Uterine fibroids
Summary/Definition
Uterine fibroids are tumors that arise from the muscle cells of the uterus and are the most common benign neoplasms in the uterus. Uterine fibroids most often occur in the muscular layer of the uterus, but rarely in the uterine ligaments or cervix (less than 5%). Lesions are usually multiple and single, and their sizes vary widely: from microscopic to very large tumors. Depending on the place of origin of uterine fibroids from the ectopic layer are divided into “subserous fibroids → intramuscular fibroids → submucosal fibroids”. Submucosal fibroids are fibroids that occur in the lower layer of the uterine mucosa and have a worse prognosis. Even small sizes can cause bleeding and have a worse prognosis. Intramural fibroids are fibroids located deep in the myometrium. As the size of the uterus increases, the area of the endometrium increases, which leads to an increase in menstrual discharge. Subserous fibroids grow just below the peritoneum, above the surface of the uterus, and can form a leg as the fibroids stretch. In most cases, there are no noticeable symptoms.
Uterine fibroids develop from a single mutated cell, its growth is influenced by the female hormones estrogen, progesterone and growth hormone. The exact cause of uterine fibroids is unknown, but it is known that it occurs in childbearing age, grows during pregnancy and decreases in size after menopause. The use of estrogen agonists increases the incidence of uterine fibroids, estrogen and growth hormone preparations increase the size of uterine fibroids, and, conversely, progesterone suppresses the growth of uterine fibroids. Factors that cause uterine fibroids include genetic factors, hormones and the action of growth factors.
Symptoms
Symptoms are common, and most people have no symptoms. According to statistics, it is known that only about 20-50% of cases develop clinical symptoms. When symptoms appear, they differ depending on the location, number and size of uterine fibroids, the most common symptom of which is heavy menstruation. In addition, symptoms such as abnormal uterine bleeding, irregular menstruation, pelvic pain, dysmenorrhea, pelvic pressure, frequent urination, dyspareunia, abdominal pain, back pain, infertility and reproductive dysfunction may occur. Other systemic symptoms include chronic anemia, headache, lethargy, shortness of breath, and excessive platelet production.
Diagnostics
In most women, uterine fibroids do not cause any symptoms and are detected by chance, however, some women may complain of sudden uterine bleeding, heavy menstruation, discomfort and bloating in the lower abdomen, as well as a dense, uneven seal in the lower abdomen that can be felt. In most women, fibroids do not cause any symptoms and are detected by chance, however, some women may complain of sudden uterine bleeding, heavy menstruation, discomfort and bloating in the lower abdomen, as well as a dense, uneven seal in the lower abdomen that can be felt. Fibroids can be diagnosed by ultrasound examination. Vaginal ultrasound shows low sensitivity and specificity, but is the first diagnostic method used because it is cost-effective and easy to carry out. Magnetic resonance imaging is a technique used to determine the exact location of fibroids if surgical intervention is necessary. In some cases, methods such as hysteroscopy or ultrasound hysterography are used.
Treatment and course of the disease
There are several methods of treating uterine fibroids. The main method of treatment is surgical removal of fibroids, but since the tendency to avoid surgical intervention has increased recently, conservative treatment or drug therapy is desirable. Treatment methods should be selected taking into account age, obstetric history, family environment and severity of clinical symptoms. Drug treatment: hormone therapy, progesterone, LHRH antagonists (luteinizing hormone — releasing hormone), antiestrogenic agents, progesterone agents, GnRH antagonists (gonadotropin-releasing hormone), wait-and-see tactics with regular preventive examinations, curettage of the uterine cavity, removal of fibroids. Non-drug treatments such as myomectomy, hysterectomy, uterine artery embolization, myolysis and radiation therapy can be used.
Complications
The lack of development of blood vessels compared to the increase in uterine muscles can cause problems with blood circulation or secondary degenerative changes in myomatous nodes may occur due to a decrease in estrogen levels or an increase in progesterone levels. Types of fibroids with degenerative changes: hyaline, cystic, calcification, infection and suppuration, necrosis, fatty degeneration and sarcomatous degeneration. Hyaline degeneration is when uterine fibroids cells change uniformly, and cystic degeneration is when uterine fibroids cells form cysts filled with fluid. Calcified degeneration means that the cells of the uterine fibroids are calcified, and infection and suppuration mean that the uterine fibroids are infected with bacteria and inflamed. Uterine fibroids cells can die or turn into fat cells (fatty degeneration) or turn into malignant tumors (sarcomatous degeneration).
