Uterus fibroma – the benign mature tumor having soyedinitelnotkanny structure and proceeding from uterus walls. Clinical displays of fibroma of a uterus are directly connected with its growth and can include violations of periods, pain and pressure in the bottom of a stomach, dizurichesky frustration, locks, waist pains. Fibroma of a uterus is diagnosed by results of gynecologic survey, ultrasonography, BONDS – gisterosalpingoskopiya, KT and MRT. Treatment of fibroma of a uterus can be conservative (medicamentous), surgical (organ-preserving or radical), low-invasive (endovascular).
Tumors of fibroidny type can arise in various bodies: most often fibromas of ovaries, a uterus, a mammary gland, skin meet. Fibroma of a uterus can be presented by single consolidation or nodal congestions; it grows asymptomatically and gradually. The size of fibroma of a uterus varies from several millimeters till 20-30 and more than a cm in the diameter. Uterus fibromas are almost not inclined to an ozlokachestvleniye.
Types of fibromas of a uterus
Classification of fibromas is based on location of a tumor within a uterus. Submucous fibromas grow in a uterus cavity, under its cover. With a growth of submucous fibroma of a uterus there are spasms and pains, quite often there are severe bleedings. Subserous fibromas are formed outside of a uterus, on its external cover. Fibroidny tumors of this kind of a bessimptomna until grow to the sizes interfering functioning of the next bodies.
Interstitsialny fibromas of a uterus – type of the fibroidny tumors which are formed in walls of body. The gynecology faces them most often. Growth of interstitsialny fibromas leads to increase in the sizes of a uterus. Intercopular fibromas are localized between the supporting uterus ligaments. Removal of such fibroidny tumors is accompanied by high risk of damage of other bodies or blood vessels.
Pedicellate fibromas of a uterus are formed as a result of emergence of a leg in subserous tumors. Growth of pedicellate fibroma of a uterus is followed by an excess of a leg and the most severe pains. Seldom found parasitic fibromas of a uterus are characterized by accession of a fibroidny tumor to other bodies. In certain cases cervical fibroma of a uterus develops.
Reasons of development of fibroma of a uterus
The Etiologichesky moments in development of fibroma of a uterus are definitely not defined. Most of researchers indicates communication of fibroma of a uterus with the increased hormonal sensitivity to estrogen and hereditary predisposition. However even in the presence of these factors fibroma of a uterus can develop not always.
Developing of fibroidny tumors of a uterus is promoted by additional conditions – late approach of menarche, abortion in the anamnesis of the woman, lack of childbirth by 30 years, the complicated childbirth, frequent diagnostic a scraping, reception of estrogensoderzhashchy hormonal means for contraception or treatment of a climax, the accompanying chronic female diseases, lack of regular sex life, etc. As often ekstragenitalny background for development of fibroma of a uterus serves the excess body weight, arterial hypertension, obesity, diseases of a thyroid gland, diabetes, a hypodynamia, stresses etc.
Representatives of negroid race are more subject to developing of fibromas, than women of the European race. Frequency of occurrence of fibroma of a uterus correlates with age: up to 20 years the fibroidny tumor is diagnosed for women in 20%, up to 30 years – in 30%, up to 40 years - in 40% of cases.
Fibromas of a uterus have gormonalnozavisimy character therefore do not develop at girls in premenarche and at women in the post-climacteric period. Growth of the available fibroma of a uterus can amplify with pregnancy development when synthesis of estrogen increases. After the delivery, as a rule, there is a reduction of fibroidny knots to their initial state. In a postklimakteriya with decrease in level of estrogen growth of fibroma of a uterus stops, and it considerably decreases or disappears absolutely.
Uterus fibroma symptoms
At most of the women having uterus fibroma, the disease proceeds without any manifestations and only at 15-25% the clinical symptomatology depending on location of a tumor in relation to pelvic bodies, quantities, the size and the direction of growth of fibroidny knots develops. Existence of fibroma of a uterus can be characterized by plentiful long periods (menorragiya) up to bleedings which lead to anemia. In certain cases bleedings from a uterus have acyclic character (metrorragiya).
