How small uterine fibroids are manifested and treated. Large uterine fibroids - is it necessary to remove it? Uterine fibroids node 12 mm

Myoma of the uterus is one of the most common pathologies of the female genital organs. Formed from a small nodule, it can grow to a large size, causing complications.

Timely stopping of a small fibroid will avoid complications and fully restore the functionality of the female reproductive system.

Myoma of the uterus is called a benign formation, consisting from endometrial cells and vascular tissue, which is localized in the walls of the uterus. The vascular tissue provides nutrition for the fibroid and the active growth of its cells.

In the absence of treatment and hormonal imbalance, the tumor grows fast, increasing in size, and can form new pathological foci.

Parameters

For the diagnosis of fibroids, two options are used to indicate its size. When diagnosed by ultrasound, the tumor is measured in millimeters and centimeters... During a clinical examination in the gynecologist's office, the size of the fibroid is determined by the degree of enlargement of the uterus typical for the period of pregnancy.

According to these parameters, small fibroids include swelling no more than 2 cm in which the uterus is enlarged according to 5-12 weeks of gestation. The main symptom of a small tumor is small dense myomatous node, which forms the center of future large sprawl.

On palpation, the node reveals tight stable core... It persists even in the absence of blood supply to fibroids or an unfavorable hormonal background.

With the initial development of fibroids and its small size, along the edges of the node can be observed peripheral growing volume... But, as a rule, a pronounced increase is characteristic of medium and large tumors.

A small tumor is myoma, which has not yet acquired an independent growth mechanism.

Small fibroids are accompanied by the appearance of some symptoms:

• an increase in the volume of menstruation;
• shortening the cycle;
• an increase in the intensity of pain manifestations during menstruation;
• emergence smearing brown discharge;
• discomfort or pulling pain in the lower abdomen.

Therapy and prognosis

When the first signs of a small fibroid appear, you need to contact a gynecologist who will carry out a detailed diagnosis and prescribe treatment. For the treatment of small fibroids, it is most often prescribed conservative therapy with the use of special medications and means, hormonal and symptomatic action.

There are several techniques that allow you to obtain a positive therapeutic effect in the treatment of small fibroids.

A course of antigonadotropins and synthetic agonists of gonadotropic releasing hormones

Today, this method is considered the most effective and gentle in the treatment of small fibroids. This hormonal treatment has several goals:

1. Regulation of hormonal levels, by reducing the hormonal activity of the ovaries, to a level that stops the development of fibroid cells.
2. Stopping the spread of benign lesions to abnormal areas, by reducing their sensitivity to estrogen.

The method is used for tumor 0.5 to 2 cm in diameter... This method is the use of drugs based on antigonadotropins and gonadotropic agonists of releasing hormones, which suppress in the pituitary gland the growth of hormones of the gonadotropic group, by exposure through the hypothalamus.

In fact, the drugs used have antihormonal action, at which the menstrual cycle stops, and all the signs of menopause appear. Due to this action, complete regression of fibroids.

The drug is used for the procedure Decapeptyl, which is intended for intramuscular and subcutaneous administration. The most preferred option is subcutaneous administration in the form of depot forms.

The procedure is carried out according to a certain scheme: the drug is administered from 1 to 5 days of the menstrual cycle, 3.75 mg, then take a break of 28 days and repeat the course. Depending on the characteristics of the tumor, treatment can last from 3 to 6 months.

Usually, after 4 months of therapy, tumor volume decreases by 70%... In addition to the therapeutic effect against benign tumors, the drug helps to restore the cycle and eliminates soreness during menstruation.

But besides the positive properties, this method has one significant drawback, with irregular use or incorrectly selected dosage, after treatment is observed renewal growth of fibroids, only in a more active form.

Embolization

Embolization is a technique indicated for the removal of fibroids by stopping her blood supply... This technique is applied with formations up to 5 cm.

The procedure is minimally invasive surgery o, which is carried out using small punctures in the groin area... All manipulations are carried out under local anesthesia, so the patient does not feel pain at all, and the point effect of surgical needles practically does not require rehabilitation.

During the procedure, the doctor uses several needles makes punctures in the area of ​​benign education, penetrating into the uterine artery and blood vessels up to 0.9 mm framing the tumor. These vessels are located on the border between healthy and pathological tissues.

Through needles, no more than 1.5 mm in size, into these vessels a special drug is delivered blocking the arterial cavity, and thus preventing blood from flowing to myoma. The drug is a mass of organic matter in the form of irregularly shaped microparticles or small balls.

To benefit from the treatment of a small tumor, usually one procedure is enough... Within 7 or 10 days after surgery, neoplastic cells perish, and the fibroid resolves. During this period, the patient does not need to be in the hospital.

A scar is formed at the site of the destroyed fibroid, which completely disappears after 3-5 months.

This method is popular and widespread in European countries. This is due to minimal side effects and trauma. After the treatment, there are no uterine bleeding and in 97% of cases, there is a normalization of the cycle and blood loss during menstruation.

