Uterine fibroids - a benign tumor is hormone-dependent (node) in the muscle layer of the uterus.The term "fibroid" means that the tumor consists mainly of connective elements.Like any other hormone-dependent diseases, uterine fibroids tends to regress in the waning hormonal function and tends to worsen during pregnancy.Small fibroids may slow its growth or regress at menopause.
uterine wall is formed by three layers:
1. The outer layer, the perimeter is a serous membrane;
2. The middle layer, the myometrium, form three layers of smooth muscle fibers: external longitudinal (podserozny), middle circular and inner longitudinal (submucosal).Unequal stratified arrangement of muscle fibers provides a good uterine contractility and strength.In addition to the muscle cells that are present in the myometrium and the elements of the elastic fibers of the connective tissue;
3. The inner layer of mucous membrane.
Uterine fibroids formed in the muscle layer (myometrium) of the ute
presence of fibroids is associated with changes in the level of estrogen in the blood, which proves that the hormonal nature of the disease.
disease occurs in the form of formation of single or multiple units of different sizes.Initially, these sites are located in the thickness of the uterine wall, can then either continue to develop within the muscle layer, or start to grow in the direction of the other layers of the uterine wall.In the majority of cases of uterine fibroids is represented by multiple units having different size and even location.In this case, talking about the nodal uterine fibroids.
Uterine fibroids is the leader among all the pathologies of the uterus in young women (30%).The largest number of cases between the ages of 20 - 40 years.Increasing the number of reported uterine fibroids due not only to the growth of the disease, but also the fact that the modern methods of diagnosis, especially early, are much more perfect.They allow you to detect the presence of small knots in the muscle wall of the uterus, which do not disturb the woman.
In very rare cases, fibroids may have an atypical location of sites where the process involved surrounding anatomical structures.Because atypical forms found fibroids cervical mezhsvyazochnaya (tumor grows between the sheets of the broad ligament of the uterus) and retroperitoneal fibroids.Uterine fibroids
relates to diseases with a very wide range of symptoms: localization and size of knots and their cellular structure and growth rate of clinical manifestations.
Uterine fibroids combines the features of the tumor, while differing from it.One of the most important features is its goodness, i.e.fibroids do not degenerate into a malignant tumor.
clinical manifestations of uterine fibroids are a very wide range - from asymptomatic forms of the disease before the state of emergency requiring immediate surgery.Among all the cases accounted for the largest proportion of asymptomatic, low-symptom and uncomplicated.
unfavorable fact is the presence of uterine fibroids in pregnant women.The presence of nodes in the uterine wall violates the contractile function of the myometrium, complicates the process of carrying a pregnancy and can lead to complications during childbirth.
diagnosis of uterine fibroids is not difficult and begins with a pelvic exam.This pathology does not threaten the lives and health of patients.Modern methods of diagnosis and treatment provide a favorable prognosis.
Causes uterine fibroids
only reliably established cause of uterine fibroids is the imbalance of hormones.The leading role belongs to increase the concentration of estrogen with a decrease in progesterone.
According to the hormonal theory of the origin of uterine fibroids, any situation that leads to a hormonal imbalance may be a precipitating factor.
There are three possible options for the development of the pathological process in uterine fibroids:
1. The stock option.In women with normal ratio of sex hormones cause of the disease may be a violation of proper operation of the uterine receptors responsible for the perception of progesterone.The quantitative ratio changes toward the hormones estrogen.Such violations may result from abortion, the inflammatory process in the uterus (endometritis) or hypoplasia (underdevelopment) of the uterus.
2. Ovarian option.In inflammatory diseases of the ovaries, cystic changes, broken processes of normal hormone production.Ovarian dysfunction may cause the occurrence of uterine fibroids.
3. The central option.If it affects the central nervous system dysfunctional disorder may occur in the pituitary - hypothalamus, responsible for the regulation of hormonal processes in the body of a woman.Stressful situations, vegetative-vascular disorders, neurological disorders and other similar reasons can lead to uterine fibroids.
Hormonal imbalance can be caused by diseases of the liver, which is responsible for the disposal of hormones or hormonal changes in ovarian function.