Menorragiya are followed by the most severe pains and belly spasms, allocation of blood clots. At pedicellate fibroma of a uterus pain quite often arises also during the intermenstrual period. At uterus fibroma the woman can feel the discomfort or weight in the field of a basin caused by pressure of fibromatous knots upon adjacent bodies. The waist and crotch pains caused by squeezing of the nerves going to the lower extremities are quite often noted.
At uterus fibroma as a result of pressure upon a bladder desires to an urination become frequent; when squeezing a mochetochnik can develop ; pressure upon a wall of a rectum is shown by locks, pain at defecation. The woman with fibroma of a uterus can feel painful feelings at intimate proximity.
Fibroma of a uterus and pregnancy
Small asymptomatic fibromas of a uterus, as a rule, do not interfere with pregnancy emergence. As an exception serve the fibroidny tumors blocking fallopiyeva of a pipe and blocking a way to spermatozoa that makes impossible fertilization of an ovum. Existence of fibroma of a uterus can adversely affect the course of pregnancy. The knots, big by the sizes, reducing free space of a cavity of a uterus do not allow an embryo to develop fully. Such fibromas of a uterus can become the reason of late abortions or premature birth with the birth of the premature child.
Large fibromas of a uterus can cause the wrong provision of a fruit that not only complicates the course of pregnancy, but also makes heavier the rodovy act. In such cases Cesarean section is quite often made. The heaviest and dangerous to patrimonial process is existence of cervical fibroma of the uterus creating an obstacle for pass of a head of the child and threat of the most severe bleeding. Conducting pregnancy at women with fibroma of a uterus requires special attention and the accounting of all possible risks.
Diagnosis of fibroma of a uterus
Initial detection of fibroma of a uterus usually happens on consultation of the gynecologist. At a two-handled vaginal research the uterus of a dense consistence increased in sizes decides on a hilly surface. By means of transvaginal ultrasonography of a small pelvis the uterus fibroma arrangement, its sizes, density and the relation to the next structures is specified, differentiation from an ovary kistoma is made.
X-ray or OUSE-gisterosalpingoskopiya allows to define presence of submucous fibroma of a uterus at an endometrialny hollow. At spontaneous bleedings during the intermenstrual period the separate diagnostic scraping or a biopsy of endometrium with a histologic research of fabrics is made for an exception of cancer of uterus.
For final confirmation of the diagnosis of fibroma of a uterus and its distinction with uterus sarcoma, fibroma and kistomy an ovary carrying out MPT or KT is shown. Resort to a diagnostic laparoscopy at impossibility to distinguish uterus fibroma from an ovary tumor by noninvasive methods. On the basis of set of diagnostic data tactics concerning uterus fibroma is defined.
Treatment of fibroma of a uterus
All women having uterus fibroma are subject to observation of the gynecologist or gynecologist-endocrinologist. Small asymptomatic fibromas of a uterus demand control in dynamics. Tactics of expectation can be shown to patients of preklimakterichesky age. Conservative therapy is justified at the uterus fibroma sizes less than 12 weeks of pregnancy; subserous or interstitsialny arrangement of knots; absence meno-and metrorragiya, pain syndrome; protivopokazannost of surgical tactics. Medicamentous therapy at fibroma of a uterus includes reception of NPVP, medicines of iron, vitamins, hormonal means.
The basis of conservative treatment at fibroma of a uterus is made by hormonal therapy various groups of medicines. For suppression of synthesis of yaichnikovy steroids at fibroma to a uterus derivatives of androgens can be used (, ). Androgens accept a continuous course up to 8 months therefore the sizes of fibroma of a uterus can decrease. Application of gestagen (a didrogesteron, a noretisteron, progesterone) allows to normalize growth of endometrium at hyper plastic processes. Efficiency of gestagen concerning fibroma low therefore their reception can be justified in case of small fibroidny tumors of a uterus with the accompanying endometrium giperplaziya. The course of treatment of a gestagenama lasts up to 8 months.
