myoma node - is formed of smooth muscle and connective structures in the uterine wall of the formation of benign origin.Contrary to popular belief, very, myoma node has only a few signs of a true tumor, but in fact is not. correct to correlate it with the tumor-like formations.For example, the true tumor myoma node distinguishes his close association with the level of hormones (particularly estrogen), and a unique ability to self-regress.
Since fibroids are associated with estrogen levels, often diagnosed during their most hormonal activity of the ovaries."A favorite" age fibroids is the period from 20 to 40 years, among other age groups, they are less common.
emergence of a modern, high-precision diagnostic equipment turned fibroids in frequent disease (30% of patients with gynecological diseases).However, the fact of myoma node does not necessarily imply the need for serious treatment.Argued that the fibroids can be formed and regress on their own, many, including gynecologica
under investigation are the reasons for the formation of fibroids in the uterine wall.One of the reasons for establishing the adequacy of myoma node is considered to be hormone dysfunction.Increasing the amount of estrogen stimulates the growth nodes and estrogen deficiency in menopause leads to their reduction.Against the background of menopause, when hormonal ovarian function completely extinguished, fibroids often disappear for good.
To understand the mechanism of the formation and growth of myoma node, you must submit, how to construct the uterine wall.It creates three layers:
- Outdoor (perimeter) serous layer.Covers the uterus from the outside, it is similar in structure to the peritoneum;
- Internal (endometrium) mucous layer.Lining the uterine cavity from the inside, it is presented in layers spaced rows of squamous epithelium.The functional layer (the one that is on the surface of the uterine cavity) of the endometrium is closely linked to the cyclical hormonal changes monthly and is undergoing processes of rejection and recovery.
- Medium (myometrium) muscle layer.The thickest, and a thick layer of the uterine wall.In fact, a big muscle with a very complex structure.
myometrium is the birthplace of the myoma node.The size of myoma node does not always match the clinical picture, but it is always taken into account when deciding on surgery.
in the uterus often there are multiple nodes, each of which may vary as the stage of development and the type of growth.Growth of fibroids is an important diagnostic criterion.
to select treatment policy is important not only to the growth rate of the node, but also its location.Resulting in the myometrium node can stay in the myometrium, and can begin to grow in the direction of adjacent layers uterine wall.
When myoma nodes may experience menstrual irregularities, pains of different nature, infertility.Often, there are no clinical manifestations.The symptoms of myoma node no different specificities, so accurate diagnosis can be delivered only after additional instrumental examination (ultrasound, giteroskopiya).
Treatment of fibroids has a large number of options and a dynamic range from simple observation to surgery.
Nascent myoma node
All fibroids initially formed in the muscle layer, so their structure is dominated by modified smooth muscle cells and connective tissue.Expanding and condensing, the node can start a "move" in the direction of the uterine cavity.As a result, the localization myoma node changes.When the myoma node is located in the submucosal layer, called submucous.
Submucosa localization of myoma node refers to the most unfavorable clinical situation.Regardless of the size and growth rate of submucous nodes already in the early stages of development provoke vivid clinical picture and cause serious complications.
submucous myoma node bulges into the uterine cavity and deforms it.Menses become painful and heavy.Eventually, when a node becomes large, cyclical menstruation lose.
Long and heavy menstrual bleeding is also triggered by a violation of the tone of the muscular wall of the presence in it myoma node.
presence in the uterus submucous myoma node very short time remains asymptomatic, then it is perceived as the queen of a foreign body.Reflex uterus tries to get rid of it by means of enhanced rate.As a result, there are strong cramping, similar to birth pangs, and the node, like the fetus, pushed out, accompanied by heavy bleeding.Metaphorically this situation is described as "birth" of myoma node.The patient's condition requires immediate hospitalization and surgery.
serious consequences submucosal myoma node can be avoided if the time to diagnose its presence in the uterus.As a rule, primary diagnosis of submucous nodes begins by asking the patient and palpation of the pelvic region.The increase in size of the uterus, its contours and uneven density change indicate the potential presence of fibroids.However, palpation signs are always indirect, as they can not determine the exact location of nodes.Reliable information is provided by ultrasound, which determines the deformation of the uterine cavity and the presence in it of nodal education.
subserous myoma node
About subserous (subperitoneal) myomatous site say when he begins to rise from the opposite side of the uterus.More than half of all occurring fibroids (55%) have subserous location.
Formation node begins at the border of the myometrium and external, serous, endometrium, and then, as they grow, knot rushes toward the abdomen.
distinctive feature subserous fibroids is their weak link with the muscular wall of the uterus.Often intensive growth occurs already subperitoneal nodes and connects them with the myometrium a thin, long base - leg which promotes high mobility unit.In the case of torsion legs myoma node occurs Clinic "acute abdomen", coupled with the excruciating pain and a sharp deterioration in health.If the zone is broken leg power, develop necrosis of myoma node.Necrosis causes suppuration and tissue destruction in the node area appear not only acute pain, but the signs of infection and inflammation.Necrosis myoma node of any location (including podbryushinnye) results in purulent fusion uterine structures and the formation of cysts uterus.
Big size subserous myoma node reaches rare, half of the patients it is a very long period of time is small, not manifesting itself clinically and diagnosed by chance.The other half of the patients podbryushinnye nodes, expanding, covering pererastyagivayut of serosa, thereby provoking a constant aching pelvic pain, worse during menstruation.
Menstrual function when subserous location fibroids violated only if they are of considerable size.As a rule, there are heavy menstruation.
Located outside of the uterus, myoma subserous node in the event of a significant size, may interfere with the adjacent organs: the bladder in front and the rectum behind the uterus.
