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Intramural uterine fibroids - what is it

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Gynecological diseases can severely undermine women's health. There are often cases when women have an intramural uterine fibroid. Fibroids are benign formations of myometrium, located in the muscle layer of the uterus. Treatment is prescribed only after examination of the patient by a doctor.

The disease appears in the period when one muscle cell begins to divide and as a result of this a knot appears, which gradually begins to grow. Often, it is difficult to identify the cause of the tumor, as there can be a lot of reasons.

The most common causes are:

  • Uterine injuries resulting from operations, abortions, difficult labor,
  • Sometimes the reasons are due to hormonal disruptions, in which the body becomes more estrogen,
  • Problems with the thyroid gland, overweight, diabetes,
  • In women older than 30 years, the disease may appear as a result of the absence or irregular sexual life,
  • Inflammation of the uterus,
  • The cause of education can be a hereditary predisposition,
  • Infectious diseases,
  • Lack of physical activity, stressful states, smoking, drinking alcohol.

When a tumor appears in a patient, symptoms do not always appear, this happens until the nodes grow in size. Further, squeezing of the nearest organs occurs, because of this their work worsens. The main signs of a large tumor are painful sensations in the lower abdomen, and discharge during menstruation becomes stronger. Bleeding may occur between months.

There are several symptoms by which an intramural myoma node can be recognized:

  • Persistent abdominal pain,
  • Bleeding between menstruation,
  • Impairment of the bladder
  • Abundant discharge during the menstrual period,
  • Menstruation can be very painful
  • Due to the compression of neighboring organs with myoma, problems with urination and defecation may occur.

Diagnosing

The diagnosis of the disease is carried out as follows: to begin, the gynecologist will need to collect the necessary information about the medical history, the conditions in which the patient lives and information about the diseases she has suffered. The patient is required to undergo an examination and ultrasound examination. Only after these procedures can you confirm the presence of a diagnosis. Using a hardware radiograph, a doctor is able to determine the size and weight of fibroids.

To clarify the diagnosis, additional examinations are conducted:

  • Magnetic resonance imaging,
  • X-ray - helps to detect in which part of the uterus intramural myoma nodes are located,
  • CT scan.

Treatment of intramural fibroids depends on how quickly it grows and in which part of the uterus it is located. No less important factor in the selection of therapy is the age of the woman. Young patients doctors try to prescribe a treatment that allows you to maintain the ability to conceive and give birth to a healthy child. Hormone therapy is usually prescribed. It is a prophylactic measure, since after a tumor has been surgically removed, there is a chance that the fibroids may appear again. Sometimes hormonal drugs do not have the proper result, and the tumor continues to grow, in this situation other treatment methods are selected, for example:

Conservative treatment

  • The most common is medication treatment. This is a non-invasive form of anti-tumor. Especially suitable for women who want to have a baby in the future. And this method is also used after surgery to avoid recurrence of the disease,
  • Immunomodulators,
  • Sedative sedatives. Used to eliminate stressful conditions that provoke the growth of tumors.

Alternative medicine

This type of therapy should treat the disease if the doctor has examined and found small nodes. So that they do not continue their development, it is better to take the necessary measures, for example, to begin treatment with folk remedies. It helps to improve the work of the female body and is a good way to improve it. There are two ways to treat fibroids using unconventional methods: the first is the means taken orally and the second is the introduction of tampons moistened in the decoction of herbs into the vagina or douching.

In the treatment of herbs used:

  • Antitumor general application - the plants are poisonous. These include mistletoe, celandine, sabelnik, amanita,
  • Antitumor localized action - they are not poisonous, restore hormonal balance, due to this, the neoplasms are reduced,
  • Hemostatic - shepherd's purse, nettle, yarrow,
  • Immunomodulatory - is ginseng, lemongrass, kopechnik, pink radiola, eleutherococcus, aralia.

In addition to herbs in the treatment process use:

  • Quail eggs - you need to drink six eggs daily on an empty stomach for three weeks,
  • Tincture of walnut partitions - served in a pharmacy, or you can prepare yourself. To do this, you need 30 grams of walnut partitions. They need to pour one glass of vodka. The resulting infusion should be allowed to stand in a dark place for three to four weeks. The course of admission is one month. It is required to take 30 drops of tincture, washing down glasses of water half an hour before meals.

Surgical methods

  • Embolization is a method that does not require surgical intervention. For its implementation, the vessels are blocked, which provide nourishment to the myoma node,
  • Myomectomy - surgical removal of the tumor. The recovery period lasts a year. After the procedure, the woman remains reproductive function,
  • Hysteroestomy - the meaning of the procedure is the complete removal of the uterus. Such surgeries are done when a uterus is prolapsed or prolapsed, caused by a neoplasm, or if there is suspicion that the tumor is acquiring a malignant form. An indication is also a tumor size greater than 5-6 cm if it starts to bleed. An operation is done when a woman no longer needs to get pregnant and have children.

During the fight against neoplasms it is necessary to follow the recommendations of the doctor. This will help to further avoid the reappearance of myomas.

Intramural myoma and pregnancy

There are cases when the disease does not affect the pregnancy of a woman and the fetus develops as it should. Sometimes women are unable to bear the fetus due to fibroids. An important role in such cases is played by the location of the tumor, since it determines how well the pregnancy will be.

If the myoma node is small, then it affects her conception and childbearing. If the tumor is located near the placenta, then there is a risk of abortion. In such a situation, the fetus simply lacks the necessary nutrients for development.

Large intramural myoma nodes can cause a number of problems:

  • Heavy bleeding
  • Spontaneous miscarriage,
  • Preterm labor
  • Placenta rejection.

Pregnant women need to be monitored by a doctor to avoid an increase in fibroids and various complications.

Node removal is necessary when:

  • the rapid growth of tumors,
  • antenatal bleeding,
  • hypoxia,
  • inability to give birth on their own.

If the pregnancy proceeds normally with uterine myoma, the removal operation is performed after the birth of the baby. It happens that while waiting for a child, the disease passes without any treatment itself. This is because the balance of hormones that was disturbed began to recover. But there is a risk that the tumor will reappear some time after delivery. In the presence of the disease, it is often necessary to resort to cesarean section, since the mother herself is difficult to give birth on her own.