In two weeks after treatment is noted reduction of tumor by 74%... In 5% of patients several months after therapy completely disbanded central hub.

The disadvantage of this technique is that when the drug is injected into the vessels, not only pathological tissue, but also healthy tissue can be covered. As a result, there is death of healthy epithelium, which can provoke inflammation of the uterus, or the emergence of a new fibroid.

Progestin

When a tumor is formed in size no more than 1.5 cm, is prescribed by the use of progestin-based drugs. Most often, it is prescribed as a contraceptive pill, which is taken once a day.

They aim to fix the problem by normalization of ovarian function, which begin to actively produce progesterone, which inhibits the growth of fibroid cells. To obtain a positive result, treatment must be carried out strictly according to the scheme prescribed by the drug developer or drawn up by a doctor.

The treatment period is on average 6 months, after which an additional examination will be prescribed and, if necessary, the treatment can be continued. As a rule, after a full course, duration of six months, fibroids decreases by 55%.

This technique is distinguished by small side effects and high efficiency. But with prolonged use, it should be borne in mind that drugs can lead to liver dysfunction.

Levonorgestrel-containing hormonal coil Mirena

It is used to treat small tumors of the uterus, which are localized in it for a long period of time. This remedy is able to cope with fibroids that have existed for about 5 years. This kind of spiral combines therapeutic and contraceptive action.

The spiral has a depressing effect on the pituitary-hypothalamic regulation, as a result of which the production of estrogen is blocked, and pathological cells die.

The spiral is a thin T-frame, which contains the hormone levonorgestrel. Throughout the treatment, spiral produces this hormone, throwing it into the blood in small quantities. This type of treatment is used only at reproductive age. Also, the tool could not be installed with chronic inflammation endometrium.

Antiplatelet and anticoagulants

These drugs are prescribed to improve blood flow during the recovery period after treatment. As an anticoagulant, most often prescribed Warfarin, which is taken 1 time per day. To enhance the action of the drug, it is combined with antiplatelet agent... In this case, preference is given to Heparin.

Both drugs must be used At the same time. During the period of treatment, it is not recommended to change the dosage, since a lower dose will not have the necessary therapeutic effect, and too high a volume of the drug used will lead to the development of bleeding and long-term healing of the endometrium.

Symptomatic therapy

In addition to the main treatment, during the period of stopping a small fibroid, additional therapy is prescribed to eliminate the symptoms associated with the disease. For this, the following means are used:

• hemostatics. Designed to reduce the severity of bleeding with hormonal treatment. For this, the reception of Etamsilat, an extract of water pepper and a decoction based on shepherd's purse is shown;
• antispasmodics. Indicated for the elimination of pain caused by spasm of the muscles of the uterus. The most effective in this case is Spazmalgon;
• pain relievers. During the treatment of fibroids, pain relievers of the non-steroidal group are prescribed, which are aimed at stopping pain and reducing the symptoms of inflammation. These drugs include Naproxen and Ibuprofen;
• antidepressants. They help to improve the psychoemotional state of the patient, which can be noted during the first period of treatment with hormonal agents.

Indications for surgery

In addition to conservative methods, surgical methods are also used to treat fibroids. Although small benign tumors are generally not operated on, there are exceptions in some situations. Surgical treatment is indicated when the following factors are present:

• submucosal location of the tumor;
• high probability degeneration into a cancerous formation;
• submucous type of myoma with interstitial and centripetal development;
• the presence of constant profuse bleeding;
• overly active the growth of education;
• infertility;
• necrosis central hub.

Myoma is a benign neoplasm that grows in the muscle layer of the uterus. The main age of the patients, susceptible to this disease, is 20–60 years. The main cause of cervical fibroids is hormonal imbalance. When diagnosing fibroids, its size is determined. Depending on how many neoplasms were found, their type and size, treatment is prescribed in weeks.

When prescribing treatment, the doctor builds on the size of the fibroid

To accurately determine the size of fibroids, an ultrasound scan is necessary. It is generally accepted that in case of large neoplasms that exceed 60 mm or 6 cm (12-16 obstetric weeks), an operation should be performed. Benign neoplasms are life-threatening for women when there are many of them. Fibroids 20–60 mm or 2–6 cm (10–11 weeks) are treated with medication, diet and physiotherapy. That is, conservative treatment is carried out.

Classification

The dimensions of a benign neoplasm are determined in centimeters, weeks or mm on ultrasound. With the growth of fibroids, an increase in the uterine cavity occurs. This process is similar to the growth of a fetus. Therefore, the size of the cervical fibroids is compared with the weeks of pregnancy.

Myoma is divided into 3 types:

1. Small swelling of the cervix. It does not exceed 2 cm (20 mm) - 4 obstetric weeks.
2. The average neoplasm is 10-11 weeks, ranging from 2-6 cm or 20-60 mm.
3. Large myoma of the cervix. The size exceeds 6 cm (60 mm), which equates to 12-16 obstetric weeks of pregnancy.