Good results of treatment of fibroma of a uterus are shown by use of the intrauterine hormonal system of Mirren containing gestagenny hormone levonorgestret. Regular release of hormone in a cavity of a uterus interferes with growth of fibroma and renders contraceptive effect. Application the COOK (an ethenylestradiol + , an ethenylestradiol + ) effectively slows down growth of small fibroidny knots (to 2 cm). Treatment of fibroma of a uterus the combined medicines is carried out not less than 3 months.
Use of analogs of GNRG (a gozerelin, a buserelin) is directed to achievement of a gipoestrogeniya. As a result of their regular reception inflow of blood to a uterus and fibroidny knots decreases that causes reduction of the sizes of fibroma. Efficiency of therapy by analogs of GNRG is reversible as after the termination of their application knots reach the initial size in 4-6 months. In gynecology analogs of GNRG are often used in the preoperative period for the purpose of reduction of the size of knots for their easier removal. Side effects from these medicines include inflows, a pseudo-menopause, dryness of a vagina, instability of mood, development of osteoporosis. Surgical treatment of fibroma of a uterus is expedient with a submukozny growth, the expressed clinical symptomatology (bleedings, pains, a sdavleniye of the next bodies), big nodal formations, a fibroma combination to endometriosis or tumors of ovaries, a necrosis of fibroidny knot.
The conservative miomektomiya vaginal, laparoscopic or laparotomny access belongs to organ-preserving interventions at fibroma of a uterus. During operation the enukleation of fibroidny knot at preservation of a uterus is made. At a submukozny arrangement of knot resort to a gisteroskopichesky miomektomiya without cuts via the channel of the flexible optical hysteroscope. Organ-preserving operations are whenever possible performed to the women planning the subsequent pregnancy. Nadvlagalishchny amputation of a uterus or a full hysterectomy belongs to radical methods of surgery of fibroma of a uterus. Removal of a uterus can be executed through a vagina, laparoscopic or open access and is shown to the patients who are not planning the birth of children.
Modern method of treatment of fibroma of a uterus is the embolization of uterine arteries. As a result of endovascular occlusion of the vessels feeding uterus fibroma blood supply is blocked and growth of tumoral knot stops. Embolization of fibroma of a uterus is minimum aggressive and highly effective technique. In certain cases for treatment of fibroma of a uterus the ultrasonic ablation (FUZ) – "evaporation" of knot by high-frequency ultrasound under control of MRT is used.
Complications and the forecast at uterus fibroma
Growth of fibroma of a uterus can be followed reabrupt knot legs, a knot necrosis (is more often submukozny or interstitsialny), hemorrhage. Pereknut legs of fibroma proceeds with clinic of "a sharp stomach". At a necrosis pains, fever, a softening and morbidity of knot develop. The probability of malignant regeneration of fibroma of a uterus is extremely insignificant and does not exceed 1%. At the expressed bleedings fibroma of a uterus causes development of anemia.
The complications connected with expeditious treatment of fibroma of a uterus include post-operational infections, bleedings, a spaykoobrazovaniye in a small basin, formation of intrauterine sinekhiya. Pregnancy after a conservative miomektomiya arises at 40-60% of patients. Also carrying out organ-preserving interventions does not exclude development of new fibroidny knots.
Prevention of fibroma of a uterus
Specific methods of prevention of fibroma of a uterus do not exist. Nevertheless, the exception of provocative factors (abortions, uncontrollable reception of contraception, chronic inflammations, ekstragenitalny diseases, etc.) allows to reduce probability of a disease of uterus fibroma.
As effective way of prevention of fibroma of a uterus serves regular visit of the gynecologist and passing of ultrasonography.