Complications

Fibroids can cause menstrual disorders and infertility. Often during pregnancy appear pathology. A tumor located in the corners of the uterus makes it difficult to conceive a child. In the case when the node is located on the wall of the uterus and the embryo can not normally be fixed. The result is a miscarriage. Small benign lesions usually do not cause anxiety, and the woman calmly bears the fruit.

Large intramural fibroids can cause premature labor and sometimes placental abruption occurs. Ultrasound does not always give accurate information about the presence of the disease. During pregnancy, the uterus greatly increases in size, and along with it the tumor stretches. Therefore, during the inspection it is not always possible to detect the presence of a node.

Prevention

Prevent diseases will help:

  • Compliance with the day regimen
  • Proper nutrition
  • Well-chosen hormonal drugs,
  • Careful attitude to your health, visiting the gynecologist once a year,
  • In the period of menopause, you must be observed at the doctor,
  • Abortion is recommended to refuse
  • Regular sex life with one partner.

Careful attitude to yourself will help avoid serious health problems and prevent the development of the disease.

Analyzing the reviews of women, it should be noted that most of them were helped by conservative and surgical treatment of intramural fibroids.

Ksenia, 42 years old

At the next examination, myoma was found by the gynecologist, the site was small, but I was still scared. There are always fears that she can provoke oncology. On the advice of the doctor, I underwent a course of hormone therapy and after a month myoma was not. The main thing is not to start the disease, but to treat it in time.

Olga, 27 years old

My intramural myoma developed during pregnancy, severe bleeding began and it was impossible to delay the operation. The operation was successful, I recovered quickly, so do not be afraid of such procedures.

Tamara, 50 years old

Myoma has been around for a long time. I don’t want to be operated on, because it doesn’t bother me, and it doesn’t increase in size. For prophylaxis, I drink hormones once a year, and in between I use folk remedies. Borovoy uterus insist and other herbs. I feel good.

Types and symptoms of intramural fibroids

In case of intramural myoma, the mass lesions are localized in the uterine muscle layer. Subserous intramural myoma of the uterus is characterized by the growth of nodes in the direction of the abdominal cavity. For submucous myoma is characterized by the growth of formations located in the myometrium, in the direction of the organ cavity. Fungal nodes may be located in the cervix, isthmus or the body of the uterus. The sizes of such nodes vary from a few millimeters to ten centimeters. When a single intramural myoma in the uterine muscle layer grows 1 node, multiple myoma is characterized by the formation of several nodes.

Intramural myoma is manifested by the following symptoms:

  • Abundant menstruation,
  • Pain in the lower abdomen and lower back,
  • Bleeding in the intermenstrual period,
  • Anemia (anemia), accompanied by general weakness, fatigue, headaches, dizziness.

Large intramural subserous fibroids, located in the cervix, presses on the bladder or rectum. Patients appear complaints of violation of the act of defecation (constipation) and urination (pain, frequent urge, urinary incontinence). Severe pain during menstruation occurs due to difficulty rejection of the mucous membrane under the influence of estrogen. Menstruation becomes long and painful. When necrosis of the myoma node from the vagina, blood clots are released, body temperature rises, symptoms of intoxication appear. With these signs, our gynecologists provide emergency medical care to the patient.

Causes of intramural uterine fibroids

As a result of the impact of traumatic factors, the main of which is menstruation, the damaged myometrium cell is divided, resulting in a knot. It grows slowly. Sometimes the beginnings of intramural fibroids are laid during fetal development. Intensive increase in myoma formations occurs under the influence of provoking factors:

  • Hormonal imbalance (sharp increase in estrogen concentration),
  • Mechanical effects on the uterus (abortion, traumatic benefits during childbirth, surgical interventions, diagnostic curettage of the uterus cavity),
  • Uterus diseases (endometriosis, adenomyosis, sexually transmitted infections),
  • Endocrine diseases, which include thyroid disease, obesity, diabetes,
  • Congestion in the pelvic organs due to irregular sexual activity (in women after 30 years),
  • Sedentary lifestyle, stress, bad habits,
  • Burdened heredity (tumor diseases of the uterus in the immediate family).

In some cases, the growth of myoma formations is provoked by several factors simultaneously.

Diagnosis of intramural uterine fibroids

The gynecologists of the clinics with whom we cooperate, during the initial examination of the patient, conduct a bimanual gynecological examination. During the procedure, you can only determine the presence of large myoma formations. The small intramural myoma is asymptomatic. It is detected during the ultrasound of the pelvic organs. Our specialists use transvaginal and transabdominal sensors. A study using a transvaginal sensor allows you to specify the size, location, number, condition of the nodes and to identify associated diseases - adenomyosis or endometriosis.

Hysteroscopy is performed using a special apparatus, which the doctor inserts into the uterine cavity through the vagina. He examines the walls of the uterus, visually assesses the state of the volume of education. This research method is used to diagnose submucous fibroids.

To determine the extent of damage to the uterus and nearby organs, our doctors use magnetic resonance imaging or computed tomography. If necessary, differential diagnosis of intramural subserous fibroids with malignant neoplasms of the reproductive organs, we perform diagnostic laparoscopy. In order to distinguish submucous myoma from endometriosis, we perform separate diagnostic curettage of the uterus cavity. The obtained tissue samples are sent for histological examination. The definition of tumor markers helps to exclude malignant neoplasms.

Treatment and prevention of intramural uterine fibroids

Currently, gynecologists use 3 methods of treatment for the treatment of uterine fibroids: conservative therapy, surgery and organ-preserving procedures. Specialists of our clinics make uterine artery embolization. After the procedure, intramural nodes are reduced in size and disappear over time.

The main method of drug treatment of intramural fibroids is hormone therapy. Most gynecologists believe that myoma disrupts the balance of hormones. The results of recent studies have shown that intramural fibroids predominantly occur without changing the level and ratio of sex hormones. Combined or monophasic contraceptives can stop the progression of the disease, but do not cure fibroids. Drugs have severe side effects. When they are canceled, the growth of myoma nodes resumes. After uterine artery embolization, the beginnings of intramural fibroids disappear, the disease does not recur.