Large fibroids can reach the size of 4 months of pregnancy

Size and symptoms

Early neoplasms (20 mm or 2 cm) do not bother a woman. But as soon as the tumor begins to grow and reaches 10-12 weeks (50 mm or 5 cm and more), the corresponding symptoms appear.

1. Menstrual bleeding with pain. Pain relievers do not help relieve pain.
2. If the fibroid has reached 12 weeks (6 cm or 60 mm), then the cervix enlarges and bloating occurs.
3. When diagnosed - pedicle fibroids with torsion, sharp pain in the abdomen begins. This means that blood flow is disturbed in the body of the neoplasm, and peritonitis results. It is necessary to do an ultrasound.
4. Large fibroids (10–20 weeks) compress nearby organs, which leads to improper bowel movements and urination. There is pain in the lower back and heart muscle. The legs begin to go numb when the nerve endings near the rectum are squeezed.
5. Large fibroids (more than 12 weeks), grow on the outer part, form adhesions with nearby organs and tissue layers.

Fibroid symptoms vary depending on its location and size.

Size diagnostics

The woman is examined bimanually to determine the size of the benign neoplasm. Further, appropriate tests are taken and an ultrasound scan is performed. Ultrasound with accuracy allows you to diagnose the size of the neoplasm.

To correctly prescribe the treatment, you should constantly do an ultrasound of the uterus. It will help determine how many benign lesions, size and growth rate.

The faster the neoplasm increases in size, the greater the likelihood of its transition to oncology. In such situations, an ultrasound scan is performed to determine how many neoplasms are present and to exclude cancer.

Regular ultrasound is a must. Since myoma is small (up to 12 weeks), it can be localized in dangerous parts. MRI is also used to obtain detailed information about the type, structure and size of a benign neoplasm.

Ultrasound is a common way to diagnose fibroids

Pregnancy

The tumor is small (less than 1 cm), does not particularly affect the growth of the fetus in the womb. But there should be mandatory medical supervision over the condition.

Large nodes (12 weeks and more), which are in the submucosa of the uterus, interfere with the normal development of the fetus, forming a variety of pathologies.

A neoplasm greater than 12 weeks and located against the posterior wall increases the likelihood of preterm labor. In some situations, oxygen deprivation of the child occurs. Doctors are confident that with a small neoplasm, it will not be a problem to maintain a pregnancy and give birth to a baby.

Treatment

It is carried out using a variety of techniques. It all depends on the size in obstetric weeks and the type:

Hormone therapy

Prescribed if the size of the tumor has reached 12 weeks. Drug treatment is aimed at stopping growth and reducing the size. Such treatment is carried out for women who are going to become mothers after surgery in order to exclude the appearance of new tumors.

Medications reduce the size and prevent the recurrence of fibroids

Symptomatic treatment

1. antispasmodics and pain relievers (tumors up to 3 weeks cause severe pain during menstruation);
2. Hemostatic drugs are used for small neoplasms, if prolonged and heavy menstruation and at the time of ovulation, spotting occurs.

Surgery (fibroids over 13 weeks)

1. laser tumor resection;
2. myomectomy;
3. vascular embolization;
4. complete resection of the uterus.

Unconventional treatment

1. hirudotherapy;
2. folk remedies;
3. physiotherapy procedures;
4. gymnastic exercises.

Leech treatment is effective for fibroids

Indicators for surgery

1. The benign neoplasm is more than 12 weeks old.
2. The woman is planning a pregnancy.
3. If there is a risk of malignant tumor formation.
4. Benign education is very painful. The use of pain relievers does not work.
5. Myoma presses on the rectum, urinary system and nerve endings.
6. There are regular heavy bleeding, due to which anemia develops.
7. If the tumor is located on a long thin leg, then there is a torsion factor and the onset of peritonitis.
8. If normal urination does not occur, then there is urinary stagnation.
9. If a large myomatous node presses on the rectum, then a woman has rare stools, which leads to intoxication of the whole body. With intoxication, bloating occurs and severe pain is felt when pressed with fingers.

If, when contacting a doctor, a benign formation of the cervix was diagnosed, then:

1. On examination, it is determined how many neoplasms and their size.
2. An ultrasound scan must be done on a specific day, because cervical neoplasms change under the influence of estrogen levels.
3. A qualified doctor will never assert that education is of the average size and talk about the rules for determining them.
4. The gynecologist determines the stage of the disease using the ratio of size to gestational age and ultrasound results.
5. Sizes are determined in weeks, cm, mm.
6. Full diagnosis and medical supervision will help determine the development of cervical fibroids.

The main danger of a neoplasm lies in its potential ability to grow and degenerate into a malignant cancerous tumor, which is why it is so important to monitor the increase in the size of myomatic nodules.

