What is subserous uterine fibroids: diagnostic methods and when is surgery necessary. Treatment of subserous uterine fibroids

There are several types of myomatous nodes. A subserous myomatous node is located on the outside of the uterus and may have a base - a leg. Its structure determines the methods of therapy for this condition.

Uterine fibroids occur due to dysregulation of the growth of muscle tissue cells of the organ. The impetus is most often hormonal disorders and previous surgeries on the uterus.

Myoma can be single and differ in localization. According to the medical classification, the following types of tumors are distinguished:

Submucosal myomatous neoplasm- located in the submucosa of the organ on a thin stalk.
Interstitial, or intramural- located between the muscular layers of the uterus.
subserous tumor- localization outside the uterus, may have a leg.
Intraligamentary node- located on the ligaments or between them.
Less common born and nodules in the cervix.

The development of the pathological process in the uterus is influenced not only by the hormones of the sexual sphere, but also by dysfunction of the thyroid gland. For example, hypothyroidism is combined with an increase in estrogen levels. This can serve as an impetus for the development of a benign hormone-dependent tumor.

After cavity curettage, setting the spiral, the uterine mucosa is often damaged and its structure is disturbed. Unfavorable factors are also a combination of influence on the body of bad heredity, an unfavorable environment, negative emotions and weak resistance to pathogenic microorganisms.

They range from 1.5 cm to a dozen cm. However, more often they are found when they reach at least 4-5 weeks.

Diagnosis of subserous fibroids

Despite the fact that subserous uterine myoma is a benign formation, it is capable. The rate of malignancy depends on the type of fibroids and the totality of the influence of external factors.

When diagnosed, a fibroid of this type looks like a knot on a wide base or stalk, through which its nutrition and growth is carried out. A single node is covered by a capsule, limited from surrounding tissues, and easily visualized. Multiple formations are difficult to isolate from each other. The diameter of each of them does not exceed 10 cm.

Localization outside the uterus limits the involvement of the tumor in and does not contribute to organ enlargement. As a result, there are no obstacles to conceiving a child. If the subserous node is located near the fallopian tube, it can lead to a violation of its patency as a result of compression. In this case, maintaining the pregnancy is difficult.

Types of subserous uterine fibroids

In gynecology, a convenient classification of subserous nodes is provided.

According to her, all fibroids of this type are divided into the following types:

zero subserous node on the leg, differs in that it is not intramural.
In the first type, the percentage of the content of the intramural component occupies half of the node.
The second type is said when the intramural content is more than half of the node and the subserous component is less pronounced than the first type.

The myomatous node along the anterior wall is found in most women, the location along the posterior wall is typical for. The subserous node grows into the peritoneal cavity and unfolds in rare cases.

Reasons for development

As noted, the following factors can influence the development of a tumor:

disruption of the endocrine system;
hereditary predisposition;
damage to the myometrium of the uterus.

Pathologies of a subserous nature are focused on pain sensations of a pulling, aching nature. The area of their localization is the upper abdomen, irradiation to the back is observed.

The pain may intensify after physical overwork, numbness of the pelvic muscles, against the background of colds.

How is subserous fibroids diagnosed?

A standard appointment with a gynecologist includes a mandatory history taking, a study of the history of chronic pathologies. An in-depth medical examination includes a blood test (clinical detailed, biochemistry, hormones); inspection with mirrors; ultrasound examination; magnetic resonance imaging.

Treatment Methods

Treatment can be radical. If a neoplasm is detected at an early stage of development, observation tactics are allowed. In this case, we are talking about fibroids up to 12 weeks of pregnancy. If the hormonal background of a woman does not require correction,
sanitize only chronic foci of infection.

Medical therapy

At a size of 12-15 weeks, treatment with oral and hormonal contraceptives will be effective to reduce the production of hormones by the ovaries. Medicines are taken for at least six months. Another therapy option is. This method of treatment combines the contraceptive function. The peculiarity of the last method of therapy is that the spiral is placed only in women who have given birth. There are contraindications to the use of hormonal drugs:

increased amount of glucose in the blood;
phlebeurysm;
hypertension.

Additionally, symptomatic drugs are prescribed: painkillers, iron, vitamin complexes, hemostatic drugs. Physiotherapy includes magnetotherapy, radon baths.