Any extragenital pathology, leading to disruption of normal production of hormones in a woman's body can become the starting point of education uterine fibroids.A role in the occurrence of tumors plays a hereditary factor and immune disorders.
Uterine fibroids can occur after abortion, hysteroscopy, dilatation and curettage of the uterus, traumatic removal of intrauterine device, biopsy and other events of this kind.Aggressive gynecological manipulations can disrupt not only the structure of the uterine wall.When intrauterine intervention occur metabolic disorders, distorted local immunity develop inflammation.All these factors can trigger the appearance of uterine fibroids.
During the development of uterine fibroids goes through several stages, is a sequence of structural changes:
- Formation of rudiments fibroids: processes of active proliferation (proliferation), cell elements, at this stage the tumor is less than 3 cm in size;
- Stage of maturation: increase and growth of the muscle cells, leading to an increase in units and completion of their development;
- Stage "aging": the nodes occur degenerative processes of strong growth there.
Uterine fibroids has no clear growth and development.All the processes in step maturation have different degrees of activity, which defines disease clinic.By the nature of proliferation (growth) tumors secrete two options:
1. Simple fibroids - slowly growing, malosimptomno tumor;
2. proliferating fibroids - a rapidly growing, multiple, symptomatic tumor.
Thus, hormonal imbalance is the main cause of uterine fibroids, and especially the process of its formation and development, and determine the clinical outcome of the disease.
Symptoms of uterine fibroids
clinical picture of uterine fibroids depends on a number of factors and conditions.The most significant of these are: age of the patient, the presence of extragenital diseases, background processes, the immune and hormonal systems, especially the development of components and their location.
By the nature of the growth nodes distinguish diffuse and nodular uterine fibroids.
important criterion is the localization process:
- Interstitial location of the nodes: the process takes place within the muscular wall of the uterus.It occurs more often than other forms and is considered to be the most favorable.
- subserous (subperitoneal) location of the nodes: the pathological process develops under the serous membrane and goes into the abdominal cavity;
- submucosa (submucosal) location of the nodes is the most unfavorable.The uterine cavity is deformed due to growing within her unit.
- Mezhsvyazochnoe (between the sheets of the broad ligament of the uterus) location of the tumor;
- Atypical fibroids: cervical, mezhsvyazochnaya, retroperitoneal.
Nodal uterine fibroids gradually formed and takes the form of multiple nodes, differing degrees of maturity and localization.The clinical picture is always determined by the total set of clinical signs of individual units.For example, when the location of the interstitial sites in the uterus may see a node in the submucosal layer and change the whole picture of the disease.
Uterine fibroids present with pain of different localization and severity of a violation of the normal rhythm of menstruation, bleeding, and abnormalities in the adjacent organs.
pain in uterine fibroids has varying degrees of severity, depending on the localization of nodes and processes occurring in them.The most intense pain cramping in nature (especially during menstruation) cause submucous nodes.If the node is localized subperitoneal, a woman may experience constant aching pain due to irritation of nerve endings of the peritoneum covering the fibroids.Large tumors usually result in more pronounced clinic, they occur degenerative changes that trigger the appearance of pain.Irradiation of pain depends on the location and size of knots.If the node is located in the front wall of the uterus, pain may occur in the projection of the bladder to the rectum projected pain at the location of the nodes in the back wall of the uterus.
change in menstrual function as a result of knots in the uterus is manifested in the form of uterine bleeding.In connection with the growth of the nodes in the myometrium uterus loses the ability to full reduction, menstruation becomes long and abundant.During this period, women often do not seek medical attention, as the process is compensated, and bleeding on their own end.If the nodes continue to rise, increases blood loss, joining signs of anemia - general weakness, dizziness, decreased performance, makes women worry and consult a gynecologist.Location determines the nature of the bleeding sites.The most favorable is subperitoneal position fibroids without causing heavy bleeding.
When the location of nodes in the submucosal layer in the initial stage of their development the bleeding becomes heavy, long and painful.Increasing in size, submucous node distorts the uterine cavity, there are acyclic bleeding.