When diagnosing uterine fibroids, the dimensions for the operation to remove it are determined by a set of studies:

• visual bimanual examination on a gynecological chair using a special mirror;
• ultrasound examination, specifying the number and size of fibroids.

In order for the doctor to prescribe the correct treatment, it is necessary to repeat the ultrasound procedure several times. This will determine the rate of tumor growth. To obtain a detailed picture of the disease, it is recommended to do an MRI.

With the growth of fibroids, the cavity of the organ itself also gradually increases - this resembles the growth of an embryo. Due to this similarity, the size of uterine fibroids is usually compared with the weeks of pregnancy. For example, a uterine fibroid for 7 weeks is about 2.5 cm.

Fibroid sizes

In gynecology, it is customary to conventionally divide uterine fibroids into three types, based on the size of the neoplasm:

1. Small fibroids... It is comparable to a pregnancy of 6-8 weeks and has a volume of up to 2 cm. Usually such a tumor does not manifest itself in any way, a woman learns about the disease by chance. It is important to identify the formation during this period - a fibroid of 7 weeks in size will bring much less trouble than a running giant tumor.
2. Average myoma... In terms of pregnancy, the size will be 10-12 weeks or up to 7 cm. A patient with such a tumor may complain of heavy painful menstruation that cannot be anesthetized with medications. There is a small discharge of blood in the middle of the cycle, the so-called "daub".
3. Large fibroids... The parameters of the neoplasm are comparable to the embryo at 12-15 weeks.

Symptoms

The presence of such uterine fibroids is manifested by pronounced symptoms:

• pain in the belt, heart, and with adhesions with the tissues of neighboring organs - and in other places;
• frequent numbness of the legs due to circulatory problems;
• violation of defecation or increased urge to urinate due to the pressure of the tumor on the nearest organs - intestines, bladder;
• an increase in the lower abdomen while maintaining the same weight.

Small and medium fibroids in the absence of complicating factors allow conservative treatment without surgery. In such cases, conception and successful childbirth are possible. But large fibroids will become a serious obstacle to childbirth.

Even if the tumor is very small and is measured not in centimeters, but in millimeters, you should not relax: it may be located in a dangerous area. The growth of a tumor on the pedicle can be uncomfortable even with a size of 9 mm: when the pedicle is twisted, the pain is unbearable.

Another mandatory characteristic of fibroids is its growth rate: an increase in 12 months by more than 5 or weeks or 4 cm is considered a dangerous signal and one of the indications for surgery.

Heal cannot be cut

A patient with a diagnosed tumor first of all asks the question: at what size of uterine fibroids the operation is performed and whether it is possible to do without it.

Doctors identify several indications for surgical intervention:

1. Fibroids larger than 12 weeks or 6 cm... Such myomatic nodes pose a threat to a woman's life. If several nodes of medium size are found, their urgent removal is considered strictly mandatory. In this case, a slightly smaller uterine fibroid, for example, 5 weeks, is treated with medication under the supervision of a doctor.
2. Woman planning pregnancy... Average fibroids often cause infertility or early miscarriages. A change in hormonal levels during pregnancy stimulates tumor growth: it can be either a slight overgrowth or a sharp increase in times, posing a threat to the baby.
3. The risk of rebirth into sarcoma- a malignant tumor. First of all, such a probability is manifested by rapid tumor growth.
4. Constant severe pain... This feature is also typical for medium and large fibroids. The location of the myomatous node can cause the tumor to squeeze the nearest organs, causing severe pain. So, with pressure on the rectum, rare stools are observed - 1 or 2 times every 6-8 days. This situation threatens intoxication of the body and inflammation of the intestines.
5. Heavy bleeding... The constant loss of a significant amount of blood leads to anemia. Typically, uterine fibroids bleed heavily for 15 weeks or more.

Small uterine fibroids, i.e. less than 4 cm, rarely removed. Usually, the doctor selects the right treatment and simply monitors the condition of the tumor. It is better to treat myomatic formations in a comprehensive manner: hormonal drugs, gymnastics, diet, folk remedies. The exception is pedicle fibroids, such a neoplasm is dangerous and painful, it is removed.

Menopause stops the growth of fibroids due to a decrease in the production of estrogens - female sex hormones. Therefore, in menopause, the tactic of passive observation is also acceptable. The alternative is a radical solution to the problem, removal of the uterus.

Of course, there is no need to rush to the operating table: a knowledgeable specialist uses all the possibilities to reduce fibroids with medication. If the operation is the only possible way out, it is also not worth delaying, because delay can cost health.

Traditional and alternative surgeries

The uterine myoma, which has reached the size for the operation, must be removed - this is the golden rule of gynecology. In advanced cases, the tumor reaches the parameters of a full-term baby: it weighs up to 8 kg and has a diameter of up to 40 cm. The torment inflicted by the giant tumor body is terrible. Yet women endure pain for years and flatly refuse to remove the source of suffering.

