Women Health. Size of Uterine Fibroids in Weeks High Frequency Focused Ultrasound

Uterine fibroids at 7 weeks refer to neoplasms of the female reproductive system, namely the uterus, and are classified as a benign tumor of medium size (the size of the uterus with fibroids at 7 weeks corresponds to 2-3 centimeters). Depending on the histological structure of these tumors, they can be myomas, fibroids or fibromyomas. In fibroids, muscle fibers predominate, while in fibroids, connective tissue fibers predominate. And fibroids contain both muscle and connective tissue fibers.

The pathogenesis of these neoplasms has not been fully studied; there are several theories of the occurrence of myomatous formations, and each individually has the right to exist.

The picture of this pathological condition may be erased, have minor clinical manifestations, or be completely asymptomatic. Such neoplasms located subserosally may not give any clinical symptoms, since their size is not large enough to put strong pressure on adjacent organs. Intramurally located myomatous nodes can cause algodismenorrhea - painful menstruation. The only localization of benign neoplasms of the uterus, which at such sizes can give obvious symptoms, is submucosal myomatous nodes. They can cause pain of varying intensity: from a slight feeling of discomfort in the lower abdomen to quite noticeable pulling, stabbing pain. Also, these neoplasms can cause heavy menstruation, the amount of blood released can reach the borderline level of bleeding. Another quite pronounced symptom of these fibroids is the presence of infertility in a married couple when it is impossible to get pregnant within one year without using contraception. These seemingly insignificant nodes, located submucosally, that is, growing into the uterine cavity, deform it, interfere with the normal process of implantation of the blastocyst, thereby causing symptoms of lack of pregnancy. Nodes located in the cervix or isthmus of the uterus block the cervical canal and prevent sperm from penetrating into the uterus and then fertilizing the egg.

Therefore, timely seeking medical help can solve a woman’s problems with minimal losses.

If pregnancy does occur, then such neoplasms can cause spontaneous miscarriages, threats of termination of pregnancy, threats of premature birth, and fetoplacental dysfunction. The danger of myomatous formations during pregnancy also remains very real. In this interesting position, the nodes, located subserous on a thin stalk, have a tendency to torsion and their further necrosis, the nutrition of these tumors may also be disrupted, dynamic monitoring of uterine fibroids during pregnancy should be carried out using an ultrasound machine with a Doppler sensor to measure blood flow in the data education.

Diagnosis of tumors of this size is not difficult. However, such nodes are more likely an accidental finding rather than a targeted search for a pathological process. During a gynecological examination, if the node is located subserosally and grows into the abdominal cavity in the area of ​​the uterine fundus, then the obstetrician-gynecologist during a bimanual examination can palpate the node on the surface of the uterus. An ultrasound examination will diagnose uterine fibroids without any difficulties; hysteroscopic diagnosis can also be used, which can lead to a treatment procedure.

Uterine fibroids 7-8 weeks: treatment

Treatment of uterine fibroids. In the treatment of such myomatous formations, the leading tactic is conservative therapy, which includes the use of combined oral contraceptives, which include both estrogen and progestogen drugs. The mechanism of their action is to balance hormonal levels and reduce the influence of estrogens on this tumor. Gonadotropin-releasing hormone agonists are widely used. If progesterone-dependent myomatous nodes are detected, this treatment may be ineffective. Antiprogesterone drugs such as Esmia are used, the mechanism of action of which is based on the inhibition of the effect of progesterone on this neoplasm.

Nodules of this size respond well to conservative therapy.

Uterine fibroids 8 weeks: treatment

Uterine fibroids of 8-9 weeks require competent hormonal therapy, which should act in accordance with the pathogenetic mechanisms of its formation. If these conditions are met, then such neoplasms can be treated conservatively.

Uterine fibroids 9 weeks do I need surgery?

The approximate size of 9 weeks is 4 cm uterine fibroids, what to do with it? Such neoplasms also have a chance of being cured using conservative methods of therapy.

Uterine fibroids 7 cm, what to do?

Uterine fibroids with dimensions in weeks and centimeters equal to 7 are already large fibroids and require mandatory surgical treatment, while in the case of a diagnosis of uterine fibroids of 5 cm (treatment or surgery), non-surgical treatment is preferable.

As you can see, a slight delay in the diagnosis and treatment of such pathological conditions of the uterus can radically change treatment tactics. Just a few centimeters separate the fibroid, which can still be treated conservatively, from the tumor that needs to be operated on.

If any alarming symptoms appear, immediately contact your doctor to receive competent advice and timely treatment.

This video discusses in detail (but clearly and accessiblely) the method of uterine artery embolization: history, features and myths. In 12 minutes you will get a complete understanding of the method and find answers to most questions.

Uterine fibroids - for many women, this diagnosis sounds like a bolt from the blue, and it often happens that a misconception about this diagnosis dooms the patient to difficult experiences and completely unjustified surgical interventions.

What I would like to talk about below are the main points:

• Uterine fibroids are not scary at all (dispelling the myths again)
• There are modern techniques to avoid surgery and organ loss
• Uterine fibroids cannot be treated with Duphaston
• there is prevention of the development of uterine fibroids
• You can get pregnant and give birth with uterine fibroids

Some statistics:

• about 80% of all operations in gynecology are performed for uterine fibroids - 90% of these operations are removal of the uterus
• Every third woman over 55 years of age has had her uterus removed due to a diagnosis of uterine fibroids.
• The average age of women who have their uterus removed because they have uterine fibroids is 42 years.