In the absence of positive dynamics against the background of the use of drugs, women are offered to perform surgery. The choice of surgery depends on the patient's age, reproductive function, the desire to have children in the future. Patients who are in premenopausal, remove the uterus. Doctors believe that this operation can prevent the transformation of intramural fibroids in a malignant neoplasm. Research scientists have shown that the risk of transformation of the myoma node in cancer is low. Our experts believe that the indications for removal of the uterus are unreasonably expanded. We perform embolization of the uterine arteries, after which the myoma formations are replaced by connective tissue, from which the cancer does not develop.

Conservative myomectomy is performed by women of reproductive age planning pregnancy. This operation allows you to save a woman's childbearing function. Removal of intramural fibroids is performed with an incision of the anterior abdominal wall or by laparoscopic method. Laparotomic myomectomy is an operation that is fraught with the development of bleeding, adhesive disease, infertility. After surgery, a deforming scar forms on the skin of the abdomen, making up a cosmetic problem in the future.

During laparoscopic myomectomy, massive bleeding may develop, to stop which the surgeon will be forced to remove the uterus. После операции на матке остаются рубцы. Они могут осложнить течение беременности и родов.In patients who we did embolization of uterine arteries, scars are not formed. They later do not need cosmetic surgery. Pregnancy and childbirth proceed without complications.

Embolization of uterine arteries is a minimally invasive non-surgical method, which consists in blocking the blood vessels supplying intramural myomas with embolizing particles. The procedure is performed by an endovascular surgeon. He punctures the femoral artery under local anesthesia and passes a thin catheter into the uterine arteries through the puncture.

After the introduction of the embolizing drug, its particles block the blood flow through the arteries feeding the intramural myoma. Blood supply of the myometrium of the intact pathological process is not disturbed. Over time, intramural fibroids are replaced by connective tissue. Myoma formations are reversed and disappear. Patients go through the symptoms of the disease, the fertility function is restored, the quality of life improves.

Prevention of intramural fibroids is a healthy lifestyle, timely treatment of diseases of the female reproductive system. We recommend women to use reliable methods of contraception, to avoid abortions. The best prevention of intramural fibroids is pregnancy between the ages of 20 and 30, childbirth and breastfeeding.

Women after 30 years should undergo regular check-ups. Our gynecologists for examination of patients use modern methods of examination with the help of equipment from leading world manufacturers. We individually approach the choice of treatment for intramural fibroids. Even with large myomatous nodes, we first embolize the uterine arteries, and after reducing the size of the fibroids, the remaining formations are removed with the laparoscopic method in technically more favorable conditions. This approach allows the woman to preserve the genital organ, restore reproductive function and prevent the development of complications.

Prevalence of pathology

In the structure of gynecological diseases, intramural fibroids and other types of benign neoplasms in the uterus take second place. In reproductive age, the incidence of pathology averages 15-20% of cases, and in the premenopausal period it reaches 30-35%. In connection with the increase in the number of “aggressive” gynecological and obstetric methods of therapy in recent years, as well as with an increase in the quality of diagnostic measures, there has been an increase in the number of patients younger than 30 years with this pathology.

The growth of education usually occurs slowly, usually over five years. In some cases, there is a rapid increase in the tumor, and within one year or even faster, it increases by an amount corresponding to five weeks of normal pregnancy. Doctors determine the size of the tumor in weeks of pregnancy.

Intramural uterine fibroids can cause infertility, spontaneous abortion, abnormal fetal position, heavy uterine bleeding, premature delivery, abnormal menstruation cycles, and various complications during childbirth and the postpartum period.

The operation is shown at the size of the tumor, corresponding to fourteen weeks of pregnancy, in other cases, the radical treatment tactics are not justified. This technique is based on the traditional opinion that the body performs only the childbearing function, and then can be removed without negative consequences for the body.

This opinion is erroneous, since the risk of transformation of fibroids into a malignant tumor is practically absent. After removal of the uterus, a woman loses reproductive and menstrual functions, many patients with psycho-emotional and vegetovascular disorders.

Conservative treatment, as well as the use of minimally invasive and non-invasive therapies in the early stages of the development of pathology, allows you to stop the growth of the tumor, cause reversal and prevent impairment of reproductive function. However, the question of the use of conservative methods of treatment of intramural uterine fibroids is still causing debate in the medical community.

The main types of uterine fibroids

There are several types of tumors, depending on the location:

  1. Subserous fibroids are formed in the outer part of the body and progresses into the pelvic cavity. As a rule, this type of tumor does not lead to changes in the menstrual cycle or does not manifest at all, but it can cause some inconvenience, since the tumor puts pressure on the surrounding organs and tissues.
  2. Intramural uterine fibroids (intramuscular) is localized in the muscle layer and leads to an excessive increase in the size of the organ. This is one of the most common types of pathology. With intramural fibroids, the menstrual cycle is disturbed, pain and pressure in the pelvic region appear.
  3. Interstitial, or intermuscular, is located inside the walls of the uterus. The body grows evenly, some patients complain of heavy menstrual bleeding. Pain occurs only with a rapid increase in the size of the tumor, edema or necrosis. Intermuscular fibroids have a negative effect on neighboring organs, namely the rectum and bladder.
  4. Submucous fibroids (submucosa) grows under a layer of mucous membrane enveloping the organ cavity. It leads to an aggravation of the expressed symptoms of pathology.
  5. Cervical fibroids are formed in the muscle layer of the corresponding part of the organ. This type of pathology is diagnosed in only 5% of patients.

Myomas can be single or multiple. Often, several nodes are located in different parts of the body, which leads to the diagnosis, for example, submucous intramural fibroids or other mixed types of pathology. In this case, treatment is often complicated by the ambiguity of the clinical picture. For example, when the subserous-intramural myoma of the uterus disrupts the menstrual cycle, which is typical for intramural, but rarely happens with subserous pathology, but at the same time it puts pressure on the surrounding organs and tissues.

Causes of Leiomyoma

There are many opinions on the causes of intramural uterine fibroids. Some scientists believe that the tumor is not a tumor, but the result of focal proliferation of myometrium. So, fibroids can occur only in those areas where there is a complex intertwining of muscle fibers - these zones are called the areas of risk for the development of dystrophic disorders. Under the influence of various unfavorable factors in these zones hypoxia can occur, which causes the tendency of muscle cells to divide and grow against the background of the normal secretion of sex hormones.