The submucosal fibroid uterus grows in a knot "on the leg", this process is called "birth."During the birth of the node can reach the cervical canal and disclose it, the process is accompanied by sharp pains, profuse bleeding, infection of the uterus.If the foot is twisted knot, there is malnutrition tumor arises Clinic "acute abdomen", which requires emergency surgery.
Fibroids cervix has supravaginal location and cause deviations in the normal operation of the bladder (frequent urination, discomfort) and rectum (difficult bowel movements).Menstruation when fibroids cervical extended, can be painful.
menopause fibroids are rare.Often during this period fibroid shrinks or is experiencing a complete regression.In the case of hyperplastic processes in the uterus, especially when combined with ovarian tumors, units continue their development, which is extremely unfavorable situation in terms of the development of cancer process in the uterus.
In the current statistics of the various clinical forms of fibroids leading low-symptom, uncomplicated tumor.When patients go to the doctor in time, it can prevent undesirable consequences.
Uterine fibroids during pregnancy
combination of uterine fibroids with pregnancy is unfavorable.For most women, fibroids do not have a serious impact on the pregnancy.This can be explained by the young age of expectant mothers implies a small, "young", fibroids are not likely to cause serious complications.The largest number of pregnant women with uterine fibroid are under the age of 30 years, and half of these pregnancies first.
spontaneous abortion (miscarriage) occurs in 5 - 6% of pregnant women.The main obstacles to carrying a pregnancy when fibroids are:
- lack of ability of the uterus to retain the fetus.Located in the muscular layer of nodes cause the uterus loses its ability to "right" contract and trying to get rid of early pregnancy.
- Eating disorders and necrotic processes in the nodes.
- placentation (attachment of the ovum) at the location of a large assembly.The blood supply to the fetus can not be done correctly.
Uterine fibroids is causing incorrect position of the placenta and fetus in the uterus.
Pregnancy in women triggers a series of changes (including hormonal) that can change the state of fibroids.Adequate assessment of these changes helps to assess the chances of a woman to continue the pregnancy.
Pregnancy in women with fibroid can be saved if the unit does not exceed 10 cm, located in the uterine wall, it does not deform the cavity and does not interfere with the development of pregnancy for more than 22 weeks.An important criterion is the lack of eating disorders unit.
for up to 12 weeks, an indication for abortion is an abortion begun or unwillingness of women to bear a child in the face of such pathology.If uterine fibroids growing rapidly and begins to interfere with the development of pregnancy, in this period it is advisable to terminate the pregnancy and spend myomectomy (removal of uterine fibroids) is pregnant.
important point is the woman's consent to termination or continuation of the pregnancy.If a woman is categorically refuses to terminate a pregnancy, even with large amounts of tumor try to keep the pregnancy.
Removing fibroids of the uterus of a pregnant woman is extremely difficult to perform, so this manipulation performed in rare cases.Absolute indications for myomectomy are emergencies (bleeding, inflammation, "acute abdomen"), in all other cases the decision is made individually.
Uterine fibroids can lead to negative developments in labor: a violation of uterine contractions, bleeding, incomplete placental abruption.With a high probability of complications in childbirth a woman may be asked to surgical delivery.
Any operation in the uterine fibroids during pregnancy carries a high risk.If a woman with fibroid planning a pregnancy, you must advance to make the necessary examination and assess the chances of success.In some cases, should be treated, including operative to future pregnancy was successful.
diagnosis of uterine fibroids
diagnostic search begins with a study of patient complaints.Attention should be given the changing nature of menstruation, check the availability and nature of pain.What matters is the presence of comorbidities.
gynecological bimanual (two-handed) study, a doctor can determine the size of the increase in the uterus, detect the presence of assemblies.An important indicator is the rate of tumor growth.For this conduct annual inspections on a certain day of the menstrual cycle and comparing the size of the uterus.Dimensions uterine fibroids evaluate similar size during pregnancy.For example, after the examination the doctor can make a conclusion: Uterine fibroids corresponds to 8 - week pregnancy.If during the year the uterus changes its size by up to 4 weeks, talk about slow growth, an increase of over 4 weeks points to rapid growth.
inspection of the cervix in the mirror can reveal the presence of submucous node in the cervical canal.To clarify the diagnosis colposcopy.