Why is everyone offered to operate on fibroids?

If all operations for uterine fibroids are removed from the work of the gynecological department, then in fact doctors will sit without work and categorically not carry out the terrible plan of “surgical activity”. “Surgical activity” reflects how many patients were operated on among those admitted. This indicator must be high - otherwise they will swear a lot...

And some doctors are simply not interested in new technologies and do not know that they can be treated differently.

So to the fibroids...

What is uterine fibroid and why is it so scary?

Uterine fibroids have long been considered a true benign tumor that can transform into a malignant neoplasm. And since any tumor must be removed, preferably together with the organ in which it grows, no alternative to removing the uterus for this disease has been proposed. The only compromise was surgery to remove the fibroid nodes while preserving the organ - this option to save the uterus was mainly intended for nulliparous women to give them a chance to have a child. Sooner or later, these women, having completed their reproductive plan, found themselves on the operating table to have the uterus removed due to a relapse of the disease.

Attitudes towards the nature of fibroids began to change in the mid-90s. New scientific research opportunities have shown that, although it is similar, it is not a benign tumor. It has become known that fibroids degenerate into a malignant tumor so rarely that, in general, this probability is comparable to the development of a malignant tumor in the uterus, without the presence of myomatous nodes in it. And finally, myoma was compared in its characteristics with an ordinary wen on the skin, an atherosclerotic plaque in a vessel and a keloid scar, which made it possible to significantly reduce oncological suspicion regarding this disease.

As a result of special studies, it was possible to show that fibroids are more common than previously thought. If previously it was believed that it occurs in 30% of women over 35 years of age, it is now known that fibroids develop in more than 80% of women; it’s just that in most women this disease is asymptomatic.

Uterine fibroids currently seem to be a kind of reaction of an organ (uterus) to damage. The main damage to the uterus is menstruation, or rather a large number of menstruation.

There is an ancient Russian proverb “If you don’t give birth to Yerema, you will give birth to fibroids” - and the ancients, as usual, were right, but they could not explain it from a scientific point of view.

A woman's body was designed by nature for procreation. They were supposed to be in the reproductive cycle from the moment of maturity. Pregnancy, breastfeeding, one or two periods and pregnancy again. Thus, a woman was supposed to experience 30-40 menstruation during her life, and most likely the uterus is adapted to this. In practice, it happens that a woman gives birth to 1-2 children, usually by the age of 30, and rarely breastfeeds for more than 1 year. In this mode, a woman experiences about 400 menstruation in her life.

Like any frequently repeated process, menstruation negatively affects a woman’s body in general, and her genitals in particular. Think about it: could this have been provided for by nature, so that every month you have to experience a whole set of negative sensations, in their effect on the body, comparable to a disease. Headaches, abdominal and body pain, bleeding, bad mood, decreased performance, changes in appetite, etc. This list can be continued for quite a long time. This is how the body responds to its unfulfillment.

Every month, a woman’s entire body is adjusted to pregnancy, all organs and systems are prepared. In the second phase of the cycle, these processes accelerate, the uterus increases slightly in size, and prepares to quickly begin to grow in response to pregnancy. Pregnancy does not occur and again the whole body begins to return its “settings” to its normal state.

It is obvious that repeated repetition of a complex multi-level process begins, on the one hand, to wear out the entire system, and on the other, to “form errors,” the number of which increases many times over when combined with various diseases, infections and medical interventions. This is how most gynecological diseases are formed, including uterine fibroids.

A monthly maturing follicle in the ovary will sooner or later form into an ovarian cyst, constant growth and rejection of the uterine mucosa - polyps or hyperplastic processes; endometriosis – without menstruation there is no such thing.

Myoma is formed at the beginning in the form of tiny rudiments located in the muscular lining of the uterus. These are groups of ordinary muscle cells of the uterus, but their properties correspond to cells during pregnancy. As one American scientist said, “uterine fibroids are the pregnancy of one cell.” Indeed, each myomatous node grows from one cell.

Under conditions of repeated menstrual cycles, accompanied by fluctuations in hormones, the rudiments of myomatous nodes begin to grow. At the same time, some grow faster, others slowly, and others may even regress and disappear. Various damaging factors accelerate the growth of the rudiments of myomatous nodes, which include:

• abortions
• inflammation
• medical interventions (curettage, traumatic childbirth, operations)
• endometriosis

After all, it is known that after suffering inflammation or abortion, myomatous nodes begin to grow.

There are also juvenile fibroids, which occur in young girls under 25 years of age. It is believed that damage to the cells of the uterus, which leads to the growth of these nodes, occurs during fetal development. Precursor cells of the muscular lining of the uterus take a very long time to develop during pregnancy and have a long unstable period. In this unstable state, they are most susceptible to various damaging factors. Thus, if cells become defective in the prenatal period, they then only need a hormonal stimulus to begin to grow. This hormonal stimulus is the onset of menstruation.