In addition, growth can occur under the influence of mutations of normal muscle fibers due to the influence of growth factors and sex steroids. This is possible upon the occurrence of favorable conditions. Modern medicine has not yet established the molecular disorders that contribute to such a transformation.

Smooth muscle fibers may remain prone to proliferation from the embryonic period. They go through a long period of development - from fourteen to thirty weeks of gestation. Fibers at this time easily undergo mutations under the influence of various external causes or maternal factors (for example, sex steroids, tropic hormones and growth factors). Mutated cells begin to develop after the first menstruation under the influence of estrogen. Currently, this theory of the appearance of fibroids is most justified.

Provoking factors

The main risk factors that trigger the development of intramural nodes of uterine fibroids and other benign neoplasms:

  1. Unfavorable heredity. The probability of pathology in women whose immediate relatives suffered from the same disease is higher.
  2. Early puberty and the onset of menstruation.
  3. Absence of children. Increasing the number of full-term pregnancies significantly reduces the risk. In women with three full-term pregnancies - by 50-90%.
  4. Overweight and low physical activity. At the same time, obesity after puberty is a significant risk.
  5. The presence of hypertension up to 35 years and receiving antihypertensive drugs for five years.
  6. Frequent stress and chronic psycho-emotional stress.
  7. Abortion, especially surgically. Frequent diagnostic and therapeutic curettage of the uterus.

Pathology development mechanism

Uterine fibroids develop on the background of a local decrease in the elasticity of the vascular walls, which leads to blood overflow and the accumulation of potassium ions. According to another version, a neoplasm results from the influence of estrogens on the mechanisms of cell death. In recent years, other interrelated mechanisms have been established:

  1. Increased sensitivity of tissues affected by the hormones of the reproductive system.
  2. Changes in hormones that affect smooth muscle.
  3. Changes in the formation of new blood vessels in the area of ​​the tumor.

Stages of development of uterine fibroids

In the development of intramural fibroids and other gynecological pathologies of a similar nature, but there are three localization stages:

  1. Formation of growth zone in the place of concentration of small vessels. Such zones of risk are characterized by a high rate of metabolic processes, permeability of the walls of blood vessels and tissues.
  2. The tumor differs in the form of a small nodule. The neoplasm consists of fibers that are clearly not different from the neighboring tissues.
  3. Education is defined as a dense knot with clear boundaries. The capsule is formed by surrounding tissues. The node differs from normal fibers by its large size, the density of nuclei, and the content of individual muscle fibers in the cytoplasm.

Clinical symptoms

Practically in 50% of women, the disease develops without manifestations and is diagnosed by chance during a pelvic ultrasound or on a routine examination by a gynecologist. In this case, the clinical signs can be varied:

  1. Pain of varying intensity and nature in the lower abdomen. In a third of patients, the pains are aching or pulling, which is associated with pressure on the plexus of nerve fibers and stretching of the peritoneum. If the tumor grows rapidly, the sensations become more intense. With the development of necrosis, pain may be accompanied by fever, vomiting and general weakness.
  2. Bleeding out of cycle, prolonged or too heavy menstruation. Blood loss leads to headaches, weakness, dystrophic changes in the heart muscle, anemia, fatigue.
  3. Dysfunctions of the pelvis. The symptom is manifested by frequent urination, constipation.
  4. The presence of a dense education in the lower abdomen.
  5. Infertility (occurs in 30% of women with uterine myoma) or miscarriage.

Disease treatment methods

Treatment of intramural fibroids comes down to three main tactics: expectant, conservative therapy, and surgical intervention. Despite the high prevalence of the disease, the algorithm for managing the patients has not yet been developed, so much depends on the specific doctor.

Expectant tactics

This method is suitable for a small number of patients. This group includes women who have no symptoms of pathology, and the tumor sizes correspond to 10-12 weeks of pregnancy, there are already children in the family, and no future pregnancy is planned. Patients should be monitored with ultrasound and monitoring of tumor markers in the blood.

Doctors recommend that patients refrain from lifting weights more than 3 kg, heavy physical exertion, thermal baths, massage of the abdomen, body wraps, prolonged exposure to the sun and visiting a tanning bed, self-control pills, applying cosmetic procedures on the abdominal area and any physiotherapy procedures on the pelvic area .

Active myoma therapy

Active tactics involve minimally invasive and surgical procedures. Used selective embolization of the arteries, the effectiveness of which is about 98.5%. According to reviews, intramural myoma after a similar diagnosis recurs in 40% of cases. Surgery is the main treatment method for 80% of patients. Especially often used surgical excision in complex cases, for example, with subserous-intramural myoma.

Indications for surgery

The absolute contraindications for intervention are:

  1. Correspondence of tumor sizes with a period of more than 14 weeks of pregnancy.
  2. Any progress in postmenopausal disease or rapid growth in reproductive age.
  3. Localization on the cervix.
  4. Long menstruation with profuse blood loss.
  5. Necrosis of the node.
  6. Infertility, if its cause is identified precisely myoma.
  7. The negative impact of tumors on the pelvic organs.

The choice of method and volume of the operation is made depending on the age of the woman, the presence of concomitant diseases, and planning for future pregnancy.

Symptomatology

The formation of an intramural node in the uterus is not always accompanied by obvious signs. Much depends on the number and size of tumors. A woman needs to carefully monitor her reproductive system, determining the changes in her work. Thus, the following symptoms may indicate the presence of benign seals in the uterine muscle tissue:

  • heavy and prolonged menstrual bleeding,
  • mid cycle bleeding
  • feeling of tightness in the lower abdomen,
  • pain in the uterus, extending to the back and sometimes to the legs,
  • frequent urination,
  • fluid retention in the lower limbs due to impaired lymph flow,
  • problems with bowel movement,
  • intense pain during menstruation,
  • inability to conceive a child.

What changes the intramural uterine myoma causes are affected by its location, size and growth rate.

A woman who does not undergo a regular examination by a specialist risks running into the advanced form of the disease and its complications.

Transvaginal examination

This type of diagnosis is made using ultrasound radiation. During the procedure, the patient sits in a gynecological chair and a device sensor is inserted through the vagina. This technique is more effective in the study of fibroids than the inspection with the movement of the sensor in the abdomen. As a result, the exact location, size and density of the tumor is determined.