Removal of uterine fibroids is an abdominal operation, but some fear of it is justified and natural. The intervention is carried out under anesthesia, so you should not panic.

Modern medicine offers different options for getting rid of fibroids, let's start with sparing alternatives:
... It is applied to a knot no more than 6-7 weeks in size. The doctors' comments characterize the laser as the least traumatic method, which has a lot of advantages:

• does not leave ugly seams, only a small scar measuring 1.5 - 2 cm, as seen in the photo;
• maintains maximum fertility;
• rehabilitation lasts only 14 days.

Considering that the latest sensitive equipment is used and highly qualified doctors work, many patients prefer to clarify in advance how much the operation costs in different clinics. You can save money on expensive treatment by getting a quota from the state. True, it will take some time.

Embolization of the uterine arteries... The efficiency of UAE is 98%, while with conventional surgical excision the risk of recurrence is 40%. A solution is injected through a catheter in the femoral artery, which clogs the vessels feeding the myoma. As a result, the tumor gradually dries out and dies off. It is best to do this when the fibroid is about 9 weeks old or less. The long-term consequences of the procedure are not fully understood. In some patients after UAE, there was an absence of the menstrual cycle - amenorrhea.

How is the operation going - video

Abdominal surgery

It happens that the state of the fibroid does not allow the use of alternative methods of removal: the situation is complicated by necrotic processes in the tissues, the tumor stem is twisted, etc. Then surgeons perform traditional abdominal operations, making incisions in the abdominal wall. After such removal of uterine fibroids, the woman will have to spend the postoperative period in the hospital under the supervision of doctors.

There are four types of traditional abdominal surgery:

Laparoscopy or myomectomy... The intervention takes place through the introduction of special equipment - a laparoscope - into punctures on the abdominal wall, so it does not leave large scars. The second plus is a short rehabilitation period, it will be only a week. With laparoscopy, several fibroids are usually removed, not exceeding 15 mm in diameter. The uterine cavity should be enlarged for a maximum of 15-16 weeks. For the uterus itself, the consequences of such an operation are the least severe, the risk of adhesions in the fallopian tubes is minimal.

Laparotomy or removal of myoma nodes through a small incision made in the abdominal wall. Indications for laparotomy:

• distortion of the shape of the uterine body caused by rapid tumor growth;
• the growth of large tumors in the abdominal cavity or pelvic area;
• knot size over 12-15 weeks.

Hysteroscopy or resectoscopy... A special device, a hysteroscope, is inserted into the uterine cavity through the vagina. The method is applied to single nodules in the uterus 6 weeks or more in size located on the back or front of the uterus. It is advisable to carry out the intervention in the first 7 days of the cycle. The operation is so simple that it can be performed on an outpatient basis.

Hysterectomy- complete removal of the uterus. A drastic measure used in extreme cases when other methods are no longer effective:

• with a gigantic tumor;
• degeneration of a benign tumor into a sarcoma;
• the presence of many different types of nodes;
• menopause.

Recovery will take 2 months. The doctor will prescribe pain relievers for several days. painful sensations do not even allow you to just stand, and performing the simplest movements is painful. Then you need to drink a course of antibiotics. Based on the patient's condition, fortifying drugs are prescribed. In the postoperative period, there is a high risk of bleeding. Any discharge of blood is a reason to immediately seek medical help.

Removal of fibroids - video with Elena Malysheva

Features of rehabilitation

The operation to remove uterine fibroids is not the most difficult and dangerous, but it is still important to follow a number of rules in the postoperative period. This will help to quickly return to normal rhythm of life and restore hormones.

The advice of gynecologists is mandatory, all the more it is not difficult to follow them:

• avoid constipation, especially in the first postoperative days;
• try to move more, while eliminating any stress on the abdomen (leisurely walking is suitable);
• in the first six months after the operation to remove uterine fibroids, you can lift no more than 3 kg;
• eliminate stressful situations, because they lead to hormonal disruptions and relapse of the disease.

You can only plan a pregnancy after consulting your doctor. The performed operation is always stress for the reproductive organs, which may take quite a long time to recover.

During the rehabilitation period, it is mandatory to take medications that normalize the structure of the uterine body and the menstrual cycle. Any unpleasant symptoms cannot be ignored - it is better to make sure once again that everything is fine than to allow complications to develop.

Myoma is a benign tumor, but if it is large, the complications can be very serious. The abdomen increases, as during pregnancy, the shape of the uterus is disrupted, and the volume of the cavity decreases. Overlap of the cervical canal is possible. The physiological processes in the reproductive system are disrupted. The general health of the woman is deteriorating. When choosing a method of treatment, various factors are taken into account, the most reliable and gentle method is chosen. Estimation of the size of the fibroid is important, since there must be good reasons for the operation.