Diagnostic approaches

At a time when ultrasound was practically unavailable, and the quality of the devices left much to be desired, it was almost impossible to detect small myomatous nodes. Basically, doctors had to deal with already large nodes that could be detected with their hands or with patients who complained of heavy menstruation. In fact, these were already advanced cases. It was then that indications for hysterectomy were formulated, which still exist today. In these indications, in addition to other points, there are two very subjective criteria: “the size of the uterus corresponds to more than 12 weeks of pregnancy” and “rapid growth of fibroids”

When myomatous nodes begin to grow in the uterus, the uterus itself increases in size accordingly. Since the uterus normally increases in size only during pregnancy, the enlargement of the uterus due to myomatous nodes began to be measured in weeks of pregnancy. For example, “uterine fibroids 7-8 corresponding to 7-8 weeks of pregnancy.”

Estimating the size of uterine fibroids in weeks of pregnancy is extremely subjective. The uterus with myomatous nodes, as a rule, grows unevenly - the nodes grow in different directions, some stretch in width, some in length. In addition, the thickness of the subcutaneous fatty tissue of the anterior abdominal wall and the height of the uterus are important in assessing the size of the uterus. All this leads to the fact that one doctor can look at a woman in a chair and say that she has had uterine fibroids for 8 weeks, and another, after looking, will say that she has had uterine fibroids for 12 weeks. In fact, during the operation it turns out that the size of the uterus barely reaches 6-7 weeks of pregnancy.

“Rapid growth” is also a very subjective criterion, since it is directly related to the desire or ability to correctly determine the size of the uterus in the weeks of pregnancy. The criterion of “rapid growth” was introduced due to the concern that rapid enlargement of myomatous nodes is highly suspicious of malignant degeneration of fibroids. This fact has been repeatedly refuted, since it has been shown that in the vast majority of cases, the rapid growth of myomatous nodes is not associated with malignant degeneration of fibroids, but is a consequence of secondary degenerative changes.

Now imagine how convenient the situation is when the indication for surgery is a subjective criterion in the form of the size of the myomatous uterus for more than 12 weeks or “rapid growth”. Under this “subjective sauce” the largest number of uterine removals are performed, despite the fact that the true size of the uterus may be slightly larger norms.

Who needs this and why?

There are several reasons:

1. Dispensary registration in antenatal clinics

Each antenatal clinic has a dispensary registration of women for various diseases. Most women are registered at the dispensary for fibroids. They are regularly invited to appointments and monitor the dynamics of growth of myomatous nodes. The number of such women is increasing year by year. A woman can be removed from the dispensary register after the disease has actually been cured, and the only radical treatment method is amputation of the uterus. Therefore, after observing for some time, at one of the appointments you can write down on the card that the uterine fibroids grew before 12 weeks of pregnancy, and “quickly” and send for surgical treatment. After removal of the uterus, a woman is removed from the dispensary register. Again, reporting is required.

2. Surgical treatment of uterine fibroids – profit for the clinic and implementation of the “surgical activity” plan

Monitoring a patient with fibroids is a troublesome and cost-intensive task. Any operation is always more expensive, be it funds from the insurance company or personal gratitude from citizens. Now that laparoscopic operations are performed in almost every major medical institution, removal of the uterus by this method has become routine. The surgical technique was well established and the intervention was tolerated relatively well. So it is proposed to quickly and efficiently solve the problem. If a woman no longer has reproductive plans, then convincing her that this is the simplest and easiest way to treat fibroids does not cost anything. Clinics give honest advice, surgeons cut things honestly. In this case, the only indication for amputation may be simply the fact of the presence of uterine fibroids, even if it does not give any symptoms, even if the myomatous node is small and does not interfere with anything.

The main idea of ​​everything I wrote above is that the patient with uterine fibroids is actually being misled. Taking advantage of the fact that the patient is not oriented in medical matters, she is not told about all the available methods of treating her disease, or is provided with negative and false data about the effectiveness of alternative treatment methods - either intentionally or simply out of ignorance.

How to treat uterine fibroids?

First, I would like to list all the currently available treatments for uterine fibroids:

• Drug treatment: GnRH agonists (zoladex, buserelin, diferelin, lucrin, etc.), progesterone receptor blockers (mifepristone)
• Uterine artery embolization
• Conservative myomectomy (hysteroresectoscopy)
• Uterine amputation

Thus, in addition to hysterectomy and passive follow-up, there are other treatment methods.

Dimensions of uterine fibroids

Despite the fact that the classification of uterine fibroids by week of pregnancy is accepted all over the world, in my opinion, in the era of ultrasound diagnostics, this approach to determining the size of uterine fibroids is somewhat outdated.

Using ultrasound, you can measure the size of each myomatous node, count their number and determine their location. Such a detailed description of the uterus, altered by myomatous nodes, is more informative than the conclusion - “uterine fibroids 8-9 weeks”.

In addition, the choice of treatment method, the prognosis of the disease and the conclusion about the possibility of pregnancy depend on the size of the nodes and their location.

Choosing a treatment method for uterine fibroids

Before describing each of the treatment methods listed above, we will discuss in what situations simple observation may be appropriate.

A very important thought! The myomatous node does not immediately appear in the uterus of large size; it grows from the rudiment and at the very beginning it cannot be detected even with an ultrasound. Then it increases in size and here the paths of all nodes diverge. Some nodes reach a certain size and stop growing, others slowly but surely continue to grow, and others can grow rapidly.