Ultrasound is a highly informative diagnostic method often used in gynecology. It is available to every patient, as it is inexpensive and is performed in many hospitals. Ultrasonic radiation is absolutely harmless to humans, so a survey with his participation can be carried out at any frequency. There are no contraindications to the method. In addition to the initial diagnosis, ultrasound is used to monitor changes during treatment.

Hysteroscopy

Hysteroscopy is an additional diagnostic method. This is an invasive procedure with a number of contraindications. It is carried out with the help of a hysteroscope equipped with a camera, which is inserted into the uterus through the vagina. The method with 100% accuracy determines the submucous myoma of the uterus.

Before the examination, an anesthetic agent is injected into the cervix. The image from the camera is immediately transmitted to the monitor. Having noticed a suspicious place, the doctor can perform a biopsy, that is, take a piece of tissue with a hysteroscope for a detailed examination. Thus, the diagnosis and treatment of uterine fibroids in some cases can be carried out simultaneously.

Magnetic resonance imaging (MRI)

MRI in the study of intramural fibroids of the uterus often plays an irreplaceable role. This method of diagnosis is appointed at the final stage of the survey, when previous techniques have not given a clear description of the disease. MRI allows you to determine the exact location, size and type of nodes formed. Even seals measuring a few millimeters are detected.

To check the health of the uterus using magnetic resonance imaging, MRI of the small pelvis is prescribed. Additionally, it is possible to assess the condition of the urinary, lymphatic and circulatory systems, intestines, ovaries and vagina.

This method of examination is highly informative, as it shows organs in layered cuts. A computer program links individual frames into a single image, creating a three-dimensional model. The disadvantage of magnetic resonance imaging is the use of X-rays. This limits the frequency of diagnosis and the number of those to whom it can be shown. So, MRI is not prescribed to pregnant women and children unless absolutely necessary.

Treatment of intramural fibroids

A woman with intramural myoma of the uterus should fully rely on the experience of the attending physician. Creating a treatment strategy, he will take into account such features of the disease:

  • size, location and intensity of the development of compaction,
  • pathology symptoms
  • accompanying illnesses,
  • age of the woman.

Возраст пациентки интересен врачу в связи с тем, что некоторые методики лечения не дают возможности сохранить репродуктивную функцию. Имеет значение также взгляд самой женщины на этот вопрос.

Hormone therapy

Having carefully studied the hormonal background of the patient, the doctor may prescribe drugs for its correction. Such treatment is considered classic, it can stop the growth of intramural uterine fibroids and even begin the process of its reduction. The method is effective in cases of small tumors.

Hormone therapy should be carried out very carefully, as additional failures in this system can lead to exacerbation of the problem or the occurrence of other disorders in the body. The main task in most cases of uterine fibroid treatment is to suppress the production of the hormone estrogen.

Physiotherapy

Some physiological procedures help to stop the growth of uterine intramural fibroids, cope with heavy bleeding, normalize hormone levels and improve well-being. Among them:

  • electrophoresis - effective in the presence of a small tumor in the uterus with slow growth,
  • magnetic therapy - reduces the level of estrogen and helps to cope with stress, which play a large role in increasing uterine tumors,
  • bromine and radon baths - designed to establish hormones and strengthen the immune system.

Folk remedies

Fully rely on traditional methods of treatment of uterine fibroids is not worth it. But as an addition to the basic therapy, they are quite applicable. Many people use a lot of means of fighting tumors in the uterus, the most popular of which are:

  • decoction of flax
  • potato juice,
  • motherwort tincture,
  • propolis tincture,
  • decoctions of pine forest uterus, burdock,
  • tincture of celandine.

Each tool has a proven regimen and a list of contraindications. Before using popular recipes for the treatment of intramural uterine fibroids should consult with your doctor.

Conclusion

Intramural uterine fibroids - a common disease of women, occurring throughout the world. Experts have two ways to combat pathology - hormonal and surgical. Some physiological procedures and popular recipes can help in recovery. Due to the instability of the hormonal system of the female body, each woman must constantly monitor her performance and avoid factors that adversely affect her.

Causes of intramural fibroids

The development of the pathological process contributes to many factors. First of all, these are hormonal disorders, leading to an increase in the amount of estrogen produced. During the period of menopause myoma nodes may disappear spontaneously. Benign uterine tumors are often found in women who have not had a childbirth in history or have late given birth to their first child.

Long-term use of hormonal contraceptives can trigger the growth of fibroids. Other causes are damage to the walls of the uterus during abortions, diagnostic curettage or surgical interventions.

The development of intramural fibroids can occur against the background of pathological processes associated with a deficiency or excess of female sex hormones (endometriosis, adenomyosis), inflammatory or infectious diseases, polyposis, and cervical erosion. The risk of developing fibroids increases in the presence of metabolic disorders: diabetes, obesity.

Benign neoplasms of an organ often develop in women living in unfavorable environmental conditions, malnourished, and have bad habits. Due to the genetic predisposition of uterine fibroids can be detected in adolescent girls. Thus, the development of the disease contributes to many factors, to eliminate the influence of which is almost impossible.

The clinical picture of the disease

Symptoms of intramural fibroids depend on the localization of nodes, their size and orientation. A characteristic symptom of the disease are intermenstrual bleeding. Menstruation is accompanied by intense pain, their duration and profusion increase. Often, on the background of prolonged bleeding, anemia develops, accompanied by general weakness, pale skin, chronic fatigue. With the development of new myomatous nodes, acute pains in the lower abdomen occur. Especially severe course is characterized by tumors with long legs. Complications such as torsion and necrosis are indications for emergency surgery.

As the fibroid grows, it begins to squeeze nearby organs and nerve endings. Pressure on the bladder and intestines leads to increased urination, constipation, pain during defecation. Necrosis of myomatous nodes is the most severe complication, in which severe pains in the uterus, heavy discharge with blood clots, fever and other signs of intoxication of the body are observed. Treatment involves urgent surgical intervention, taking antibacterial and anti-inflammatory drugs.

Uterine fibroids contribute to the development of infertility. A tumor interferes with the attachment of a fertilized egg. If the pregnancy does occur, it proceeds with complications. If there are knots of small sizes, problems with conception may not be observed, the woman has all the chances to endure and give birth to a healthy child. The level of estrogen during pregnancy decreases, and myomatous nodes dissolve.

