Myoma of a uterus is the hormonal and dependent, good-quality, opukholevidny formation of a uterus proceeding from its gladkomyshechny and connecting (fibromyoma) fabric. Myoma of a uterus happens single, but is more often – in the form of multiple miomatozny knots with various localization. Myoma of a uterus can the size from a small small knot to a tumor be powerful about a kilogram when it easily is defined at a stomach palpation. The sizes of myoma can be compared to the uterus size on this or that term of pregnancy. Myomas of a uterus of the small sizes can develop without clinical manifestations and incidentally are found during gynecologic survey.
Myoma of a uterus is the hormonal and dependent, good-quality, opukholevidny formation of a uterus proceeding from its gladkomyshechny and connecting (fibromyoma) fabric. Myoma of a uterus happens single, but is more often – in the form of multiple miomatozny knots with various localization. Myoma of a uterus can the size from a small small knot to a tumor be powerful about a kilogram when it easily is defined at a stomach palpation. The sizes of myoma can be compared to the uterus size on this or that term of pregnancy. Proceeding from the direction of growth of miomatozny knots, distinguish the following types of myoma of a uterus: subserous, submukozny and interstitsialny.
At subserous myoma of a uterus the knot develops on the wide basis or a long leg. Subserous myoma podbryushinno, on the surface of a uterus under a serous cover is localized. Submukozny (submucous) myoma of a uterus grows in a uterus cavity. At interstitsialny myoma of a uterus the tumoral knot settles down in the thickness of a muscular wall of a uterus.
In the majority of myoma of a uterus settle down in a uterus body (95%), in other cases – in a uterus neck (5%). Uterus myoma most often occurs at women in the reproductive period. In a postmenopause usually growth of myoma of a uterus stops and there is its return development. In general myoma of a uterus is diagnosed more than for 20% of women at the address to the gynecologist with certain complaints or is casual.
Uterus myoma reasons
Now the gynecology cannot give definite answer to a question of the cause of myoma of a uterus. Violation of hormonal function of the ovaries producing surplus of estrogen is considered the main reason for development of myoma of a uterus. It is confirmed by the fact that reception of hormonal contraceptives with high doses of estrogen promotes the strengthened growth of myoma of a uterus, and, on the contrary, the termination of production of estrogen in a postmenopause leads to its regression and disappearance. However, cases of developing of myoma of a uterus at women with a normal hormonal background are known.
Other risk factors in development of myoma of a uterus are surgical termination of pregnancy, the complicated pregnancies and childbirth, (endometriosis) of a uterus, inflammatory diseases of uterine tubes and ovaries, cysts of ovaries, lack of pregnancy and childbirth at the woman is more senior than 30 years, obesity, a hereditary factor, immune and endocrine violations, long insolation.
Uterus myoma symptoms
Myomas of a uterus of the small sizes can develop without clinical manifestations and incidentally are found during gynecologic survey. Cases of regeneration of myoma of a uterus (fibromyoma) in a malignant tumor seldom, but nevertheless meet in clinical practice.
Growth of myoma of a uterus is followed by emergence of symptoms, the most frequent of which are strengthening and lengthening of menstrual bleedings (menorragiya) with allocation of clots of blood, developing of acyclic uterine bleedings (metrorragiya) and the anemia developing on their background.
Myoma of a uterus is characterized by the pain syndrome depending on localization and the sizes of a tumor. Pains most often arise in the bottom of a stomach or in a waist. With a slow growth of myoma of a uterus of pain can have the constant, aching character. Submukozny myoma of a uterus proves sudden skhvatkoobrazny pains. The pain syndrome develops with increase in myoma of a uterus in sizes, at an initial stage they are almost always painless.
In development of myoma of a uterus there is a sdavleniye of nearby bodies – a bladder and a rectum that is shown by disorder of their functions: the frequent, complicated urination and chronic locks. Big myomas of a uterus (more than 20 weeks of pregnancy) can cause the syndrome of a sdavleniye of the lower hollow vein which is shown heartbeat and the expressed short wind, especially in a prone position.
Uterus myoma complications
Myoma of a uterus is artful and dangerous by the numerous complications. Most often meet violation of blood supply of miomatozny knot development of a necrosis, tumor legs, bleeding, anemia pereknut. Submukozny myoma of a uterus can cause the uterine reductions and the birth of miomatozny knot through the opened neck which are followed by pains and bleeding. Not incubation of pregnancy and infertility can also accompany development of myoma of a uterus. Malignant regeneration (malignization) of myoma of a uterus in a cancer tumor makes up to 2% of cases.
Diagnosis of myoma of a uterus
The diagnosis "uterus myoma" can be established already on primary gynecologic survey. At a two-handled vaginal research the dense, increased in sizes uterus with a hilly, knotty surface is palpated. It is more reliable to determine the uterus myoma size, its localization and classification ultrasonic examination of bodies of a small pelvis allows.
As informative method of diagnosis of myoma of a uterus serves hysteroscopy – inspection of a cavity and walls of a uterus by means of the optical device-gisterokopa. Hysteroscopy is carried out both with diagnostic, and with the medical purpose: identification and removal of myoma of a uterus of some localizations. In addition a gisterosalpingoskopiya (ultrasonography a research of a uterus and uterine tubes), sounding of a cavity of a uterus, diagnosis of sexually transmitted infections and an oncopathology can be carried out.
Treatment of myoma of a uterus
The choice of tactics of treatment of myoma of a uterus is defined by the tumor size, expressiveness of its clinical manifestations and age of the patient. Depending on it treatment can be conservative (therapeutic) or surgical.