If there was only one node in the uterus, other than this node, new nodes may not appear. But there is another situation when the number of nodes increases.

No one knows how the node will behave - it will grow, stabilize, or disappear altogether. But you need to understand that fibroids have stages, and small nodes are actually the earliest stage of the disease, and large and very large fibroids are already advanced forms of the disease.

As you know, any disease is easiest to treat at an early stage – treatment of uterine fibroids is no exception. Therefore, even if a woman’s ultrasound accidentally reveals small myomatous nodes (no more than 2-2.5 cm), releasing such a patient with the words: “we will observe, if the fibroids grow, we will treat” is equivalent to the situation when the patient goes to the doctor with complaints of cough, and the doctor, instead of treatment, says: “We’ll watch and see if pneumonia develops, then we’ll treat.” Absurd, isn't it?

It has been known for quite some time that modern hormonal contraceptives are able to restrain the growth of small myomatous nodes, the size of which does not exceed 2-2.5 cm. In addition, long-term use of contraceptives ensures the prevention of the development of this disease (as explained above, by suppressing cyclicity in the female body).

Thus, if small myomatous nodes are detected, even in the absence of symptoms of the disease, the patient should be offered to take modern monophasic contraceptives. In the same case, if they are contraindicated for her, or the patient categorically objects to taking them, dynamic monitoring of the growth of myomatous nodes can be allowed, but ultrasound should be performed at least once a year. If the nodes begin to grow, then treatment should be started immediately and not wait for their further increase, even if there are no symptoms of the disease.

Taking oral contraceptives can be replaced with a special intrauterine hormonal system, Mirena. This is actually a regular intrauterine device, but containing a container with a hormone that is released in small doses into the uterine cavity over 5-6 years. This is the period for which this system is being installed. It, like oral contraceptives, inhibits the growth of myomatous nodes.

In what other cases can you observe fibroids and do nothing?

There is no clear answer here; the decision must be made individually. Too many criteria should be taken into account when making such a decision (including the location of the node, its size, the age of the patient, the degree of blood supply, the presence of reproductive plans, the presence of other diseases, etc.)

Thus, dynamic observation of uterine fibroids can be allowed only by assessing many facts.

Before we begin to describe methods of treating uterine fibroids, we should tell you what types of nodes there are and what the main idea of ​​treating this disease is.

What are the types of uterine fibroid nodes?

Myoma nodes can be located in different parts of the uterus.

• Actually outside the uterus, “grow on a stalk”
• Part of the node is outside the uterus, and part is in the wall
• In the wall of the uterus
• In the wall of the uterus, but grows towards the cavity
• And nodes that protrude into the uterine cavity to varying degrees; some nodes can be completely in the uterine cavity “pedunculated”

There are also other localizations, but they are extremely rare.

The closer the node is to the uterine cavity, the more likely it is to cause symptoms of the disease in the form of heavy, prolonged menstruation, pain and interfere with the development of pregnancy. Accordingly, the more external the node, the less it manifests itself, except in cases where the node is large enough and compresses neighboring organs (bladder or rectum)

Further, the closer the node is to the uterine cavity, the more significant its size. Let me explain - even a small nodule in the uterine cavity can cause prolonged heavy menstruation, while a large nodule outside the uterus can remain asymptomatic for a long time.

Consequently, the choice of treatment method depends not only on the size and number of nodes, but also on their location.

What is the main idea of ​​treating uterine fibroids?

The uterine fibroid node can be reduced, fixed in size and removed.

Two types of treatment reduce the size of fibroid nodes - medications and uterine artery embolization (indirect, focused ultrasound)

Each node has its own limit, below which it cannot decrease. In other words, “dry residue”. I often give the example of an apple being turned into dried fruit - the larger the apple initially, the more dried fruit it will make, the juicier it was, the more it will shrink when dried.

Also with myomatous node. Large nodes, as a rule, shrink worse and mainly due to the fact that the content of connective tissue begins to prevail in their structure, which practically does not lend itself to regression. However, there are also small nodes, almost entirely consisting of connective tissue - fibroids. Fibroids also do not shrink well, and large, succulent ones regress to more than 80% of their original size.

On average, after treatment, the myomatous node decreases by 40%. When choosing a treatment method, you should keep this in mind. It is not rational to reduce the size of an 8 cm node with medication, since the remainder will be a 5 cm node, which will also remain clinically significant, especially if this node grows towards the uterine cavity.

Drug treatment of uterine fibroids

Important! Uterine fibroids cannot be treated with Duphaston. Progesterone (Duphaston is its analogue) is the main factor in the growth of fibroids (this was proven more than 10 years ago) - for those who don’t believe, see Western scientific publications.

Despite this, Duphaston continues to be prescribed to patients with uterine fibroids - how can this be? Below we will talk about the drug Mifepristone (progesterone receptor blocker) - this drug reduces the size of uterine fibroids only by preventing progesterone from exerting its effect on uterine fibroids. That is, no progesterone means no fibroid growth.

Duphaston is strictly contraindicated for the treatment of uterine fibroids! Duphaston grows fibroids, and after that you are sent for surgery with the sauce “the treatment did not help, the nodes are growing, you need to cut them off, as if something bad had happened.”
Some kind of Paleolithic...