The opposite clinical picture is observed in the presence of large tumors that adversely affect the development of the fetus. Since fibroids occupy all free space, the risk of premature birth, fetal malformations, postpartum hemorrhage, placental abruption increases. Intramural uterine fibroids during pregnancy may not be detected by ultrasound. The muscles are stretched and the tumor is hidden. However, this does not indicate a complete recovery, since after birth the nodes appear again.

Ways to detect the disease

To detect uterine myoma with careful examination of the patient is easy. Begin diagnosis with a pelvic exam with a bimanual examination and the use of mirrors. A preliminary diagnosis can be made when uterine deformity is detected. Transvaginal ultrasound allows you to determine the localization, size and number of myomatous nodes. This procedure helps to identify and related pathologies - adenomyosis and endometriosis. The results obtained are compared with the standards and make a diagnosis.

Using hysteroscopy assess the state of the tumor, detect the presence of complications. CT allows you to determine the prevalence of the pathological process, the damage to nearby organs. Laparoscopy allows you to distinguish uterine myoma from ovarian tumors.

Ways to treat the disease

The treatment regimen is selected depending on the size and location of the fibroids, the patient's age, the presence of concomitant pathologies. When treating women younger than 40 years old, conservative and organ-preserving surgical methods are used. Myomatous node is subjected to embolization, as a result of which the blood supply to the tumor stops. After a few months, the affected tissues of the uterus are restored, after which the next stage of treatment begins. Myomectomy is an operation to remove tumor nodes.

Surgical intervention can be both abdominal and endoscopic. The choice of method depends on the location, size and extent of the tumor. During surgery, the affected tissues are removed and sent for histological examination. This method is often used when combining fibroids with endometriosis. Planning for pregnancy is possible no earlier than one year of operation. Vaporization - alternate exposure to high and low temperatures, leading to the destruction of myoma nodes. These methods may be ineffective in the presence of tumors larger than 6 cm. When treating women older than 40 years, a hysterectomy is used - removal of the uterus by the laparoscopic or abdominal method.

Indications for radical surgery are:

  • massive bleeding,
  • tumors larger than 12 weeks of gestation,
  • suspected malignant degeneration,
  • the presence of severe forms of anemia.

Sites of small size can be eliminated by conservative methods. These include hormonal drugs, the types and dosages of which are selected depending on the severity of the disease and the individual characteristics of the organism. This method is ideal for women who are planning a future pregnancy. After conception, most myomatous nodes spontaneously absorb. Conservative treatment can not be only fibroids containing calcinates.

Hormone therapy is prescribed and after the removal of the tumor, it avoids the recurrence of the disease, accelerates the restoration of reproductive functions. During the period of treatment, the woman must comply with all recommendations of the attending physician, including the right diet. In the presence of intramural fibroids with several nodes, it is necessary to try to eliminate the influence of all provoking factors.

Single nodes are found only in the early stages of the pathological process, which are asymptomatic. Therefore, doctors are most often faced with neglected forms of the disease. Hormone therapy involves long-term medication, during which the woman should be under the supervision of a doctor.

Disease description

Myoma - This is the proliferation of the wall of the body with the formation of a benign tumor. Depending on exactly which tissues are involved in the pathological process, various types of myomatous nodes are distinguished.

Intramural or interstitial myoma of the uterus is completely in the thickness of the muscular layer of the uterine wall.

Least the third part of it is formed by muscle fibers, the rest is the share of connective and nervous tissue, blood vessels and extracellular substance.

It happens:

  • diffuse - if sprawl is single, but very extensive - rarely occurs,
  • nodal - one or several local tissue growths are diagnosed in the organ wall,
  • with centripetal growth - tumor growth at the same time causes a protrusion of the uterine wall into its cavity, characterized by the most pronounced clinical manifestations,
  • small - up to 2.5 cm in diameter,
  • average - up to 6 cm in diameter, which corresponds to the size of the uterus as at 10-12 weeks of pregnancy,
  • big - The size is larger than with a 12-week pregnancy.

Distinctive characteristics

Characteristic features in comparison with other forms of myomatosis:

  • occurs more often than other forms of myomatosis - diagnosed in 6 out of 10 women with similar tumors,
  • the tumor is localized inside the uterine wall, in the muscle layer, and its growth initially leads to an increase in the organ as a whole without changing its contours - this may delay the diagnosis of the disease,
  • in most cases, the interstitial myoma of the uterus body at early stages does not make itself felt with the help of specific symptoms - the clinical picture is erased,
  • the interstitial node of uterine fibroids, especially the small one, is not always possible to detect using simple ultrasound examinations — hysteroscopy
  • unlike submucous, interstitial uterine myoma of small size does not interfere with conception and during pregnancy pregnancy,
  • compared to other species, the intramural form is less likely to be reborn into a malignant tumor.

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Specific and non-specific symptoms

For intramural fibroids is characteristicIt may take a very long time from the appearance of a tumor to the first symptoms.

The myomatous site of small size (up to 20 mm) practically does not make itself felt in the interstitial myoma of the uterus. As education grows, the symptoms become more pronounced.

Determination of small sizes

Uterine fibroids of small sizes (up to 20 mm) are mainly of a hormonal nature and are manifested against the background of excessive estrogen production. Some experts tend to attribute congenital pathogenesis to the disease. In most cases, the nodes of small size are not accompanied by severe symptoms and are detected during the prophylactic ultrasound gynecologist.

The main method of researching small-sized nodes is ultrasound of the pelvic organs. If necessary, also held:

Tactics of treatment of small nodes elective, may be:

- waiting. Used in the absence of symptoms, not all specialists are prone to this method of treatment, considering that a slowdown can lead to an increase in the size of the nodes,

- drug or conservative.

Get acquainted with general information about the intramural node.

So what is uterine intramural myoma? This is a benign tumor that forms in the muscle section of the uterus. Since this is the largest part of the uterus, it is most vulnerable to the appearance of a tumor.

Intramural myoma node is the most common diagnosis among these pathologies and has its own characteristics of the development of the disease. And the treatment tactics is selected individually, based on a preliminary examination.

There are several types of nodes in the body of the uterus:

Submucous form - nodular form of fibroids, which is located in the mucous layer of the uterus. Overgrowth occurs mainly in the ventral side. Submucous nodes cause severe pain with intense periodicity. The uterus quickly grows in size.