Treatment during pregnancy

A subserous myomatous node can be detected during pregnancy on ultrasound. What are the complications of this pathology? If the neoplasm is located on the leg, its torsion may occur. The operation is carried out, taking into account all the risks to the fetus. When the pregnancy cannot be terminated, expectant management remains. The growth of fibroids can lead to compression of the ureters, which will lead to disruption of the kidneys, the development of a dangerous condition - pyelonephritis. Due to irradiation in the area of the rectum, its inflammation occurs. However, observation of the entire period of pregnancy allows timely prevention of complications for mother and baby. When determining the tactics of therapy, the doctor takes into account several factors:

gestational age;
size and type of tumor;
location of education;
the patient's age.

A large tumor is removed surgically, by laparoscopy, or by the abdominal method. The choice of tactics is determined by the doctor according to the indications.

Surgery

Absolute indications for removal of the uterus are its development on the leg and large size. Also, the surgical method is resorted to with a pronounced nature of pain, infertility and the ineffectiveness of conservative therapy with medications.

Abdominal surgery is used as a radical method of getting rid of the tumor. Indications for its implementation:

large node size;
tumor degeneration.

Myoma is excised in the suprapubic region after dissection of all layers of tissue.

A hysterectomy involves removing the tumor along with the organ. It is carried out according to vital indications and only to women who have given birth.

Laparoscopy is a modern sparing method. Its advantage is the absence of postoperative scars, rapid rehabilitation after surgery.

Uterine artery embolization is rarely used. The method consists in stopping the supply of the node after blocking the blood flow to it. This method is an alternative to surgery.

Planning for pregnancy after surgery

Doctors always try to save the uterus during surgery to remove fibroids. The duration of recovery depends on the method of therapy chosen, the individual physiological characteristics of the woman. In any case, if the recommendations of the attending physician are followed, conception can be planned as early as a year after the operation, with normal tissue healing.

Nutrition with a subserous node

A properly composed diet is also of great importance for the recovery of a woman's body. To normalize the work of the digestive tract, the level of hormones and vitamins, you must adhere to the following scheme:

To normalize metabolism, food should be plant-based, contain enough fiber.
Buy lean meats: poultry, veal.
Avoid spicy, spicy, fried foods.
Eat dairy products, grain products daily to remove toxins from the body.
Marine fish has an antitumor effect and contains a complex of minerals.

Improper nutrition during the rehabilitation period will slow down the recovery process and cause general harm to the body.

After thirty, a woman should undergo a complete gynecological examination every six months, this significantly reduces the risk of developing pathologies of the reproductive system. Regular care of your health minimizes negative factors.

Interesting video:

Subserous uterine fibroids (or subperitoneal) refers to one of the varieties of hormone-dependent benign uterine formations. And since the uterus plays a key role in women's health, identifying the cause of the distortion of its work, symptoms, as well as timely treatment will not allow many complications to develop. The main place of concentration of nodes in uterine myoma is the muscle layer. A characteristic feature of the disease is that the node can grow into the uterine cavity. The subserous myomatous node can be located on a wide or elongated (like a leg) base, due to which it is fixed on the muscle layer. At a specific moment, it is laced from the uterine body and is introduced into the peritoneal cavity or into the ligaments of the uterus itself near it.

Single nodes are surrounded by a modified smooth muscle tissue like a capsule. Group localization is noted not so often. At the same time, the menstrual cycle undergoes almost no changes, only pain signs are occasionally felt. Large group formations can harm the work of nearby organs - the rectum at the back and the bladder at the front.

Often there are also atrophic phenomena in the female body due to torsion of the legs of the myoma. When the supply of the myomatous node is blocked, tissue necrosis is possible with the development of inflammatory and purulent lesions in nearby organs and systems. With uterine fibroids, there may be such symptoms:

elevated temperature;
the occurrence of sharp pains;
dizziness and fainting;
hyperhidrosis;
severe tachycardia.

Stages of development of the myomatous node

The subserous node of the uterus, until the final formation, sequentially undergoes three stages of development.

Stage 1: intensive growth in the tissue area, the maximum level of metabolism and vascular permeability index.

Stage 2: accelerated development occurs, however, accurate differentiation without the use of microscopic equipment is still not possible.

Stage 3: individual examination clearly differentiates education. Examination under a microscope reveals morphologically damaged tissue around the mass, indicating progression of tumor growth.

