Uterine fibromyoma is one of the most common benign tumors in women. The frequency of occurrence is strikingly high – every fourth woman over 30 years old and every 30% woman of pre-menopausal age has this pathology. Approximately every second patient of the Department of Operative Gynecology undergoes a planned surgical intervention for uterine fibroids.
Uterine fibromyoma or, more precisely, leiomyofibroma is a tumor of the smooth muscle tissue of the uterus with a pronounced connective tissue component. Myoma (leiomyoma) of the uterus in its pure form is not common. So, fibromyoma with nodes located in the middle part of the myometrium has a ratio of muscle and connective tissue parts of 2: 1 and more resembles a true myoma. In the subperitoneal nodes of fibroids, this ratio is 1:3.
The reasons for the development of fibroids include , first of all, the stimulating effect of the hormonal background on the myometrium. It has been established that an increased estrogen background is not observed in all patients, but with all this, a violation of estrogen metabolism and the function of the corpus luteum develops, a change in the sensitivity of the uterus to the action of hormones.
A certain role in the occurrence and development of uterine fibroids is played by disorders in the hypothalamus – pituitary gland – ovaries – uterus. Although there are few specific data in this regard, most authors agree that from the onset of puberty to the onset of menopause, the level of estrogen in the blood increases by about 3 times, and this factor should be considered, if not causal, then one of the important starting points. Heredity also matters, i.e. in families where there were fibromyomas and polycystic ovaries, the risk of developing fibromyomas in direct relatives is much higher.
The development of uterine fibroids is most often characterized by the formation of multiple nodes of various sizes. Single nodes are not common. The most frequent localization of the nodes is along the midline, near the tubal nodes and the lateral sections of the cervix, where there are close interweaving of muscle fibers. Quite often, the knot begins to grow inside the muscle layer. Outside the uterus, fibroids often grow on a muscular stalk. Sometimes the leg is so thin that it can twist and cause complications in the course of the disease. Simple fibroids, proliferating fibroids and presarcoma are traditionally stages in the development of a malignant disease – sarcoma, and therefore timely treatment of fibroids is the most effective way to prevent the development of leiomyosarcoma.
The clinic depends on the type of tumor growth, its localization and some other factors. With a slow growth of nodes, the disease can proceed for years without any manifestations, despite the rather large size of the fibromyoma at the time of its detection. The rapid growth of the tumor gives more pronounced symptoms, so such patients enter the surgical department after 1–2 years from the onset of the disease.
Patients consult a doctor when they detect bleeding, anemia associated with it, pain in the lower abdomen, symptoms from the bladder and other neighboring organs. Bleeding traditionally manifests itself in the form of heavy periods (with clots, more than 5 days), but then can be transformed into cases of bleeding outside of menstruation.
With a long course of the disease, ovarian dysfunction is observed up to the absence of ovulation or a violation of the function of the corpus luteum, which leads to even more pronounced hormonal changes. These shifts are considered a stimulating factor in the development of ovarian cystic changes, as well as endometrial hyperplasia. With the onset of menopause, there is a decrease in the size of the tumor. If the size of the tumor for a year increases by 5 weeks of pregnancy, then a thorough examination will be necessary to exclude the malignant transformation of fibroids into sarcomas.
The diagnosis can be made without difficulty already during a traditional gynecological examination. If submucosal fibromyoma is suspected, a hysteroscopic examination (examination of the uterine cavity) will sometimes be necessary. Of great importance in the diagnosis are the means of medical imaging, among which the leading place is given to ultrasound. Magnetic resonance imaging, X-ray and some other methods are also used.
Mostly surgical. Today they try to use organ-preserving operations. However, with the rapid growth of the tumor, suspicion of malignancy, large volumes of the tumor, radical operations are performed: amputation of the uterus, hysterectomy.
But modern surgery is able to remove even large fibroids laparoscopically, which creates additional chances of treatment for the doctor and patient. Sometimes you can do without surgery. In these cases, drug inhibition of tumor growth is carried out due to complex treatment with hormonal and non-hormonal products.