Interstitial form - knot formation is located in the inter-wiring apparatus. As a rule, there is a plurality of nodes in the muscles, then it causes heavy menstruation.

Intramural uterine myoma - Education found in the muscle layer.

Intramural subserous fibroids - formed on the outside of the uterus, affecting the pelvic region. They are characterized by mild symptoms, which is the reason for late detection. In this case, the diagnosis is “uterus podcherosis fibromyoma”.

According to the degree of the disease, single and multiple occurrence of tumor nodules can vary.

Causes of

The following reasons may lead to the development of this pathology:

  • Violation of hormonal levels.
  • Any disorders of the nervous system.
  • Uterus traumatic factor: abortion, scraping, surgery.
  • Hormone-related diseases - endometriosis and adenomatosis.
  • Chronic inflammatory or infectious process in the uterus.
  • The presence of diseases such as diabetes, overweight.
  • Conducting irregular sex life.
  • Endocrine diseases.
  • Wrong lifestyle and nutrition, bad habits.
  • Period of menopause.
  • Hereditary predisposition

Diagnosis of the disease

The presence of tumors in the form of intramural fibroids anywhere in the uterus can be detected on a routine checkup by a gynecologist. With the help of mirrors on the gynecological chair, an increase in the uterus will be noticed by a doctor. For accurate diagnosis will need additional examinations and procedures:

  • Ultrasound procedure
  • Hysteroscopy.
  • Magnetic resonance imaging.

Treatment tactics

The course of treatment depends on the age of the woman, the location and size of the tumor, as well as the presence of concomitant diseases and the reasons for the appearance of this pathology.

With a small size of the intramural node - up to 2 cm - expectant tactics with regular observation are permissible.

The age of the woman is important for determining the preservation of reproductive function and the need to preserve the patient's internal organs for carrying the child. Treatment can be a medical method, as well as surgery.

In the course of medication, patients are prescribed hormonal drugs to normalize the menstrual cycle and reduce the size and growth of the nodes. As a rule, the hormonal course is 8-9 months. For large sizes of intramural nodes, hormone therapy can also be prescribed before the operation, to reduce their size.

Effects

When untimely or independent treatment may develop the following complications:

  • Anemia,
  • Large blood loss
  • Dizziness, nausea and vomiting,
  • Tumor pressure on nearby organs,
  • Development of bladder problems,
  • Impaired kidney function,
  • The development of frequent constipation:
  • Inability to make a child,
  • Infertility.

Pregnancy and intramural node

Pregnancy may well occur and fully develop without features in the presence of intramural fibroids. But sometimes, miscarriage, other complications can occur.

During pregnancy, the location of the fibroid and the node is very important. Myomatous nodes can be positioned so that they can provoke the development of complications in this important period.

In addition, the size of the node is important. Small knots will not prevent conception, if there is no growth, then the gestation period will pass without complications.

When an education is found near the placenta, it can trigger an abortion caused by intrauterine infection of the fetus or an inadequate supply of nutrients from mother to child.

If there are large nodes, pregnant women may experience the following complications:

  • Late start of labor,
  • Spontaneous miscarriage,
  • Rejection of the placenta,
  • Profuse bleeding.

For these reasons, ultrasound during pregnancy is performed often enough to control growth and prevent the development of complications.

When indicated, the surgical removal of the node is prescribed, namely when:

  1. A rapid increase in the size of the tumor site,
  2. The impossibility of an independent labor process due to the location of the tumor,
  3. Prenatal bleeding,
  4. Acute fetal hypoxia.

As a rule, neoplasms during pregnancy, if they are not the cause for the development of a complication and do not cause inconvenience, pain to the expectant mother, are removed after childbirth.

If the intramural node develops due to hormonal disruption, the disease can self-heal during pregnancy as the hormone levels are restored. However, this is not an indication that the fibroid has resolved completely. Since the muscles during pregnancy stretch, the nodes during the examination may remain unnoticed. Also, an ultrasound examination at the location of nodes in the muscle layer may not be reliable. After childbirth myoma may reappear.

Keep in mind that this pathology significantly complicates the course of labor. As a rule, delivery in such cases is performed using a cesarean section.

Is the disease dangerous during pregnancy?

If intramural fibroids are diagnosed during pregnancy, then the patient will face various serious complications:

  • labor starts before the appointed time,
  • increases the likelihood of miscarriage,
  • placental abruption,
  • profuse bleeding.

Features of surgical techniques

There are several types of operations for intramural myoma.

  • Embolization The main task is to disrupt the normal circulation of blood that enters the node. After that, the cells of fibroids gradually die off. Before the procedure, the gynecologist will prescribe hormonal preparations.
  • Myomectomy will quickly and without pain remove all intramural nodes. The operation is performed by two techniques - this is laparoscopy or removal by opening the cervix. The specialist excises only the place where the node was located. A year later, the girls will be able to plan a pregnancy.
  • Vaporization With the help of such a surgical procedure, the tissues of an intramural tumor are killed due to the effects of low and high temperature.
  • Laparotomy is used in cases where the node has a very large size.

The choice of treatment method and the best option for surgery for intramural myoma is selected for each patient individually. If the node was found at the initial stage, then women are prescribed conservative treatment with the help of hormone therapy. This is especially true for girls who are planning to have a child in the future. There are cases when intramural fibroids and nodes dissolve independently. This is due to changes in hormonal levels.

About the disease

Intramural myoma is a benign growth of smooth muscle cells of the uterus, the name is determined by the location of the nodes - in the thickness of the myometrium. In contrast, submucous nodes grow under the mucous membrane, endometrium, and subserous nodes are located closer to the outer surface of the uterus.

The uterus is an unpaired muscular organ, it is intended for carrying and giving birth to children. The inner epithelial layer creates conditions for the attachment of a fertilized egg and the development of the embryo.

The muscular wall is formed by three layers of cells, which are located in three directions - outside and inside longitudinally, and between them - in a circular way. Their contraction during childbirth pushes the baby out.

Adverse factors affect smooth muscle cells, damaging them. This leads to the appearance of nodes consisting of myocytes and connective tissue cells.

The most likely causes of intramural fibroids are:

Hormonal changes with a predominance of high levels of estrogen. This hormone causes increased division of uterine cells, its effect may manifest itself in the form of an increase in the mucous layer, then they talk about endometrial hyperplasia.

