Central.Associated with dysfunction of the cerebral cortex, that is, of "the pituitary gland - the hypothalamus."Pronounced stress, cardiovascular disorders, neurological disorders and acute infections can distort the normal function of the ovaries of control, causing hormonal disruptions.
- Ovarian.Fibroids uterine body is not formed in the short-term changes in the normal operation of the ovaries, but the long-term ovarian dysfunction on the background of an infectious inflammation, cystic growths leading to persistent anovulation followed giperestrogeniey.
- Uterine.To the queen to "recognize" the hormones in the endometrium have special nerve endings (receptors) that can perceive them.Damage to the receptors perceiving progesterone leads to undue influence of estrogen on the uterus.Such violations can be provoked abortion or diagnostic procedures in the uterine cavity, chronic inflammation (endometritis) or hypoplasia (underdevelopment) of the uterus.
There is a probability of occurrence of uterine fibroids, after abortion, incorrectly performed hysteroscopy traumatic removal of intrauterine device, diagnostic curettage, biopsy and similar traumatic events.Injury uterine wall leads to local upsetting the surrounding tissue, reducing inflammation and local immunity.
Among pregnant uterine fibroids diagnosed infrequently (0.5 - 6%).In the first two months of fetal development changes the ratio of hormones and structural changes occur in the womb in the form of endometrial growths.All this stimulates the growth of fibroids.
task of disposing of excess estrogen is assigned to the liver.For serious liver pathologies where there is an infringement of this function may develop hyperestrogenia.
confirmed significant part of heredity in the formation of uterine fibroids.In patients with a family history of fibroids are often present gormonalnozavisimyh gynecological pathologies associated with giperestrgeniey.
Despite the close relationship with uterine fibroids dyshormonal disorders, it occurs far not every patient with hormonal dysfunction.Therefore, the search for other nodes in the mechanisms of the myometrium, especially combinations thereof proceeds.
Signs and symptoms of uterine fibroids
impossible to give exact symptoms that indicate the presence of fibroids in the uterus.The clinical picture is influenced by many factors and conditions.Contrary to popular belief about the decisive importance of size and number of fibroids in the clinical picture, the primary factor is their location.
Initially, all nodes appear in the myometrium and through several stages:
1. Formation.Near the small vessels of the myometrium appears hotbed of enhanced proliferation of muscle cells.
2. Maturation.Formed "glomerulus" small quantities (less than 3 cm) from the muscle bundles extending in different directions.Gradually unit is sealed and increased, and around the surrounding tissue of the elements appears a kind of capsule.At this stage, there is an intensive growth of uterine fibroids.
3. «Aging" node.Active growth of fibroids is not, but there are degenerative disorders within the assembly.
increase in tumor size is not always clear, therefore, stands:
- Simple uterine fibroids.Slow growing and malosimptomno uterine fibroids small size, often the unit.Often simple fibroids are diagnosed by chance.
- proliferating uterine fibroids.It grows rapidly, provoking clinical manifestations.Diagnosed as multiple uterine fibroids or uterine fibroids large unit.
node type of growth in the diagnosis of fibroids is very important, since the size of uterine fibroids for operations are one of the primary criteria.
uterine fibroids can be formed at different depths in the muscular wall of the uterus.Depending on the location of single or multiple fibroids classified:
- interstitial (intramural) arranged in the muscle thickness (40%);
- submucous protruding into the lumen of the uterine cavity and deforms it (5%);
- subserous, protrude from the outer wall of the uterus toward the peritoneum (55%).
not often have fibroids mezhsvyazochnoe location where the node is located between the sheets of a broad uterine ligament.Atypical location of uterine (cervix, retroperitoneal area) is extremely rare.
Multiple uterine fibroids does not appear overnight, the formation of all the nodes is slow and does not amount to each of them.Therefore, while in the uterus may be present fibroids in various stages of development and in different locations, and the clinical picture of the disease is made up of symptoms provoked by each node separately.If the most typical, interstitial, location of fibroids in the uterus comes another node, but in the submucosal layer, quiet clinical picture may acquire characteristics of an emergency.