In most cases, group localization is noted, when several nodes grow at the same time. In practice, mixed forms of fibroids may appear, which are practically not amenable to diagnosis during a gynecological examination. They can announce their presence only by the appearance of prolonged menstrual and postmenstrual bleeding. Such a formation, in particular, is an intramural-subserous variety, choosing the muscular layer of the organ as its location. This is it, when it grows to significant values, deforms the uterus, negatively affects the performance of the gastrointestinal tract and urination systems. due to the random division of connective tissue cells. This type of fibroids is located in the intermuscular space under the upper epithelial layer. It can grow beyond the body of the uterus in the direction of the peritoneum. In this case, subserous-interstitial fibroids are diagnosed.

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The root causes of the formation of subserous nodes

The nature of the pathology is currently not actually established. Only conjectural opinions are put forward.

One of them takes long-term and unstable rearrangements in the uterine origin in the perinatal period as the basis for the development of a tumor state (for example, the presence of a defect in muscle cells). The second version notes the possibility of cellular damage in an adult organ due to various influences. A newer version is based on the assumption of the accumulation of cells with altered functions of apoptosis (programmed death).

A certain number of altered cells are excreted with menstrual flow, some of them remain. An increase in the number of deformed cells with a new lunar cycle ensures the development of myomatous nodes. An increase in estrogen levels during the menstrual period contributes to their accelerated growth. It is also taken into account that protein production in the genes involved in the growth of embryonic tissue can be disrupted. Such changes cause chaotic division of immature cells with damage that contributes to the appearance of malignant or benign formations (with incomplete damage). In other words, gene dysregulation leads to an increase in the size of the cell complex in the myomatous node. This process is triggered by factors such as:

disruptions in the hormonal background that caused neuroendocrine-metabolic syndrome;
surgical operations with hypoxic, dystrophic or traumatic complications;
the formation of scar tissue due to myomectomy;
inflammation and tumor conditions of the ovaries and mammary glands;
violation of the production of thyroid hormones and insufficiency of the adrenal cortex;
long-term use of contraceptives;
transferred urogenital infectious diseases;
hereditary reasons.

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Symptoms of a subserous node

Early forms of subserous formations do not show signs as such. Symptoms become noticeable only when the nodes reach an enlarged size. They let you know:

copious menstrual flow and often with bloody clots;
prolonged period of menstruation;
more meager uterine secretions in the middle of the cycle;
infertility and inability to bear a fetus;
enlarged abdomen and a feeling of constriction of the intestines and organs of urination.

The torsion of the leg of the node is evidenced by:

an abundance of bloody discharge;
signs of hyperhidrosis and weakness;
feeling of nausea;
pain radiating to the lumbar region.

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Diagnostic methods for detection and treatment of subserous uterine nodes

Detection of subserous fibroids is possible through echography. Magnetic resonance topography makes it possible to differentiate the disease and clarify the topographic position of the tumor formation. On the three-dimensional image of the filmed process, its parameters are visible. Hydrosonographic examination allows you to recognize the smallest formations and determine the degree of damage to the uterus. Separate diagnostic curettage is performed to exclude pathological processes in the female genital mucosa. Laparoscopy is done when it is impossible to differentiate the disease.

Treatment of subserous uterine fibroids is assumed to be both conservative and surgical. The surgical method has proved to be more effective.

Removal of subserous formations in the uterus is indicated for:

severe blood loss;
large size education;
progression of the tumor process;
with malnutrition of subserous nodes.

At the same time, different methods of treatment are chosen. Among them:

laparoscopic myomectomy - is prescribed for the removal of intramural-subserous small formations with a leg by exfoliation through 3 punctures on the abdomen;
hysteroscopic myomectomy - an operation performed through the vagina;
total hysterectomy - involves the removal of education with the uterus and appendages.

Nodal embolization and FUS ablation are considered non-surgical methods.

It is quite possible to cure a subserous variety of fibroids with folk remedies. Why the doctor can additionally prescribe various tinctures, suppositories and ointments. The first category includes poisonous plants. Antitumor properties have their extract on alcohol.

Reception in small drop doses is indicated for such means as:

Dzungarian and Baikal wrestler;
mistletoe white with propolis in the form of tincture;
marsh cinquefoil with speckled hemlock.

Raw materials are best purchased at a pharmacy. On the package it indicates the dose for body weight and the prescription. Despite the fact that the plants are very effective, they are still poisonous. They should be handled with care. Treatment with medicines and folk recipes is necessarily accompanied by a diet, which the doctor advises about.

The most serious complications of subserous nodes in the uterus are heavy and acute bleeding.

