Uterine fibroids: causes, treatment, consequences

A fairly relevant problem in medicine (or more precisely in the field of gynecology) are uterine pathologies. They include various inflammatory lesions of the endometrium and myometrium. One of the most common pathological conditions is uterine fibroids. In medicine, this term refers to a benign tumor. For what reasons do uterine fibroids occur in women, and how is the disease treated? The answers to these questions should be known to all the fair sex, because anyone can face a similar problem.

The essence of the disease and the theory of the origin of myomas

Such a female ailment as uterine fibroids became known back in 1793. British pathologist Matthew Bailey first described this disease. In subsequent years, uterine fibroids was studied by specialists. To date, it is known that a tumor is a hormone-dependent neoplasm of the uterus (myometrium). It is detected, as a rule, in women from the age group older than 30 years.

Statistics show that approximately 1/3 of the fair sex who come to gynecological clinics are diagnosed with uterine fibroids. However, the prevalence of the disease is not judged by the number of patients who applied. In 70% of cases, the tumor grows asymptomatically. Women often do not even suspect about its presence, and even more so do not know about the causes of uterine fibroids.

Studies by experts show that a tumor develops from one abnormal cell. There is debate about how this precursor cell appears. There are several theories:

1. Mesenchymal. This theory says that the causes of uterine fibroids are negative changes that occur in the prenatal period. Undifferentiated mesenchymal progenitor cells of smooth muscle cells of the uterus develop for a long time in the fetus. During this time, they are adversely affected by various factors. In such conditions, there is the likelihood of a defective cell.
2. Infectious. This theory indicates the formation of the growth zone of fibroids around endometriotic foci in the myometrium, inflammatory infiltrates.

Risk factors

In the past, attention was paid to the study of the disease in question, but this did not allow us to determine the exact causes of the appearance of uterine fibroids. Specialists could only identify predisposing factors. These include the early menarche. Studies have shown that women with early periods beginning earlier than 10 years have a higher chance of developing a tumor. With this beginning of menstrual cycles, the number of cell divisions that the myometrium undergoes during the reproductive period increases. This, in turn, increases the likelihood of mutations in the genes.

The following factors contribute to an increase in the likelihood of fibroids:

• history of childbirth;
• obesity;
• age (late reproductive period);
• African American race;
• reception of "Tamoxifenum".

Extremely contradictory reports in the literature on the effect of combined oral contraceptives (COCs) on the growth of a benign tumor. In early works, which indicated the causes of uterine fibroids, experts speculated on the possible negative impact of these drugs. However, in the future, scientists conducted research, proving the exact opposite effect. They noticed a decrease in the probability of growth of uterine fibroids with an increase in the duration of contraceptive use. After 5 years of using COCs, the risk was reduced by 17%.

In the future, nevertheless, the point of view about the absence of the negative effect of contraceptives was criticized. Myoma was included in the number of contraindications for taking COCs. Why are the research results different? Modern experts explain this inconsistency with different doses and types of estrogens and progestogens contained in combined oral contraceptives.

Classification of fibroids

Benign uterine tumors are not characterized by any specific symptoms. Signs of the disease are determined by the type of neoplasm. Depending on the location in relation to the muscle layer of the uterus, fibroids are secreted:

• intermuscular, or interstitial (tumors are located in the thickness of the wall of the internal organ);
• intraligamentary, or interconnected (nodes grow between the posterior and anterior leaves of the wide ligament of the uterus);
• submucosal, or submucous (neoplasms grow towards the uterine cavity);
• subperitoneal, or subserous (tumors grow towards the abdominal cavity);
• mixed (a combination of 2 or 3 forms).

Additionally, in the medical literature on uterine fibroids, causes, signs, symptoms and treatment of this disease, the term “interstitial tumor with centripetal growth” is found. This term refers to a submucosal neoplasm that affects the muscle layer (located in it more than 1/3 of the volume of the node). Among submucosal benign structures, a neoplastic tumor is also distinguished. Its feature is the growth in the uterine cavity towards the internal pharynx. Often, such a tumor extends beyond the external opening of an internal organ.

In 2011, the International Federation of Obstetrics and Gynecology (FIGO) published a classification of fibroids. Selected types of tumors are indicated in the table.

Clinical picture

The disease may be asymptomatic. In such cases, women have no complaints, no changes in the menstrual cycle are observed. When a fibroid occurs with symptoms, it makes itself felt with pain, bleeding, impaired functioning of adjacent organs. Pain is localized in the lower abdomen and lower back. They are diverse:

• sharp
• cramping;
• constant aching.

The first of them arise with uterine fibroids due to malnutrition of the node. Cramping pains are observed during menstruation and indicate submucous localization of the tumor. Constant aching sensations are characteristic of subperitoneal fibroids and are caused by distention of the peritoneum, compression of the nerve plexuses of the small pelvis.

The most common symptom of a benign tumor in the uterus is bleeding. For submucous localization of fibroids, prolonged and heavy menstruation is characteristic. In medicine, they are also called menorrhagia. Intermuscular and subperitoneal myomas are characterized by acyclic uterine bleeding (metrorrhagia) that occurs in the intermenstrual period.

Violation of the functioning of neighboring internal organs is observed only in some neoplasms. If the myoma is located in front of the uterus, it puts pressure on the urinary tract and provokes a violation of urination. If the tumor is localized on the opposite side, it makes it difficult to empty the intestines.

Possible complications

All women are advised to periodically visit a gynecologist to prevent the negative effects of uterine fibroids. There are several reasons. Firstly, with the growth of the tumor, signs appear that reduce the quality of life, cause discomfort. Only at the initial stage, the disease does not bother. Secondly, some women lose their uterus due to fibroids.