Content:

Types of fibroids

The neoplasm arises in the muscle tissue of the uterus, gradually increases in size due to abnormal cell division. Unlike a malignant tumor, myoma does not spread to other organs; it grows much more slowly. Initially, the cells develop abnormally only in the muscle tissue, and then the tumor goes beyond it. Depending on the direction in which it grows, the following types of fibroids are distinguished:

1. Submucous - it is formed deep in the muscle layer (myometrium), grows towards the mucous membrane of the uterine cavity, therefore it is called "submucosa".
2. Subserous (subperitoneal) originates in the outer muscle layer, grows towards the serous membrane, which separates the uterus from the abdominal cavity. Nodes can have a wide base or a thin stem.
3. Interstitial (intramuscular) - develops in the middle of the muscle layer, without going beyond its limits.

When assessing the degree of danger of a tumor and choosing a method of treatment, specialists take into account its location. In most cases, myomatous nodes are located in the body of the uterus (corporal view), but sometimes they also occur in the cervix (cervical fibroids).

The tumor can be single or multiple, in the form of several nodes. For a specialist choosing a method of treatment, the size of uterine fibroids is of great importance.

How are sizes determined?

The growing tumor stretches the uterus, which leads to a gradual enlargement of the abdomen (similar to how it grows during pregnancy). By which week of pregnancy the size of the abdomen corresponds, the size of the fibroid is estimated.

The exact size of the tumor in centimeters can be determined using ultrasound. This method even detects myoma less than 1 cm in size. An ultrasound scan is performed either through the anterior wall of the abdominal cavity or through the vagina. This allows you to identify and measure fibroids of any location and size.

In difficult cases, when a small tumor is located, for example, between the ligaments, the method of hysterography (X-ray of the cavity with the introduction of contrast liquid) is used. To study fibroids and assess its size, hysteroscopy (examination with an endoscope inserted into the uterine cavity through the vagina), diagnostic laparoscopy (an optical device is inserted into the uterine cavity through a puncture on the anterior wall of the peritoneum) and MRI are also used.

All myomatous nodes, depending on their size, are divided into three categories:

Sometimes uterine fibroids reach the size at which the abdomen is, as at 37 weeks of gestation.

In addition to size, the rate of tumor growth is also taken into account. It is believed that a tumor grows rapidly if its size increases by 2-2.5 cm (or 5-6 weeks) per year. Thus, the growth of small and medium fibroids is assessed. If they are small and grow slowly, then conservative treatment is possible. For sizes over 8 cm (or 15 weeks), the nodes are removed.

In addition to the size of the tumor and the rate of development, when prescribing treatment, the severity of the symptoms, the woman's age, and her intention to have children are taken into account.

Danger of large fibroids

There are uncomplicated and complicated forms of the disease. Possible complications are:

• necrosis of the myomatous node - an acute painful condition in which there is a torsion of the leg, a violation of the blood supply to the fibroid;
• the formation of cystic cavities (the threat of purulent inflammatory processes);
• compression of blood vessels and nearby organs;
• malignant transformation (into a sarcoma).

Myoma can reach a diameter of 25 cm. A large tumor located outside, on the front wall of the uterus, compresses the bladder, which leads to difficulty urinating or, conversely, can cause urinary incontinence. In addition, fistulas may appear that connect the uterine cavity and the bladder.

If a large fibroid is located on the back of the uterus, then it becomes difficult to empty the intestines, constipation occurs.

A large node can compress the inferior vena cava, making it difficult for blood to move from the lower body to the heart. In this case, the woman has shortness of breath and a rapid heartbeat even at rest. In the presence of many medium and large nodes (myomatosis), persistent uterine bleeding occurs, not associated with menstruation. This leads to anemia.

Video: Complications with large nodes. When and How is Surgical Removal Performed?

When is the surgical method of treatment used?

Surgery for uterine fibroids is mandatory in cases where its rapid growth is observed - up to 2 cm (4 weeks) in diameter during the year, as well as if the tumor has a leg and there is a danger of twisting it.

An unconditional indication for surgical removal of fibroids is the appearance of uterine bleeding and severe anemia in a woman. This is possible due to a violation of the elasticity of the muscles during the development of large myomatous nodes in it, deterioration of contractility.

Myoma must be removed by surgery if it is the cause of infertility or miscarriages. The operation is also prescribed if a woman has severe pains in the abdomen, rectum, bladder, as they are squeezed, blood circulation is disturbed.

Video: Treatment of fibroids with hysterectomy and uterine artery embolization

What types of surgery exist

When choosing a method for performing an operation, the size of the uterine fibroids and its localization are of primary importance. In each case, the doctor decides on the method of removing the tumor, the possibility of preserving organs and menstrual function.

Myomectomy

This is an operation in which only the tumor is removed, the uterus is preserved. Most often, this method is used to treat women under 40 who would like to maintain the ability to give birth to a child.

Removal of the tumor is carried out in various ways.

Laparotomy- This is the removal of fibroids located deep in the muscle tissue or under the outer lining of the uterus by an incision in the abdomen above the pubis. Hulling of the tumor is performed. The risk of infection and complications is minimal. This method is especially effective when there are many nodes, there is an increased likelihood of damage to large vessels. It is much easier to prevent bleeding during open surgery. In addition, the removal of myoma nodes can be done quickly.