It is extremely rare for malignancy of nodes and other serious problems.

Subserous myomatous nodes are formed imperceptibly for a woman. The patient, as a rule, turns to doctors when the tumor has already increased significantly and compresses other organs. Pathology as a whole proceeds latently. However, fibroids require timely diagnosis and treatment. Learn more about the disease.

What is subserous fibroid

Benign tumors of the reproductive organs are considered to be a negative consequence of hormonal imbalance in a woman's body. A neoplasm that occurs on the surface of the uterus and grows towards the abdominal cavity is classified as subserous or serous fibroids. It is important to note that the primary focus appears in the thickness of the myometrium, and only then does the nodal segment of the tumor form.

What does a subserous fibroid look like?

This type of formation has a wide base, which is attached to the myometrium by means of a thin stalk that imitates a kind of channel. The latter connects the primary node of the myoma with its rest, located outside the boundaries of the uterine wall. In this case, the occurrence of both single and multiple nodes can be observed. Depending on the localization, subserous uterine fibroids can have the following forms:

Intramural. Tumors of this type are considered the safest in terms of the likelihood of pregnancy. The intramural-subserous node is located on the surface layer of the myometrium and in no way affects the functionality of the female reproductive organs.
Interstitial-subserous. This type of neoplasm occurs in the thickness of the muscle tissue, and then rushes into the peritoneal cavity. As a result, the wall of the uterus thickens somewhat, provoking miscarriage.

Why does subserous uterine leiomyoma appear?

Hormone-dependent tumors appear due to neuroendocrine disorders, as a result of which the interaction between the ovaries and the corresponding parts of the brain is lost. Often, the thyroid gland and adrenal glands are involved in the imbalance. At the same time, many women are interested in how leiomyoma differs from ordinary fibroids.

The main difference between these two tumors lies in the fact that the first develops against the background of numerous pathologies of the female genital area, while the second is the result of the prevalence of estrogen over progesterone. Among the provoking factors for the development of the disease, experts often name abortions, sexually transmitted diseases, and constant stress. In addition, leiomyoma can develop due to the following reasons:

diseases of the heart and blood vessels;
late onset of menarche;
menopause;
heavy menstrual bleeding;
anemia;
obesity;
endocrine pathologies.

How does a subserous fibroid manifest itself?

The initial stages of tumor formation are asymptomatic. As subserous uterine fibroids grow, the compression effect of the tumor on nearby organs and tissues occurs, which provokes patients with problems with emptying the intestines and bladder. However, the tumor negatively affects the muscle tone of the uterus, which is why women suffer from heavy discharge during menstruation. The disease may be accompanied by other symptoms:

aching pain in the lower abdomen;
dysuria;
hyper sweating;
iron deficiency anemia.

Interstitial subserous uterine fibroids

Each individual tumor process develops according to a strictly individual scenario. It was already mentioned earlier that subserous-interstitial uterine fibroids have features that radically distinguish it from other forms of pathology. Due to the fact that the tumor initially develops in the muscle layer, the uterine wall thickens and prevents pregnancy. To top it off, subserous uterine fibroids are characterized by special signs:

radiating pain;
dysfunction of the excretory systems of the body;
profuse menstruation.

What is dangerous subserous tumor

The main disturbing factor in the physiology of this neoplasm is the possible torsion of the tumor stem, followed by the death of its tissues due to vascular embolism. In such a dangerous situation, a sick woman needs urgent surgical removal of necrotizing fibroids. It is important to note that even a short-term delay in dead areas in the body can provoke severe poisoning of the body with tumor decay products.

Diagnostics

Unfortunately, most patients turn to specialists when the pathology begins to manifest itself with certain symptoms. For this reason, the diagnosis of fibroids is often of a verification nature. However, for a more accurate differentiation of a subserous neoplasm, the following laboratory and instrumental studies are prescribed for sick women:

Ultrasound of the pelvis - helps to determine the localization of fibroids.
A vaginal smear for purity and the presence of oncocytology is prescribed to detect latent infections, atypical cells.
Hormonal studies - reveal the prevalence of some bioactive substances over others.
MRI - provides a layered visualized image of education.
Diagnostic curettage of the uterine cavity, followed by histology of the obtained samples - is carried out to determine degenerative changes in the endometrium.
Hydrosonography - determines even the smallest foci and their development.
Laparoscopy - carried out in case of insufficiency of other studies.