If the disease is not treated, then complications will arise in the future. The most common of them is tumor necrosis. It begins due to torsion of the legs, a violation of blood supply and is manifested by symptoms of an acute inflammatory process.

Women who have experienced fibroids are worried about whether this benign tumor degenerates into a malignant one. This is possible, but the likelihood of the beginning of such a process is quite low. In 0.25–0.75% of cases, women of reproductive age are diagnosed with cancer. In the postmenopausal period, these figures increase to 2.6-3.7%.

Infertility complicated by pregnancy and childbirth

In medical articles on the causes, symptoms and treatment of uterine fibroids, among the negative consequences is still infertility. It is diagnosed in approximately 24% of women with a benign tumor. In 33–69% of cases, infertility is eliminated after removal of the node. Those women who, in the presence of fibroids, still manage to conceive a child, sometimes encounter a complicated pregnancy:

• threatened miscarriage;
• late gestosis;
• fetal growth retardation;
• premature detachment of the placenta;
• polyhydramnios;
• chronic fetal hypoxia.

Complications during delivery are found, such as premature discharge of amniotic fluid, primary weakness of labor, prolonged labor. About 65% of female doctors do a cesarean section. At the same time, in 42% of pregnant women, the volume of surgery expands to myomectomy in order to treat uterine fibroids and because of the need to remove a benign neoplasm. The remaining 35% of women give birth on their own.

Treatment appointment

The treatment of uterine fibroids is always prescribed individually. It is impossible to find out the causes of the tumor, therefore, doctors take into account only the following factors:

• the presence of uterine bleeding and pain;
• problems with urination or defecation;
• the patient’s age and the expected period before menopause, a woman’s desire to maintain fertility;
• the size of the neoplasms, their number, location, change in volume during the observation period.

Treatment can be medication, surgery, and combination. The first method is also called conservative treatment of uterine fibroids in women. The reasons for the treatment are the need to stop the growth of the tumor, to achieve its reverse development. Surgical treatment is prescribed to remove the neoplasm from the body. At the same time, the volume of surgical intervention can be different - conservative myomectomy (removal of the tumor), subtotal (removal of the uterus without the neck) and total (removal of the uterus with the neck) hysterectomy. Combined treatment involves surgery followed by and / or prior administration of hormonal drugs.

Conservative therapy

Drug treatment has certain indications:

• the patient wishes to maintain her reproductive function;
• tumor size does not exceed 12 weeks of pregnancy;
• the disease is characterized by a clinically low symptom course;
• the node (on a broad base) is characterized by an interstitial or subserous location, there is an intermuscular or subperitoneal myoma;
• the development of a benign tumor is accompanied by extragenital pathologies with a high surgical and anesthetic risk.

During conservative therapy, the doctor prescribes non-hormonal drugs - hemostatics for uterine bleeding, non-steroidal anti-inflammatory drugs and antispasmodics for pain. Additionally, diseases that contribute to tumor growth are treated.

Hormone therapy is carried out in several stages:

1. First, knot regression inducers, GnRH agonists, are used to treat uterine fibroids. The reasons for their use are that these drugs contribute to the reduction of tumors to clinically insignificant sizes, the cessation of uterine bleeding. Such drugs are usually prescribed for 6 months (no more).
2. The next stage is considered stabilizing. The doctor prescribes modern microdosed oral contraceptives or an intrauterine hormonal releasing system. The treatment is carried out over a long period and helps to stabilize the size of myomatous nodes and inhibit the development of new benign tumors.

Surgical intervention

An operation to remove a tumor or uterus is performed only for certain reasons:

• uterine fibroids does not correspond to small sizes - it exceeds 12 weeks of pregnancy;
• the neoplasm is growing rapidly;
• the patient is worried about meno- and metrorrhagia causing anemia;
• a woman has a submucosal tumor, an intermuscular neoplasm with centripetal growth, or a subperitoneal node on the leg;
• fibroid necrosis detected;
• there is a combination of fibroids with ovarian tumors, impaired functioning of neighboring organs;
• there is a history of infertility or miscarriage.

One of the possible surgical interventions is conservative myomectomy. This is an organ-preserving operation. During it, myomatous nodes are removed, and the uterus is preserved. With this operation, the possibility of future pregnancy remains. Removal of fibroids is performed under general anesthesia and requires a hospital stay for 3–7 days. The recovery postoperative period takes 3-4 weeks.

Removing the uterus is another treatment option. It is considered a last resort. In approximately 5–10% of cases, this operation is inevitable with uterine myoma. The reasons for its implementation are neglected disease, large tumors, and suspected malignant neoplasms. The operation is also performed under general anesthesia. In the hospital, women after her are from 3 to 7 days. The recovery postoperative period in uncomplicated course takes 3-6 weeks.

Combination treatment

Combination therapy consists in conservative myomectomy while taking the necessary medications in the pre- and postoperative period. Treatment is carried out according to indications:

• a woman plans to have a baby in the future, which means that she wants to preserve her uterus and reproductive function;
• the patient has a myoma with a large number of nodes;
• revealed fibroids with a node larger than 5 cm.

The first stage of combined treatment may consist of 2 injections - an analog of GnRH with an interval of 28 days. After drug treatment, a conservative myomectomy is performed. This is the second stage of therapy. After the operation, another injection of the GnRH analogue is performed. This is the third stage of therapy at which the combined treatment ends.

Uterine fibroids - a fairly serious disease, despite the fact that at first it can be asymptomatic. Sometimes it can be prevented. In the specialized medical literature on the causes, signs and symptoms of uterine fibroids, primary preventive measures are described. They consist in the timely correction of hormonal disorders in the body, the correct treatment of inflammatory diseases of the female genital organs, the passage of preventive examinations by a gynecologist once every 6 months, and the rejection of abortions.