Laparoscopy- removal of fibroids through 3 small holes in the abdomen using optical instruments. Carbon dioxide is preliminarily injected into the uterus to create conditions for freer manipulation of instruments and to avoid cuts. The image is displayed on the screen, which allows you to control the process.

The advantage of the method is that the wound heals quickly, the operation is low-traumatic, and there is no seam left after it. It is performed under general anesthesia. The disadvantage is that there is a minimal likelihood of internal cuts, so the woman is under the supervision of doctors for 3-4 days. Sometimes, if the myomatous node is located on the posterior or lateral outer surface of the uterus, it is removed through a puncture in the posterior wall of the vagina.

Addition: If necessary, this method can be used to remove large myomatous nodes in pregnant women. In this case, the fetus is not injured, the pregnancy is proceeding normally.

Hysteroscopic myomectomy. A method that is used to remove fibroids in the cavity itself. It is carried out with an optical instrument (resectoscope) through the vagina. The method is not used if a woman has inflammatory diseases of the genital organs or cervical defects.

Hysterectomy

Removal of the uterus completely or with preservation of the cervix. Such an operation is performed in the most severe cases, when there are many large nodes, myoma occupies the entire cavity, and there is severe bleeding. At the same time, the level of hemoglobin is critically low, there is a high probability of the tumor degenerating into a sarcoma. Most often, such operations are performed on women over 45 years of age.

Removal of the uterus is performed in several ways: through an incision in the lower abdomen, through punctures in the abdominal wall (laparoscopic method), through the vagina. After the operation, a woman cannot have menstruation. But if the ovaries are not removed, then the rest of the symptoms of menopause may be absent. The possibility of sexual activity after the operation remains.

Video: Methods for removing fibroids while preserving the uterus

Minimally invasive treatments for fibroids

When treating fibroids with these methods, no incisions or punctures are required.

Embolization of the uterine arteries. The method consists in the fact that through the inguinal artery with the help of a catheter, "plugs" made of plastic or gelatin are brought to the vessels of the fibroid, which block the flow of blood. Due to lack of nutrition, the tumor gradually shrinks. The procedure is performed under local anesthesia.

FUS ablation(focused ultrasonic). Removal of fibroid nodes is carried out using a directed ultrasonic flow, which causes heating and evaporation of the nodes located in the muscle. The process is monitored using a magnetic resonance imager. In this case, anesthesia is not required, the functions of the uterus are fully preserved. The method is effective even with large nodes.

Video: Evaporation of fibroids using FUS ablation

The possibility of pregnancy with fibroids

Large fibroids (over 15 weeks) cause infertility if they block the tubes or neck, obstructing the flow of sperm. In the presence of nodes no more than 3 cm in diameter (that is, less than 8 weeks), pregnancy is possible. If the nodes do not increase, then their existence does not affect the course of pregnancy and the development of the fetus. Complications arise when a tumor grows in the uterine cavity, fills it, making it difficult for the fetus to develop. This often ends in a miscarriage.

Sometimes, if the fetus is already large enough and begins to experience a lack of nutrition due to the pressure of the fibroids on the vessels, a cesarean section and subsequent removal of the uterus are performed. A cesarean section has to be done even if the fibroid occurs in the cervix or overlaps it.

Myoma is a benign tumor growing in the uterine myometrium (muscle layer of the organ). The age of the disease ranges from 20 to 70 years, but the majority of patients are from the middle age category.

The main reason for the formation of uterine fibroids, doctors consider changes in the patient's hormonal background.

After uterine fibroids have been diagnosed, the question arises about its size. After all, the treatment depends on how many large tumors were found, what type they were, and their size in weeks. In order to determine the size of uterine fibroids in weeks, you need to do an ultrasound. It is believed that large fibroids, the size of which is more than 12-16 weeks (more than 6 cm or 60 mm), must be operated without fail: such nodes are life-threatening for the patient, especially if there are a lot of them. Tumors less than 10-11 (2-6 cm or 20-60 mm) obstetric weeks are not subject to mandatory surgical intervention, they can be cured conservatively (medication, physiotherapy, diet).

Classification of fibroids by size

Since the progression of the myomatous node enlarges the uterine cavity, like the baby growing in it, in medicine it is customary to compare its size with the weeks of pregnancy.

To determine what size the tumor is in mm or cm, the following table of correspondence between the height of the fundus of the uterus with a period will help:

Based on these data, doctors differentiate uterine fibroids into three types:

1. Small: size up to 2 cm (up to 20 mm) - 4 weeks;
2. Medium tumor: size from 2 cm to 6 cm (from 20 mm to 60 mm) - 10-11 weeks;
3. Large fibroids: size over 6 cm (over 60 mm) - 12-16 or more weeks of pregnancy.