Treatment of subserous fibroids

Therapy of tumor processes depends on the neglect of the disease and the rate of growth of the formation. When choosing treatment methods, the woman's desire to become pregnant and give birth to a child in the future is also taken into account. In the case of an acute complication, surgical removal of the tumor is almost inevitable. So, the interstitial-subserous node is often an indication for resection of the uterus. It is important to note that today there is an ablation procedure that allows you to absolutely bloodlessly cure a subserous tumor. In addition, with myoma, it is prescribed:

Conservative hormonal treatment:
- gonadotropin-releasing agonists;
- antiprogestogens;
- combined oral contraceptives;
- gestagens;
- selective modulators.
Surgery by one of the following methods:
- embolization of the uterine arteries - overlapping of the vascular lumen;
- conservative myomectomy - exfoliation of the tumor;
- hysterectomy - extirpation (complete removal) or amputation (partial removal is indicated if the woman has not given birth) of the uterus.
Alternative treatment using:
- Cherry decoction. One part of dry fresh twigs of the plant is poured with three parts of boiling water and infused under the lid for about 20 minutes. It is recommended to drink the remedy for subserous myoma three times a day on an empty stomach. The duration of the course depends on the further course of the disease.
- Boron uterus tinctures. 3 tablespoons of dry raw materials are placed in 600 ml of alcohol and left in a dark place for 2 weeks. Herbalists recommend drinking a tincture of a boron uterus from fibroids, 12-28 drops 20-30 minutes before meals. The course usually lasts about 3 months.

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Subserous uterine myoma is a tumor of a benign nature, which is formed from the cells of the muscular tissue of the uterus and is localized under the serous membrane of the organ. The neoplasm is hormone-dependent.

In most cases, there are no symptoms, while other women complain of pain in the lumbar region and lower abdomen, as well as unsuccessful attempts to conceive a child.

Subserous uterine fibroids or subperitoneal, most often diagnosed in patients over the age of 30-35 years. With the onset of menopause, as a rule, involution of the neoplasm occurs due to changes in the hormonal background in the body and a decrease in estrogen production.

Kinds

There is the following classification of education, based on the size, structure, number and localization of myomatous nodes:

Dimensions. Depending on the size of the fibroid, small formations are distinguished - up to 20 mm in diameter, which corresponds to about 5 obstetric weeks of pregnancy, medium ones - up to 60 mm and 10 weeks, and large nodes - more than 60 mm in diameter and corresponding to a gestational age of more than 12 weeks.
Structure. Depending on the type of cells of smooth muscle tissue and their proliferative activity, the myomatous node can be simple, presarcoma and proliferating.
Number of nodes. The subperitoneal tumor can be either single or multiple (i.e., several myoma nodes progress at once).
By localization. Myoma can be on a thin stalk or a wide base, be directed into the abdominal cavity, or be located directly in the muscle tissue under the serosa (intramural or interstitial).

Reasons for development

Most doctors consider hormonal imbalance to be the main reason for the development of subserous uterine fibroids. What can cause it:

Diseases of the endocrine system. Diabetes mellitus, adrenal dysfunction, hypothyroidism and other pathologies can affect the synthesis of estrogen.
Violations of the central regulation. Failure of the ovaries can be caused by the presence of tumors in the body, with damage to the vessels of the brain.
Stagnant processes in the organs of the reproductive system. The cause of the problem is often the lack of physical activity, irregular sex life or its complete absence.
Impaired ovarian function. The balance of progesterone and estrogen can be disturbed in infectious and inflammatory diseases, polycystic.
Prolonged use of hormonal contraceptives. Artificial suppression of the process of ovulation with the help of contraceptives can lead to a violation of the production of hormones in the body.
Overweight. Adipose tissue is able to influence endocrine secretory activity, as a result of which the amount of estrogen produced in the body is higher than normal.

Perhaps the development of subserous uterine fibroids and in the presence of the following factors:

genetic factor. The body's tendency to develop a tumor is inherited.
Operations on the uterus. Scraping, and other manipulations that injure the mucous membrane of the organ, are ways to provoke the development of a neoplasm.

Subserous uterine fibroids: symptoms of the disease

In most cases, the presence of small myoma nodes does not cause any concern, and the woman does not have any. Signs of subserous fibroids occur, as a rule, with an increase in the number of nodes or their size, and also depend on the location of the tumor.