Multiple uterine fibroids with interstitial localization of small units for a long time can not disturb the patient.
Despite the diverse and mixed clinical picture of uterine fibroids may isolate some of the most commonly observed symptoms of patients:
- Menstrual dysfunction.Most often it appears on the initial stage of tumor formation in the form of longer and more plentiful monthly (giperpolimenoreya).Such violations do not lead the patient to the doctor, especially if they are not accompanied by other negative symptoms, do not break the habitual rhythm of life and self-cropped reception styptic.Over time, menstrual disturbances become more pronounced: bleeding is an acyclic nature, and a significant amount of blood loss reaches, causing anemia.
on menstrual disorders affect the location of fibroids.Subserous uterine fibroids usually do not affect the nature of menstruation.Interstitial fibroids menstrual cycle does not change, but located intramuscularly large uterine fibroid prevents proper reduction of muscle tissue and provokes heavy menstruation.
submucosal fibroids location is considered to be the most unfavorable.Bulging into the uterine cavity, uterine it deforms significantly reduces uterine tone and at the early stages of provoking heavy bleeding that eventually losing cyclicity.
- Pain.Uterine fibroids may be accompanied by pain of diverse intensity and localization.Interstitial fibroids larger with slow growth causing dull aching pain, and submucosal sites often cause severe cramping pain.
irradiation of pain associated with the localization of fibroids.They can be projected on the area of the bladder, lumbar rectum.When blood circulation in the unit, followed by tissue necrosis his pain is so pronounced that resemble hospital acute surgical pathology ("acute abdomen").
- Violation of the adjacent organs.Placed in the uterus nodes lead to an increase in its dimensions.Therefore, the uterus begins to push located near the bladder and rectum, causing its dysfunction.
- Infertility.Uterine cancer is due to the potential development of primary and secondary infertility.It is associated not only with the existing hormonal changes, but also with a mechanical obstacle for normal conception and gestation produced myoma nodes.
presence of fibroids in the uterus may be suspected in the presence of the above complaints.At gynecological examination revealed an increase in the size of the uterus and changing its density.Sometimes she palpated "lumpy" by located outside subserous nodes.
essential diagnostic aid has an ultrasound scan.It determines the change in the size and density of the uterus, the presence of nodes and their location, endometrial and uterine cavity deformation.
Often, ultrasound and pelvic examination is sufficient for setting the correct diagnosis.However, if the examination reveals endometrial hyperplastic processes, there is a need to clarify the nature of the changes in the mucous layer.Perform diagnostic fractional scraping the uterine cavity with subsequent laboratory study of the material obtained.
list of diagnostic measures depends on the type of uterine fibroids and its location.You can use a hysteroscopy, metrosalpingography (ISG) for a more detailed study of the state of the endometrium, as well as ultrasound.
subserous fibroids often difficult to distinguish from ovarian tumors without laparoscopy, which allows you to view all the pelvic organs and detect any abnormalities.Sometimes patients call this method "laparoscopic uterine fibroids."This definition is not entirely correct, because laparoscopy involves inspection of the entire pelvic area when examined not only the fibroids but also the surrounding tissues and organs.When people talk about a laparoscopy, in order not to list all the structures around it, using only the name of the method.Instead, the phrase "laparoscopic uterine fibroids" literate say "laparoscopy".
For proper tactics subsequent treatment of uterine diagnosis involves search for the cause of development, therefore, regardless of the characteristics of the tumor, always conducted the study of hormonal status of patients screened for the presence of an infectious inflammation of the genitals.
subserous uterine fibroids
When subserous (subperitoneal) location of fibroids begin to develop in the myometrium at the border with the serous membrane and then increasing to form protrusions at the side of the abdomen.For subserous nodes typically lack ingrowth of muscle layer in the base, as they grow in the side of it.Therefore, they often have a thinner base - leg.