If myometrium is affected to a greater extent, then nodes are formed. The decrease in estrogen levels during menopause leads to the reverse development of fibroids.

  • Traumatic manipulation of the uterus - abortions, scraping, difficult childbirth, surgical interventions. In the muscle layer there are proliferating (young) cells, their damage during rough manipulations causes a gradual accumulation of such myocytes. Hormonal shifts that necessarily accompany abortion, childbirth, enhance the process of knot formation.
  • Inflammatory and infectious diseases of the uterus - endometritis, genital infections. Inflammation is accompanied by swelling of the tissue, the liquid part of the blood leaving the bloodstream, which leads to compression of microvessels and ischemia. The damaging factor in this case is directly an infection and oxygen starvation of the tissues.

    Endocrine Diseases - diabetes, damage to the thyroid gland, affect the overall level of hormones. Obesity always leads to an imbalance of sex hormones. This is due to the hormonal activity of adipose tissue and its ability to increase the synthesis of estrogen.

    Diabetes and thyroid hypofunction in most cases are accompanied by an increase in body weight.

  • Irregular sex life after 30 years, a sedentary lifestyle leads to stagnation of blood in the pelvis, which contributes to myometrial hyperplasia.
  • Stress and bad habits in women, they can cause fluctuations in hormones and increase the risk of developing fibroids.
  • The occurrence of fibroids in relatives speaks in favor of a possible hereditary predisposition to the disease.
  • In half the cases, the fibroids are asymptomatic. Symptoms become noticeable when the adjacent organs are squeezed, when the uterus increases in size due to large nodes. Some signs appear due to deformation of the organ. Symptoms:

    1. Abundant and prolonged menstruation. associated with a change in the shape of the inner surface of the uterus, the deterioration of the rejection of the endometrium and its possible hyperplasia.
    2. Bleeding between menstruation also associated with high levels of estrogen and hyperplastic processes in the mucosa.
    3. Painful menstrual bleeding due to difficulty separating the endometrium.
    4. Lower abdominal pain occurs when blood flow is disturbed in the nodes due to compression of the supply vessels.
    5. Abundant blood loss causes anemia.which is accompanied by dizziness, increased heartbeat.
    6. Big myoma squeezes the neighboring organs - The bladder and rectum, which leads to a breakdown of urination and bowel movements.
    7. Malnutrition of large fibroids causes necrosis.. This is accompanied by severe pain, fever, intoxication, and discharge of blood clots from the genital tract.
    8. Infertility, miscarriages, bleeding during pregnancy and after childbirth a consequence of changes in the shape of the uterus, hormonal regulation disorders.

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    Hormonal therapy

    Selection of a drug for treatment is always individual. Use the following groups:

    • Progestin The natural hormone of the second phase of the menstrual cycle, lowers the level of estrogen. Progesterone or duphaston is used for treatment, which can be used even during pregnancy. The Mirena intrauterine device is also effective against fibroids.
    • Anti-progestogen drug Mefipriston apply twice per cycle with small nodes.
    • Gonadotropin releasing hormone agonists reduce the concentration of estrogen, which leads to a decrease in the site.
    • Tamoxifen - selective estrogen receptor modulator has anti-estrogenic effect.
    • Antiandrogenic drugs (Danazol) by reducing androgens, they affect gonadotropins, which inhibits the growth of the node.
    • Combined oral contraceptives will help in the treatment of small nodes up to 2 cm in diameter.

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    Other drugs

    Other medications are used to relieve the symptoms and effects of fibroids:

    • Nonsteroidal anti-inflammatory drugs needed to eliminate pain. Analgin, Nimesulide, Meloxicam, Ketorolac are effective.
    • Iron preparations essential for the treatment of anemia. Apply Sorbifer, Maltofer, Totem.
    • Hemostatic agents needed for heavy bleeding, Etamzilat is effective in injections or tablets.

    FUS ablation

    Focused ultrasound - the destruction of fibroids in a non-invasive way using ultrasound under the control of MRI is performed as follows:

    1. Prior to the procedure, a survey is conducted to determine the location and size of the nodes. It is impossible to use the method with submucous and subserous nodes on the leg or sizes greater than 500 cm3.
    2. Calculates the distance to the nodes.
    3. Appropriate hardware settings are made.
    4. Under the control of MTP, ultrasound acts on the node. Anesthesia and anesthesia at this stage are not needed.
    5. After the procedure, analgesics are prescribed.

    Surgical treatment is possible radical - removal of the body, conservative-plastic - myomectomy.

    To remove the uterus resorted to in the following cases:

    1. No need to save childbearing function.
    2. The size of fibroids more than 15-16 weeks of pregnancy.
    3. The rapid growth of the node.
    4. Increased tumor in postmenopausal women.
    5. Suspicion of sarcoma.
    6. Dysfunction of neighboring organs.
    7. Bleeding, leading to the development of anemia.

    Operation process

    1. General anesthesia.
    2. Access to the abdominal cavity laparoscopically with a small amount of fibroids. If the size of the uterus is more than 16-18 weeks, laparotomy is performed.
    3. Tie up the vessels that feed the uterus.
    4. The appendages are cut off, the neck is preserved.
    5. The uterus is released from the ligaments and removed. A revision of the ovaries for tumors.
    6. Check the reliability of hemostasis.
    7. Layered abdominal closure.
    8. On the wound - aseptic dressing.

    Rehabilitation

    After the operation, thrombosis prophylaxis is continued for a month (compression garments, low doses of aspirin). After removal of the uterus, hormone replacement therapy is prescribed to prevent castration syndrome. After removal of the nodes after 1, 3 and 6 months perform a control ultrasound.

    With timely treatment, the prognosis is favorable. In childbearing age, reproductive function can be preserved and pregnancy can be achieved.

    Large intramural fibroids

    Large nodes that grow on the outer layer of the uterus can form adhesions with adjacent tissues and organs, as a result of which pains are recorded in different areas of the body. Large myomatous nodes (50 mm and more) over time begin to squeeze adjacent organs, causing dysuric disorders, an impaired intestinal motility. With deformation of the uterus, menstruation becomes long, bleeding occurs, the development of infertility is likely.

    For approval of the diagnosis of large-sized nodes is carried out:

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