How can subserous uterine fibroids manifest:

, feeling of heaviness;
painful, prolonged and clotted menstrual flow;
intermenstrual spotting;
pain in the lumbar region.

Possible Complications

Of the possible complications of subserous uterine fibroids, which may be dangerous, the following should be mentioned:

torsion of the leg of the neoplasm;
tumor tissue necrosis;
infertility;
spontaneous miscarriages with successful conception;
development of endometrial hyperplasia in the uterus.

Transformation of myomatous tissue cells into malignant ones occurs very rarely.

On the video about subserous uterine fibroids and its dangers

How is it diagnosed?

To make a diagnosis in gynecology, the following methods are used, which allow you to determine not only the presence of its fibroids, but also its location, structure, number of nodes, nutritional features:

examination by a gynecologist;
ultrasound examination by transabdominal and transvaginal methods;
MRI and CT of the pelvic organs;
diagnostic laparoscopy.

Laboratory diagnostics is also prescribed - a general blood test and a blood test to determine the level of sex hormones. If there are indications, a woman is referred for a consultation with narrow specialists - an endocrinologist, oncologist, surgeon, etc.

Treatment Methods

The tactics of treating subserous uterine fibroids is to preserve the reproductive function of a woman.

includes:

Hormonal preparations. They are based on progesterone. The action is aimed at normalizing the hormonal background and reducing the size of myomatous nodes.
Antispasmodics. They improve well-being and minimize pain.
Vitamin complexes. Allows to strengthen the immune system.

In the presence of indications or in case of ineffectiveness of drug therapy, an operation is performed. The following options are possible:

A cavity operation during which subserous nodes are removed. In indications, the large size of uterine fibroids or malignancy of its tissues. Removal is performed by an incision in the lower abdomen.
Laparoscopic removal of fibroids. Excision of pathological formations is carried out through punctures using a special apparatus - a laparoscope.
Hysterectomy or. It is carried out with a large size of the uterus, associated complications and a threat to life for the patient.

Recovery period

During the rehabilitation period after surgery, you should strictly follow all the doctor's recommendations. This is the only way to help the body recover faster and eliminate any complications.

The ban on physical activity. To avoid stagnant processes in the body, special exercises are shown that have a beneficial effect on the state of the body.
The ban on visiting the bath, sauna, solarium. You can not be under the rays of the sun.
Eliminate the use of hygienic tampons, give preference to pads.
Do not take any medications on your own, without consulting a doctor, especially hormonal drugs.
Healthy and balanced nutrition should prevail in the daily menu. Following a diet will help you avoid excess weight and maintain health.

Subserous uterine myoma is a benign neoplasm with a low risk of becoming malignant. If the disease is diagnosed in a timely manner, the woman has passed the course of treatment prescribed by the doctor, then the prognosis is favorable without relapses in the future and the need to remove the reproductive organ. This is evidenced by numerous reviews of women after a course of therapy.

Subserous myoma- a benign hormone-sensitive neoplasm, which consists of smooth muscle cells of the myometrium and is located under the serosa of the uterus. In 60-70% of cases, the disease is not clinically manifested. Some patients are concerned about pain in the lower abdomen and lower back, impaired reproductive function, signs of pressure on the pelvic organs. To confirm the diagnosis, ultrasound, angiography and dopplerography of the uterus, tomography of the pelvic organs, and laparoscopy are prescribed. Treatment involves the use of hormonal drugs, myomectomy and radical interventions.

General information

Subserous, or subperitoneal, fibroids (leiomyomas) are most often detected in women over 30 years of age. At the same time, at present, the prevalence of the disease in the age group of 20-30 years has increased by 30-35%. Women during menopause fall ill extremely rarely, usually the cessation of menstrual function is accompanied by tumor involution. In girls, before the onset of menarche, subserous myomatous nodes are not detected. Such statistics confirm the leading role of the hormonal factor in the development of subperitoneal leiomyoma. The incidence among urban women is significantly higher than among women living in rural areas.