Symptoms and dimensions

Uterine fibroids in the early stages (up to 2 cm or 20 mm) do not make themselves felt in any way. But with the growth of the tumor and after it reaches a large size (for a period of 10-12 weeks or 50 mm or more), the following symptoms begin to manifest themselves:

• Heavy menstrual bleeding with severe pain that is not relieved by pain medication;
• If the tumor is large (more than 12 weeks), the uterus begins to enlarge and the lower abdomen swells accordingly. At the same time, the patient's weight remains at the same level;
• If a woman is diagnosed with fibroids on the leg, when it is twisted, sharp pains in the abdomen may appear. This means that the blood flow in the tumor body is disturbed and is fraught with peritonitis;
• Large nodes in the uterus (10-20 weeks or more) can squeeze nearby organs and cause disturbances during bowel movements (chronic constipation) and urination (frequent urge to use the toilet), pain in the lower back, heart and lower extremities (as well as their numbness) when squeezed nerve endings near the rectum;
• Large fibroids growing on the outer layer of the uterus can form adhesions with adjacent tissues and organs, which, when moving, give off pain in various parts of the body.

Diagnosis

When visiting a doctor, a woman is examined bimanually (visual-manual examination using gynecological mirrors) to establish the correspondence of the size of the uterus in weeks, after which she is sent for tests and an ultrasound examination (it will accurately determine the size of the tumor itself).

In order to correctly prescribe the appropriate treatment for the situation, you need to regularly do ultrasound (ultrasound) of the uterine cavity. This will reveal exactly how many fibroids are in her cavity, what size they are in weeks and centimeters, how fast they progress (how fast they grow). The fact is that the rapid growth of myomatous nodes (more than 4 weeks in 12 months) can be one of the signs of the transformation of a neoplasm into a malignant cancer.

Regularly undergo an ultrasound scan even in the absence of any symptoms of fibroids: it can be small (up to 10 mm), but located in a dangerous area.

Also, to obtain comprehensive data on the size, localization, structure and type of myomatous node, the method of MRI and transvaginal examination (ultrasound may be wrong) is used, a photograph of the neoplasm is taken for further study by the attending physician.

Pregnancy and node sizes

Myomatous nodes of small size (up to 10 mm) will not have a significant effect on the growth of the baby in the mother's womb, however, it is imperative to monitor their condition during pregnancy (very rarely there is an intensive growth of uterine neoplasms during gestation).

Large tumors located in the submucous uterine layer can inhibit the normal development of the baby (there is much less space in the uterus) and cause various pathologies.

In the case of localization of a myomatous node more than 12 weeks in size on the back wall of the organ, when the fetus is also attached to this place, the onset of premature birth or oxygen starvation of the baby is possible.

Obstetricians are of the following opinion: with a small myomatous node growing either in the outer uterine layer or in the median muscular layer, it is quite possible to endure and give birth to a healthy baby.

Tumor treatment

Myomatous nodes are treated with various methods, depending on their type and size in weeks:

• Hormone therapy is applicable in cases where the size of fibroids does not exceed a period of 12 weeks. Medicines act in the direction of inhibiting the rate of progression of a pathological neoplasm and reducing its size. Hormonal treatment is widely used when fibroids are detected in young and middle-aged women who want to have offspring in the future, as well as after surgery to prevent the formation of new nodes;
• Symptomatic treatment:

Antispasmodic and analgesic drugs (even nodes as large as 2-3 weeks can cause severe pain during menstruation);

Hemostatic agents are prescribed for fibroids of the smallest sizes (a submucous node 4 mm in diameter can sometimes provoke intense intermenstrual uterine bleeding) with appropriate indications: long and heavy menstrual bleeding, bleeding from the genital tract during ovulation;

• Surgical intervention is indicated if the tumor has reached the size of 13 weeks or more:

Vascular embolization;

Removal of fibroids with a laser;

Myomectomy;

Removal of the uterus, complete or partial, with or without a cervix;

• Unconventional methods:

Traditional treatment;

Physiotherapy treatment;

Gymnastics;

Treatment with leeches.

When is surgery indicated?

• If the fibroid is larger than 12 weeks of pregnancy;
• If a woman plans to bear and give birth to a child in the future;
• If there is a risk of degeneration of the myomatous node into a malignant uterine tumor - sarcoma;
• If the tumor causes constant severe pain that is not relieved by pain medications and antispasmodics;
• If the myomatous node compresses the bladder, rectum and nerve endings, causing a lot of inconvenience and discomfort;
• If the neoplasm causes constant severe bleeding, against the background of which the patient developed anemia;
• If the tumor (even if it is small) has a long thin stem: there is a high risk of torsion and peritonitis;
• If the fibroid interferes with normal urination (there is a constant stagnation of urine);
• If, due to compression by a large myomatous node of the rectum, the patient has extremely rare stools (1-2 times a week), accompanied by intoxication of the body and bloating with pain on palpation.