GnRH agonites

These drugs (Zoladex, Buserelin, Diferelin, Lucrin-depot, etc.) introduce a woman into artificial menopause, against the background of which a decrease in myomatous nodes occurs. In addition, they also have a direct effect on uterine fibroids. GnRH agonists block the local production of hormones in the nodes (which support the growth of the nodes) and the synthesis of connective tissue (the accumulation of which also leads to an increase in size).

The drugs are administered intramuscularly once every 28 days. Usually the course of treatment ranges from 3 to 6-7 months. Side effects develop differently for everyone - from mild “hot flashes” to relatively severe conditions. After treatment, myomatous nodes may begin to grow again, so such drugs should not be prescribed in isolation. To stabilize the achieved results after a course of therapy with GnRH agonists, hormonal contraceptives are prescribed or the Mirena coil is introduced.

It is advisable to use GnRH agonists only for small myomatous nodes up to 3-5 cm, then after reduction, the size of the nodes will remain clinically insignificant, and it will be easier to stabilize them with the help of contraceptives or Mirena. Prescribing GnRH agonists to large nodes is not rational; there are other treatment methods for such nodes.

GnRH agonists should not be prescribed at all before surgery to remove fibroids. It is believed that after such preparation, the amount of surgical blood loss is reduced and the reduced size of the node is easier to remove. In fact, the volume of blood loss actually decreases, but at the same time, the myomatous node seems to be “soldered” into the surrounding muscle tissue of the uterus, which makes it difficult to remove. The most negative consequence of the preoperative administration of GnRH agonists is that during treatment, small myomatous nodes become even smaller and cannot be detected during surgery and, accordingly, removed. It is from these small nodules that are left that new nodes are subsequently formed and the disease recurs.

GnRH agonists should be prescribed after surgery to remove myomatous nodes to allow the uterus to fully recover and suppress the remaining rudiments of myomatous nodes.

Progesterone receptor blockers

Currently there is only one drug from this group - Mifepristone. It is known that the female sex hormone progesterone is the most powerful factor in the growth of uterine fibroids. Mifepristone blocks all binding sites for this hormone on uterine fibroid cells, thereby preventing it from realizing its effect.

While taking this drug, the size of myomatous nodes decreases in the same way as when using GnRH agonists. The drug is better tolerated. Mifepristone is also advisable to prescribe only in the presence of small myomatous nodes.

Uterine artery embolization

In fact, a unique method of treating uterine fibroids. Its appearance actually marked the beginning of a new era in the treatment of this disease.

What is uterine artery embolization?

The term “embolization” means the blockage of the blood vessels that supply an organ, resulting in the cessation of its blood supply.

The essence of the uterine artery embolization (UAE) technique is as follows: the uterus is mainly supplied with blood by four arteries: the right and left uterine arteries and the right and left ovarian arteries.

The share of the uterine arteries in supplying the uterus with blood is the main one. Now imagine that you sharply reduce watering your favorite ficus to a minimum - it is obvious that very soon it will simply dry out. Likewise, an organ that has lost a significant share of its blood supply gradually begins to decrease in size, only there is one nuance here. Uterine fibroids also feed from the uterine arteries, but since they formed later than the uterus grew, the system of blood vessels in it is not perfect and flawed (“made hastily and not thought out in case of any violations”).

Thus, cessation of blood supply to the uterus through the uterine arteries becomes “lethal” for fibroids, but not for healthy uterine tissue, since the presence of a normal blood network in it allows it to “exist” due to the flow of blood through the ovarian and other small arteries. In other words, cessation of blood flow in the uterine arteries leads to the “shrinking” of fibroids, but has virtually no effect on the functioning of healthy uterine tissue.

As a result of this procedure, after just three months the volume of fibroids is reduced by an average of 43%, and within a year – by 65%. Heavy, long, painful menstruation with clots by the second or third month after UAE in 90% turns into short, moderate or even scanty, painless menstruation. Most importantly, after this procedure, uterine fibroids rarely recur. EMA is a self-sufficient method. After this procedure, there is no need to take any medications or procedures - you solve the problem of uterine fibroids once and for all.

How does this procedure happen?

This is interesting!

How uterine artery embolization is performed at the Perinatal Medical Center (video from the operating room). Now you can see everything with your own eyes.

Under local anesthesia (this is more than enough), a puncture of the right femoral artery is performed (the same as an intravenous injection only on the leg), and a catheter is inserted.

Then, under the control of a special X-ray machine, they alternately enter the right and left uterine arteries and inject a suspension of microparticles (balls measuring 300-700 microns) into each of them. These particles will block the blood flow in the uterine arteries.

This procedure usually takes from 15 to 40 minutes and occurs without anesthesia - as it is simply not needed. Throughout the entire procedure, the patient does not experience any pain.

After the procedure is completed, the patient returns to her room, where she remains until the morning. Some time after the procedure, pain appears (pulling in nature), reminiscent of pain during menstruation. The severity of pain varies, from mild to moderate, sometimes quite severe. Painkillers are prescribed to relieve pain. By morning the pain usually disappears completely. In the next 5-7 days, you may experience a condition reminiscent of a mild cold, that is, fever, weakness, drowsiness. Most often, women spend this time at home and after it is over they can go to work. After just one menstrual cycle, you can feel the effect of the procedure.