Causes of subserous fibroids

According to many experts in the field of gynecology, the main factors provoking the development of leiomyoma with subperitoneal nodes are endocrine disorders and pathological changes at the level of myometrial cells. The immediate causes of hormonal imbalance are:

Violations of the central regulation. Injuries and damage to the vessels of the brain, tumors, constant stress affect the secretory activity of the hypothalamic-pituitary region. One of the manifestations of such disorders is the hyperproduction of FSH and LH - gonadotropic hormones that regulate the endocrine function of the ovaries.
Extragenital endocrine pathology. Hypothyroidism, autoimmune thyroiditis, diabetes mellitus, adrenal diseases and some other diseases are accompanied by a violation of estrogen production and a change in the ratio of their individual fractions.
Ovarian diseases. With neoplasms, inflammatory processes, traumatic injuries of the uterine appendages, the secretion of estrogen and progesterone, the main female hormones that affect the proliferative activity of myometrial cells, can change.
Obesity. Adipocytes have endocrine secretory activity, are able to secrete estrogen.
Long term hormonal contraception. Prolonged suppression of ovulation with synthetic sex hormones can disrupt their natural production.
Stagnation in the pelvic organs. Low physical activity, irregular sex life without sexual discharge lead to venous congestion in the uterus and appendages, followed by the development of hormonal imbalance.

Since hormonal disorders are not detected in all patients with subserous myoma, some authors believe that pathological sensitivity or activity of the cells of the muscular layer of the uterus plays a significant role in the development of the disease. Such violations lead to:

hereditary factor. Scientists have identified two groups of genes that can influence the development of myomatous nodes. Some of them provoke increased proliferation of myometrial cells, others change the sensitivity to estrogen and progesterone.
Myometrium injuries. Frequent abortions, invasive diagnostic and therapeutic procedures, surgical interventions on the uterus cause local changes in smooth muscle cells.

Pathogenesis

At the first stage of the formation of the subserous node, pathological changes occur at the cellular level. In some smooth muscle cells, under the action of sex hormones, metabolic processes are accelerated, while an increase in tissue permeability is noted. The second stage of pathogenesis is characterized by the appearance of cell clusters, defined as microscopic nodes. At the third stage, neoplasms are determined macroscopically. The nodes can be formed on a wide base or a thin stem, along which the vessels that feed them pass. An important point in the pathogenesis of subperitoneal fibroids is the gradual decrease in the sensitivity of proliferating cells to the stimulating effect of hormones and the further development of the tumor under the influence of its own autocrinoparacrine factors. As the disease increases, it is clinically manifested by a decrease in the contractility of the myometrium and pressure on adjacent organs.

Classification

Subserous leiomyomas can have different sizes, number of nodes, histological structure and location features in relation to the uterus. Accordingly, the disease is classified according to the following criteria:

By size. There are small fibroids up to 4-5 weeks of pregnancy (up to 20 mm), medium - from 4-5 to 10-11 weeks (20-60 mm) and large - from 12 weeks (more than 60 mm).
By number of nodes. Subperitoneal fibroids can be single and multiple.
According to the morphological structure. Depending on the type and proliferative activity of smooth muscle cells, tumors are simple, proliferating and presarcoma.
By location features. Subserous neoplasms can grow on the surface of the uterus facing the abdominal cavity, or between its ligaments; have a wide base or leg.

Symptoms of subserous fibroids

Clinical symptoms are detected only in 30-40% of patients and indicate a significant duration of the disease. Solitary and small neoplasias usually develop asymptomatically and are first detected by gynecological ultrasound. For subperitoneal growth of nodes, menstrual irregularity is uncharacteristic. If the tumor has a wide base, the contractile activity of the myometrium may be disturbed, which is clinically manifested by profuse and prolonged periods, the development of anemia with pallor of the skin, complaints of general weakness, fatigue, poor performance, periodic dizziness and headaches.

In large tumors, pain syndrome and signs of pressure on adjacent organs are observed. Patients complain of recurrent lower back pain, which may intensify during menstruation. Particularly strong pain sensations occur when the myomatous node grows together with the peritoneum. With the pressure of neoplasia on the bladder, the urge to urinate becomes more frequent. Compression of the rectum is manifested by constipation, increased urge to defecate, an increase in hemorrhoids. Much less often, fibroids disrupt the venous outflow from the extremities, which is accompanied by edema. Unlike submucous tumors, subperitoneal neoplasms have less effect on reproductive function - the inability to become pregnant or bear a child is usually noted only by those women in whom the growth of the node has led to the formation of a bend in the uterus or a significant deformation of its cavity.

Complications

The most dangerous complications of subserous fibroids are torsion of the leg, necrosis or heart attack, which are accompanied by intense pain in the lower back and lower abdomen, severe weakness, sweating, vomiting, fever, dysfunction of the rectum and bladder. With the subperitoneal location of the neoplasm, secondary anemia due to blood loss, infertility and premature termination of pregnancy, myxomatous transformation of the tumor, hyperplastic processes in the endometrium can also be observed. Malignancy is extremely rare (no more than 0.25-0.75% of cases).