Diagnostics subserous myoma node starts with palpation of the pelvic region.It may be found to increase the density of the uterus, the deformation of its outer contour.If a node has a leg, it can be moved at a palpation.Small fibroids on a broad basis, usually not palpable, but their presence indicates asymmetry uterine contours.
more precise information on the localization of myoma node subserous offered an ultrasound scan.The screen is well visualized well-rounded education is displaced, having the uterus overall unbroken loop (that is tightly knit with it), if there is a thin legs - without the effect of "growing" in the muscle wall.
For more accurate information on the state of the uterus and surrounding structures can be performed laparoscopy.The method allows to directly view the uterus outside and make a differential diagnosis subperitoneal myoma node and a tumor of the ovary.
interstitial myoma node
When developing myoma node only grows within the muscular wall of the uterus, it is called interstitial.It is not often there are situations when the initial interstitial myoma node, reaching a significant size, is able to leave the myometrium.
interstitial myoma node grows long and often does not manifest clinically.It can be diagnosed by chance.Intramuscular nodes do not have legs and almost not subject to the degradation of the power failure, however complications in the form of torsion base and / or necrosis they are unusual.
Located in the muscular wall of the uterus, interstitial myoma node distorts its contractile function.As a rule, lose the old uterine wall tone, and muscle contractions do not occur simultaneously.Therefore, when menstruation Maintenance of rhythm are more abundant and longer.
massive blood loss during menstruation may trigger the symptoms of anemia.There is a weakness, dizzy, she tires easily.
As a rule, the nature of the menstrual function affects the size of myoma node: the higher, the more pronounced menstrual changes.Also, depending on the size of the node pain: if the site is large, there are aching and indistinct pain.
number of fibroids is not inferior to the significance of their value.Multiple units, even small dimensions are able to stretch the cavity and increase the surface area of the uterus, but it also provokes the most menstrual blood loss.
Large single or multiple small fibroids of the uterus and increase the value of its weight, than increase the burden on the ligaments.Supporting the uterus ligaments stretch "potyazhelevshy" uterus, appear persistent pain of varying intensity.
Unfortunately, if the interstitial myoma node "matures" slowly, the first symptoms of dull unheeded.Changes in menstrual function and not strong pain patients correlated with benign causes and eliminate them (often successful) on their own.
intramural myoma node
term "intramural", like most medical definitions, comes from the Latin word forms intra (within) + murus (wall), localization involves something in the wall of a hollow organ.
intramural fibroids are diagnosed more frequently hosts other sites.They can be single or multiple, small or large in size, as well as combined with other localization of myoma nodes.
terms "intramural" and "interstitial" essentially identical and applied to myoma nodes denote the same - their location within the muscle layer of the uterine wall.
So everything said about interstitial myoma nodes, intramural applied to nodes.
problem influence fibroids on reproductive function, and their associated effects on the ability to conceive or bear it.And, more important is not the very existence of myoma node, and its size and location.
If the nodes are located in the corners of the uterus, they can become a mechanical obstacle to the promotion of a fertilized egg in the uterine cavity, and is located in the posterior uterine wall assembly prevents its proper implantation.When the egg is attached below, closer to the cervix, the pregnancy is terminated well before the due date.
If the uterus has multiple small fibroids, often they do not complicate pregnancy and childbirth.But large single myoma node during pregnancy is able to provoke a lot of negative effects: miscarriage or early delivery, bleeding during delivery or after, late placental abruption.
intramural myoma node during pregnancy behave ambiguously.Since the beginning of pregnancy, the ratio of sex hormones change, and in the tissues of the uterine wall begin structural changes.In the first eight weeks of pregnancy may increase myoma node, and then stop the growth or even significantly reduced in size.
disappearance fibroids during pregnancy is possible if the basis is the excess of estrogen, during pregnancy with hypoestrogenism nodes begin to decrease.
Sometimes the disappearance of fibroids in pregnancy is not associated with their re-development, and to the uterine wall stretching when nodes are stretched with the myometrium, and not visible by ultrasound scan.As a rule, the second scanning of the uterus after childbirth can be detected again.
Treatment and removal of myoma node
size, location and growth of fibroids are taken into account when choosing treatment strategies.
Contrary to erroneous opinion of many patients, fibroids do not operate always.Also they are not always subjected to any other treatment.Small knots asymptomatic with no signs of rapid growth sometimes observed for many years, and by the end of hormonal ovarian function in elderly patients they own diminish and disappear.
Conservative therapies take into account the origin of the myoma node.Drug treatment is advisable in uncomplicated sites, not exceeding 3 cm. If the patient refuses surgery can be treated nodes and a little bigger.
The most popular method is hormone therapy.The treatment regimen and a list of medications are always individual, as counted hormones, the immune and endocrine systems, the presence of complications.Hormonal treatments are chosen so that they can mimic normal menstrual cycle.For this purpose, we used progestins (Duphaston, Progesterone, Utrozhestan and the like), combined estrogen-progestin drugs (Jeanine, Yasmin, and the like).After 45 years, when the menstrual function keep the netselessobrazno, use androgens.
terms of treatment depend on the specific situation, but having a positive effect in six months is necessary.If not, you should consider another treatment option - surgery.
So when require surgical treatment of fibroids?
1. If submucous location nodes.
2. When the size of the uterus greater than those in the 13-week pregnancy.
3. No effect on previously conducted hormone.
4. nodes too quickly grow (the uterus is increased for the year by more than four weeks' pregnancy ").
5. There are large subserous nodes (one or more).
6. Do myoma node has a long leg.
7. The nodes are present signs of twisting the legs and / or necrosis.
8. If the localization of nodes provokes infertility.
In any surgical treatment of the surgeon seeks to preserve the uterus and remove only the node itself, but in menopausal uterus is removed, along with the nodes.
After surgery, treatment does not end there.If the cause of the nodes in the womb is not removed, they will appear again.