Uterine artery embolization can be performed for any size and location of myomatous nodes. It is advisable to perform this procedure even in the presence of small nodes, actually for preventive purposes, so as not to take contraceptives and not worry that one day the growth of nodes will begin. For large nodes, embolization alone may be sufficient (nodes in the uterus may remain quite large, but they will not grow further and there will be no heavy bleeding) or embolization will be the initial step before surgery to remove fibroids, especially in women planning a pregnancy.

The combination of uterine artery embolization followed by removal of the remaining nodes is an approach that allows restoring reproductive function in women with the most complex types of uterine fibroids.

These are situations when the uterus is actually “stuffed” with fibroid nodes of different sizes and it is not possible to remove all the nodes without risk to the uterus and the patient. 6-8 months after embolization of the uterine arteries, the number of nodes decreases, the remaining nodes are clearly demarcated from the surrounding myometrium, the contour of a normal uterus begins to emerge, and the cavity is leveled. Removing nodes from such a uterus becomes easier, blood loss is sharply reduced, and after removing all the nodes, the uterus quickly returns to its original size.

Is it possible to become pregnant after uterine artery embolization and is this procedure performed on nulliparous women?

Yes, you can! And this is proven by the increasing number of children around the world born to women who have undergone uterine artery embolization every year.

Within a few months after embolization, blood flow in the uterus is restored in full. Ovarian function in young women is not affected, despite the fact that during embolization, emboli enter the bloodstream of the ovary.

A decrease in ovarian function can be observed in women mainly over 45 years of age. The radiation dose during the procedure does not exceed acceptable values ​​(this has been shown in large Western studies)

Of course, after embolization of the uterine arteries, not so many children are born, but this is due to the fact that the overwhelming number of women with uterine fibroids are over 35 years old, and many have already given birth to children or by this age they have additional factors of infertility (for example, uterine obstruction tubes or male infertility).

Uterine artery embolization and submucosal uterine fibroids (submucosal)

The effect that uterine artery embolization has on submucosal myomatous nodes can be called unique. Submucosal nodes are nodes that grow into the uterine cavity and deform it to varying degrees.

Before the advent of uterine artery embolization, such nodes were removed using hysteroresectoscopy (a large operation that is performed through the vagina - with a special tool, the myomatous node is cut into small pieces from the wall of the cavity). This operation is still performed today. The maximum node size for this operation is 5 cm. For large sizes, they most often insist on removing the uterus. Hysteroresectoscopy is most justified in the presence of small nodules that grow in the uterine cavity, like “on a stalk.”

After embolization of the uterine arteries, the myomatous node or nodes begin to gradually move into the uterine cavity, where its disintegration begins. The disintegrating myomatous node gradually flows out of the uterine cavity and is then completely pushed out of the uterus. Thus, the uterus, as it were, rejects the node from itself, and after a few weeks after this it is impossible to find a single sign that this node was in the uterus - complete healing occurs without a trace.

Against the background of such disintegration of the node, a woman, as a rule, experiences an increase in temperature, weakness, malaise, and periodic nagging pain in the abdomen. This condition can last for several weeks (depending on the size of the node or nodes), but in general it is relatively easy to tolerate. After removing the node, the woman’s condition becomes normal within one day. In my practice, the maximum size of the node that was cured in this way was 12 cm.
Who speaks poorly about uterine artery embolization and why?

As a rule, bad reviews about uterine artery embolization are:

• from doctors who have only heard about this method and have never seen it (well, rumors vary)
• for doctors who perform operations to remove uteruses and fibroid nodes - this is their main income and embolization acts as a competing method
• from extremely conservative doctors who like to treat “the old fashioned way”
• among doctors who had to deal with complications after embolization of the uterine arteries (this happens extremely rarely if the operation is performed correctly and after proper management)
• in patients who had this procedure performed poorly or had complications (as you know, there is no medicine without complications, but doctors are often silent about the successes of doctors, but I always talk about complications)

Thus, embolization of the uterine arteries is a very successful self-sufficient method of treating uterine fibroids, which has already saved many women from having the uterus removed and allowed them to give birth to full-fledged children.

Remember! Every time you are offered to remove the uterus due to fibroids, do not rush to agree; you will always have time to remove the uterus. Uterine artery embolization is a worthy alternative to this operation.

Removal of uterine fibroids or conservative myomectomy

This operation was proposed about a hundred years ago and until now the possibility of carrying out this operation is kept silent. Technically, this is a rather complex operation, and not all gynecologists are proficient in it. Removing the uterus is much easier.

Most often, this operation is performed to realize reproductive function. You can become pregnant 6 months after this operation. If there are a large number of nodes and a high risk of losing the uterus during surgery, embolization of the uterine arteries is performed six months before this operation. Then the outcome of the operation is almost always successful. In order to prevent relapse of the disease and allow the uterus to recover better after surgery, a course of therapy with GnRH agonists is prescribed for 3-6 months.

What is the best method for removing fibroid nodes?

There are two options for conservative myomectomy - laparoscopic and laparotomy. In the first case, the operation is performed using special instruments inserted into the abdominal cavity under the control of a video camera; in the second, the operation is performed by the surgeon's hands in the abdomen.