Diagnostics

When making a diagnosis of subserous fibroids, a special role is played by special research methods that allow detecting neoplasms, determining their size, clarifying the features of blood supply, location, and structure. In diagnostic terms, the most informative:

Gynecological examination. During a bimanual examination, an enlarged uterus and nodes on its surface are palpated.
Transvaginal and transabdominal ultrasound. Fibroids associated with the uterus and growing towards the abdominal cavity are detected, their size, structure and localization are determined.
Dopplerography and angiography of the uterus. They allow to assess the intensity of blood flow, visualize the circulatory system of the uterus and detect signs that indicate a malignant process.
MRI and CT of the pelvic organs. Provide the most accurate topographic picture of the pelvic organs and myomatous nodes.
Diagnostic laparoscopy. Subperitoneal leiomyomas are defined as rounded pale pink formations with a shiny smooth surface.

From laboratory tests, a general blood test (erythropenia and low hemoglobin levels are detected) and a study of the level of sex hormones (FSH, LH, estradiol, progesterone) can be indicative. Differential diagnosis is carried out with pregnancy, uterine sarcoma, ovarian tumors and retroperitoneal neoplasms. If necessary, the patient is consulted by an oncogynecologist, endocrinologist, urologist, surgeon, therapist.

Treatment of subserous fibroids

Patients with small subperitoneal nodes with preserved reproductive function, no complaints and signs of neoplasia growth are recommended for dynamic observation with an examination by a gynecologist once a year. In other forms of the disease, the specialist suggests appropriate conservative, combined or surgical treatment. Women with slow-growing neoplasms up to 12 weeks in size and moderate clinical symptoms are shown hormonal and symptomatic therapy. The treatment regimen may include:

Inhibitors of secretion of gonadotropic hormones. The appointment of antigonadotropins and GnRH agonists (gonadotropic releasing hormones) helps to stabilize and reduce the size of the nodes.
Progestin and estrogen-progestin preparations. They allow correcting hormonal imbalance and stopping tumor growth in women of reproductive age, stabilizing the effect of GnRH and antigonadotropins.
Androgens. For the purpose of drug cessation of menstrual function, it is recommended for patients over 45 years of age who do not plan pregnancy.
Symptomatic remedies. In the presence of pain syndrome, analgesics are prescribed, with metrorrhagia - hemostatics and preparations for uterine contraction. According to indications, iron preparations, vitamins, mineral complexes, etc. are used.

Combination therapy is one of the best solutions for patients of childbearing age with single or multiple slow-growing neoplasias larger than 50 mm and clinically present. The method involves conservative myomectomy, before which GnRH agonists are prescribed to stabilize the growth of myomatous nodes. Course treatment with drugs that inhibit the secretion of gonadotropic hormones is also recommended in the postoperative period to prevent relapse.

With fast-growing subperitoneal fibroids larger than 60 mm, severe pain, metrorrhagia, reproductive dysfunction and pelvic organs, surgical methods are indicated. Unlike submucosal fibroids, uterine artery embolization is not recommended in the treatment of subserous neoplasms due to the high risk of necrosis. Taking into account the reproductive plans of women and the characteristics of the course of the disease, various organ-preserving and radical interventions are performed:

Laparoscopic and laparotomic myomectomy. For clipping and enucleation of the subperitoneal nodes, mechanical, electro- and laser surgical instruments are used.
FUS ablation. Despite the low invasiveness, the method is used to a limited extent. It cannot be prescribed in the presence of 6 or more nodes, large neoplasias and pedunculated tumors.
Semi-radical and radical operations. During transvaginal, laparoscopic or laparotomy surgery, defundation, high and conventional supravaginal amputation or total hysterectomy are performed.

Forecast and prevention

Subserous myoma is a benign neoplasm with a low risk of malignancy and a favorable prognosis. Timely detection of the disease and the correct treatment tactics can restore menstrual and reproductive function. To reduce the risk of developing subperitoneal nodes and the occurrence of complications in the presence of a tumor, it is recommended to be regularly observed by a gynecologist (especially in diseases accompanied by hyperestrogenemia), rationally use contraceptive methods, and undergo invasive procedures strictly according to indications.