All patients with myoma of a uterus are subject to dynamic observation of the gynecologist (1 times in 3 months). Asymptomatic myomas of a uterus of the small sizes are usually treated conservatively. Reception of hormonal medicines – the derivatives of progesterone normalizing function of ovaries and interfering development of a tumor is the cornerstone of therapy. With the medical purpose at myoma of a uterus appoint injections, so-called, the agonists of a gonadoliberin of the prolonged action suppressing secretion of gonadotrophins and causing a pseudo-menopause. Injections are entered within half a year once a month and are capable to cause reduction of the sizes of myoma by 55%. However, these medicines at prolonged use are capable to cause development of osteoporosis in women of young age.
Unfortunately, conservative therapy can constrain only certain time development of myoma of a uterus, but not eliminate it completely. Therefore therapeutic methods are more justified in treatment of women of the advanced childbearing age, slowing down development of myoma of a uterus before a menopause when it resolves independently.
Surgical treatment of myoma of a uterus is shown:
- at the big sizes of miomatozny knots (over 12 weeks pregnancy)
- at bystry rates of increase in myoma of a uterus in sizes (more than 4 weeks in a year)
- at the expressed pain syndrome
- at a uterus myoma combination to a tumor of an ovary or endometriosis
- at overwind legs of miomatozny knot and its necrosis
- at malfunction of adjacent bodies – a bladder or a rectum
- at infertility (if other reasons are not established)
- with a submukozny growth of myoma of a uterus
- at suspicion on malignant regeneration of myoma of a uterus
At the solution of a question of the nature of surgery and its volume the age of the patient, a condition of the general and reproductive health, degree of estimated risk is considered. Depending on the obtained objective data surgery can be conservative, with preservation of a uterus, or radical, with full removal of a uterus. Concerning the young people who were not giving birth to women with uterus myoma whenever possible tactics of conservative surgical treatment for preservation of reproductive function is chosen.
The miomektomiya – a vylushchivaniye of knots of myoma of a uterus belongs to such organ-preserving operations. Further for the woman pregnancy approach is possible, but there is a risk of emergence of a recurrence of a disease. In the postoperative period application of hormonal treatment and constant observation for the gynecologist for timely knocking over of the beginning uterus myoma recurrence is shown. The least traumatic is carrying out a miomektomiya by means of hysteroscopy. Uterus myoma at the same time is excised by means of the laser under visual control of the doctor, manipulation is usually carried out under local anesthesia.
One more option of organ-preserving operation at uterus myoma - a miometroektomiya with reconstructive restoration of a uterus. The essence of operation comes down to excision of the expanded miomatozny knots in a uterus wall with preservation healthy - musculoserous fabric of body. It provides in the future preservation of menstrual and reproductive function.
Radical operations at myoma of a uterus assume full removal of body together with miomatozny knots and exclude an opportunity to have children further. Treat such operations: a hysterectomy (full removal of a uterus), nadvlagalishchny amputation (removal of a body of a uterus without neck), nadvlagalishchny amputation of a uterus with excision of a mucous neck of a uterus. At a myoma combination to a tumor of an ovary or at confirmation of a malignization of myoma the pan-hysterectomy - removal of a uterus with appendages is shown.
Carrying out a conservative miomektomiya or nadvlagalishchny amputation of a uterus perhaps with application of a laparoscopic technique (usually at the uterus myoma sizes up to 10-15 weeks of pregnancy). It considerably reduces an operational trauma of fabrics, expressiveness of adhesive process further and the period of postoperative restoration.
Alternative to surgical treatment of myoma of a uterus is the procedure of the embolization of uterine arteries (EUA) which is applied rather recently. The essence of a technique of EMA consists in the termination of a blood-groove on the arteries feeding miomatozny knot. The EMA procedure is performed in the conditions of rentgenoperatsionny under local anesthesia and is absolutely painless. Through a puncture of a femoral artery the catheter on which the embolizatsionny medicine blocking the vessels feeding uterus myoma moves is entered into uterine arteries. Further because of the blood supply termination miomatozny knots considerably decrease in sizes or disappear completely. At the same time all symptoms of myoma of a uterus disturbing the patient abate. The method of an embolization of uterine arteries already showed the efficiency: the risk of a recurrence of a disease after EMA is absent completely, and further patients do not need performing additional treatment concerning uterus myoma.
Pregnancy and myoma of a uterus
Uncomplicated and the small sizes uterus myoma usually is not an obstacle to emergence and the normal course of pregnancy. In cases when myoma of a uterus grows in her cavity (submukozny myoma), it complicates growth of a fruit and quite often serves as the abortion reason on terms of 11 weeks of pregnancy. The arrangement of miomatozny knot in the field of the tservikalny channel is an obstacle for natural childbirth. In these cases apply operation of Cesarean section to a rodorazresheniye. Pregnancy and the related hormonal background often cause rapid growth of myoma of a uterus in this connection, the pregnant woman has to be under constant observation of the obstetrician-gynecologist who is carrying out conducting pregnancy.
Forecast and prevention of myoma of a uterus
At timely detection and correctly carried out treatment of myoma of a uterus the further forecast is favorable. After organ-preserving operations at women in the reproductive period pregnancy approach is probable. However rapid growth of myoma of a uterus can demand carrying out radical operation with an exception of genital function even from women of young age. Even myoma of a uterus, small by the sizes, can sometimes become the infertility reason.
Adequate hormonal therapy is necessary for prevention of a recurrence of myoma of a uterus in the postoperative period. The uterus myoma malignization is in rare instances possible. As the main method of prevention of myoma of a uterus serves regular observation at the gynecologist and ultrasonography diagnostics for timely detection of a disease. Other measures of the prevention of development of myoma of a uterus are the correct selection of hormonal contraception, prevention of abortions, treatment of chronic infections and endocrine violations. Women after 40 years should limit themselves in long stay in the sun.