Laparoscopic myomectomy requires a very high skill of the surgeon, as he must stitch the uterus together so that it can withstand pregnancy and childbirth. This is not an easy task. There have already been many cases of uterine ruptures during pregnancy and childbirth after poorly performed operations. Laparoscopic access is most indicated in the presence of nodes growing outside the uterus “on a stalk”.

The advantages of the laparoscopic approach include a quick recovery period, less likelihood of adhesions, and less blood loss during surgery. But I repeat once again, in Russia there are only a few dozen surgeons who have sufficient experience and qualifications to fully perform this operation in the presence of several nodes in the uterus and when they are located in the wall and closer to the cavity. The names of these surgeons are usually widely known. You may be offered to undergo such an operation in any clinic, but just remember that you can check the quality only during pregnancy and childbirth, and then it may be too late.

Still, the uterus must be sewn by hand. Carefully, layer by layer, matching all layers. Abdominal surgery allows you to do this. In addition, during abdominal surgery there is a more complete opportunity to palpate the entire uterus with your fingers and find small myomatous nodes and remove them. The tool does not do this as effectively.

Therefore, I believe that removal of myomatous nodes, if these nodes are located in the wall of the uterus, they are large or there are many of them, should be performed with open surgery. This will make it possible to more confidently guarantee complete removal of myomatous nodes and better and more reliable suturing of the uterus.

When should the uterus be removed for uterine fibroids?

Only in very advanced cases, when the size of the uterus is very large and the uterus is completely stuffed with nodes, so that it is impossible to find healthy uterine tissue in the uterus. And a few more situations that do not occur so often.

It's a shame, because many women themselves trigger their disease to such an extent. They see that their belly is growing, they do not see a gynecologist for 10 years, and some even more, and in fact they come when their disease reaches a stage where organ-preserving treatment is no longer possible. Some women avoid going to the doctor because they are offered to remove the uterus from the very beginning, without being told about the available alternatives. Afraid of losing their uterus, these women grow fibroids for years and come for an appointment only when the huge uterus in their abdomen does not allow them to lead a normal life. They come to give up - doomed, sad and with strong melancholy in their eyes. And the worst thing is that if they knew that there were other treatments and came to the appointment a few years earlier, they could have used them and saved the uterus.

Why shouldn't you remove the uterus and fight for it to the end?

Treating the uterus as an organ that is intended only for childbearing actually makes it so easy to make the decision to remove it. In fact, the uterus is an organ integrated into the entire reproductive system of the body and its removal does not pass without a trace.

It is known that after removal of the uterus, the risk of breast and thyroid cancer increases. In addition, during the removal of the uterus, the blood supply to the ovaries is disrupted, which entails the development of the so-called “posthysterectomy syndrome.” This syndrome is similar to that observed in menopausal women. It often happens that after removal of the uterus, a woman begins to “age” quickly, her body weight increases, and her quality of life changes for the worse.

Changes may also occur in your sex life. Western scientists conducted a number of studies on this matter, and their results were controversial. It was noted as an improvement in sexual life after amputation of the uterus (apparently these were those women who were exhausted by the disease they had) and those who completely lost pleasure from sexual life. There is no reliable data and this is most likely due to the fact that the formation of sexual sensations in a woman is extremely complex and it is very difficult to evaluate it from all positions.

If you still decide to remove the uterus, then you need to remember that in order to prevent the development of post-hysterectomy syndrome (early aging), from the next day after the operation you need to start taking a special drug Livial, which will help neutralize the development of this pathological condition.

Other treatments

High Frequency Focused Ultrasound

This method appeared relatively recently. The meaning of this method is that, under the control of MRI (tomography), an ultrasound flow is targeted at the myomatous node. In the center of the node, the tissues are heated to a high temperature and the node dies.

On the one hand, this method is very good. The effect is through the skin, that is, generally non-contact, but there are several nuances:

• the method is very expensive (this is due to the fact that the equipment for its implementation costs many millions of euros and it must be repaid)
• You can influence one or at most several fibroid nodes
• at the same time, there should not be a lot of fat, scars on the anterior abdominal wall
• in this case, the nodes must be successfully located - that is, there should be no large obstacles on the path between the node and the beam flow
• uterine fibroid nodes have varying sensitivity to this effect, some nodes do not shrink at all after this procedure
• During the procedure, the patient must lie motionless on her stomach for several hours

Thus, the method has many limitations and inconveniences. While there is embolization of the uterine arteries, in which all myomatous nodes are affected at once, there are not so many restrictions and this method costs half as much - the use of focused ultrasound is advisable only for scientific purposes.

I don’t believe in homeopathy, dietary supplements, etc....

Conclusion

Can uterine fibroids should it cease to be one of the most pressing problems in gynecology? - MAYBE!!! How? - everything is very simple!

It is necessary to regularly do an ultrasound from early youth - once a year, and if a myomatous node is detected - immediately take measures (take contraceptives, do embolization). It is completely unacceptable to watch how the fibroid grows.

Regular examination by a gynecologist with ultrasound is the best prevention of problems associated with uterine fibroids.

Uterine fibroids are a fairly common gynecological disease in women, which is characterized by the formation of a benign tumor in the body of the uterus.

