Uterine myoma treatment

Uterine myoma (UM) — benign myometrium neoplasm. It`s spherical, well-limited and occurs predominantly in reproductive age.

The exact reason is unknown. Nodes evolve from a single mutated cell that actively divides, forming a nodule. The nature of UM is multifactorial and related to:

• Genetic changes and hereditary factors. The chance of getting UM in women, whose sisters and mother suffer from this disease is 33% higher,
• Dyshormonal disorders of female sex hormones,
• Chromosome level lesions,
• Inflammatory foci formation in myometrium caused by urogenital infections.

Risk factors for appearance of UM include:

• Childbearing age, pregnancy absence, late childbirth, abortion, miscarriage,
• Heredity,
• Obesity,
• Early menstruation onset, late menopause,
• Postmenopausal hormone replacement therapy, estrogenic oral contraceptives,
• Alcohol abuse,
• Genitourinary system infections.

Help to reduce the chance of UM:

• Pregnancy, delivery. The more births, the lower likelihood of tumor,
• Receiving progestin oral contraceptives,
• Nutritional features: consumption of green vegetables, fruits, especially citrus fruits.

Usually formed at childbearing age women and regress after menopause.

• 20-40% — at reproductive age,
• 60% — during menopause.

Rarely appears before puberty and in postmenopausal women.

By location:

• In uterus body:
  • Intramural (75%) — in uterus wall,
  • Subserous, or subperitoneal (15%) — on surface of womb, growing towards the abdominal cavity,
  • Submucous (5%) — in the uterine cavity,
• Cervical fibroids: front; rear; central; lateral,
• Intraligamentary, or interconnective.

By quantity: single, multiple.

By size:

• Small — <20 mm,
• Medium — <70 mm,
• Large — < 10 mm,
• Giant — >10 mm.

In 65% of cases, UM is asymptomatic.

In other circumstances, the characteristic signs are:

• Menstrual disorders: abnormal uterine bleeding leading to anemia,
• Manifestations associated with pressure on neighboring organs — frequent urge to urinate, urinary stagnation, constipation,
• Lower abdominal pain,
• Coagulation failure,
• For large nodes — fertilization difficulties, incorrect fetus position in uterus, premature birth.

Not dangerous for life. Rarely degenerates into malignant form (0.3-0.7%). UM are described in weeks of conditional pregnancy. Sometimes it happens that this myomatous node reaches the size of a 20-22 week old fetus. If left untreated, these enlarge the peril of severe anemia and cardiovascular disease.

Infertility often accompanies UM due to dyshormonal disorders imbalance. Difficulties in conception, gestation are observed with submucous fibroids or with large multiple neoplasms.

Diagnosis is made on the basis of complaints, gynecological examination and palpation of abdomen.

The main and optimal technique for detecting UM is ultrasound. Specialized clinics, which have necessary equipment carry out ultrasound (3D, 4D) simultaneously with echohysterography (injection of contrast fluid), which helps to find tumors and establish relationships with nearby tissues.

CT, MRI are not used so widely, due to high radiation exposure.

In most cases, no treatment is required. Doctors use a «wait-and-see» approach with regular pelvic examinations.

When choosing a treatment, the following factors play a role: the severity of manifestations, the size and number of nodes, the woman’s desire to maintain fertility.

There are such types of therapy:

• Medication — reducing symptoms or as a preoperative preparation,
• Surgical — hysterectomy (uterus removal), myomectomy (excision nodes with uterine conservation), hysteroresectoscopy (often to eliminate submucous myomas),
• Radiation — uterine artery embolization (UAE), MRgFUS.

MRgFUS-ablation is a new non-surgical safe method, for those, who don’t plan to give birth but wish to preserve the uterus.

Postmenopausal women who do not have menstruation and, accordingly, their hormone levels decrease, fibroids shrink and disappear without treatment. But if in menopause old nodes grow or new ones appear, it is necessary to exclude malignant diseases and proceed to surgery.

Regular examination by gynecologist once every 6-12 months guarantees:

• Timely detection of UM,
• Selection of individual tactics of disease management,
• Absence of complications,
• Improving quality of life.

It’s rare (0.2-2%). Nature and location of nodes in a certain way affects the course of pregnancy and appearance of negative consequences.

Possible complications of UM during pregnancy and childbirth:

• Miscarriages or premature birth,
• Fetal hypoxia,
• Improper fetus location,
• Weak or overly strong labor,
• Uterine bleeding and threat of uterine rupture.

Women with such cases need to carry out frequent examinations, prevention of miscarriage, diagnosis a condition of fetus and pregnant woman. Using ultrasound, CTG, hormonal therapy.

In 36-37 weeks, pregnant women need to be hospitalized in order to develop a plan for childbirth management. The younger the woman at the time of the hysterectomy, the faster her long-term memory and thinking ability in general will decline.