Most often this disease occurs in women aged 30 to 45 years. At the same time, the mass fraction of uterine fibroids is about 30 percent of all gynecological diseases.

In addition, its appearance is likely in 80 percent of women, most of whom do not even realize that it exists, since no changes are noted in their own health. At the same time, uterine fibroids of 8-9 weeks often already require surgical treatment.

What is fibroid?

Fibroids are tumors that form in the muscle layer of a woman's uterus. The tumor often develops very slowly. The exact reasons why one muscle cell begins to divide and create new cells that form a kind of knot called a fibroid are unknown. Depending on where uterine fibroids are located, the following types are distinguished:

• subserous (under the upper layer of the uterus, and development proceeds towards the abdominal cavity);
• interstitial (develops in the uterus inside the muscular layer);
• intraligamentous (formed in the uterus between the broad ligaments);
• submucous (formed in the body of the uterus under the mucous layer, development - in the area of ​​​​its lumen);
• cervical (develops in the muscles of the cervix).

If the nodes enlarge, the fibroids become larger and the size of the uterus itself becomes larger in the same way as during pregnancy. Therefore, the size of fibroids is usually indicated in weeks (uterine fibroids 7-8 weeks, etc.) - similar to the period of pregnancy, which corresponds to an increase in the size of the uterus. For example, uterine fibroids were detected at 8 weeks, that is, the size of the uterus has increased to the size that occurs at eight weeks of pregnancy. There are cases in which several nodes are detected at once, and their sizes may differ. This is called multiple uterine fibroids.

How is the size of uterine fibroids determined?

The size of uterine fibroids directly depends on the woman’s hormonal background, mainly on the amount of estrogen – female sex hormones – in the blood. If their level increases, uterine fibroids become larger.

The size of fibroids, as mentioned above, is compared by obstetricians-gynecologists with the size of the uterine body at a certain stage of pregnancy. During an ultrasound examination, the tumor can be measured in centimeters.

Depending on their size, uterine fibroids are divided into three main categories: small, medium and large:

• uterine fibroids 8 weeks or less and up to 2.5 centimeters in size are small;
• a medium-sized neoplasm corresponds to 10-12 weeks of pregnancy;
• Large fibroids correspond to more than 12-15 weeks of pregnancy.

An equally important parameter as the size of the body of the neoplasm is the speed of its development. It is believed that if a small or medium-sized fibroid has increased by more than five weeks over the course of a year (for example, uterine fibroids from 8-9 weeks to 13-14 weeks), then it is growing rapidly. The reasons for the rapid growth are the patient’s constant hormonal imbalances.

The size of the fibroids is especially important if the patient is pregnant. When small and small uterine fibroids are diagnosed (7-8 weeks - maximum 12), pregnancy often proceeds completely normally, without any abnormalities. In the case of large fibroids (12-15 weeks or more), fertilization and subsequent bearing of a child usually becomes impossible due to blockage of the woman’s fallopian tube, miscarriage or premature birth. If fibroids are diagnosed at 12-15 weeks during labor, severe bleeding may occur, labor may be disrupted, an infectious-inflammatory process may develop, etc.

How to identify uterine fibroids?

Uterine fibroids can be diagnosed through a gynecological examination, ultrasound examination of the uterus, as well as hysteroscopy and hysterography (if necessary).

1. Gynecological examination. During the examination, the gynecologist may detect an increase in the size of the uterus (the increase in the uterus will correspond to a certain period of pregnancy: 4, 8, 12, 16 weeks, and so on.).

2. Ultrasound examination of the uterus is of two types: vaginal ultrasound, as well as ultrasound examination through the anterior abdominal wall. A similar examination of the uterus demonstrates an enlargement of the organ, as well as the fibroid itself (large and small). Myoma can be detected already at the very initial stages, when its diameter is less than 1 centimeter, not to mention quite large nodes of uterine fibroids 7-8 weeks or more.

3. If it is extremely difficult to identify fibroids, then a diagnostic technique such as hysterography can be used. In this case, the doctor injects a contrast agent into the uterine cavity and takes an X-ray.

4. During hysteroscopy (another method for determining uterine fibroids), a hysteroscope will be inserted into the uterus, with the help of which the doctor will examine the uterus from the inside.

5. To identify small fibroids (6-8 millimeters) located in some unusual areas, computed tomography or diagnostic laparoscopy can be used.

How to cure uterine fibroids?

The method and duration of treatment for uterine fibroids is determined by many factors, the main of which are the following:

• size (small uterine fibroids 8 weeks or less, small - 10-12 in size and large - 12-15 weeks or more);
• how the symptoms are expressed;
• woman's age;
• the patient’s desire to become pregnant and give birth.

Today there are two main directions of treatment for uterine fibroids:

1. Medication. The goal of treatment is to control the increase in the size of uterine fibroids and the symptoms of the disease.

2. Surgical. Radical or organ-preserving operations aimed at eliminating fibroids.

Uterine fibroids are a benign tumor that appears in the reproductive organ. The age group susceptible to the disease is women 20-70 years old. This disease occurs due to hormonal imbalance. At the initial stage, the disease has no symptoms; only when pain and bleeding occur does a woman decide to undergo examination. The size of uterine fibroids in weeks is diagnosed using ultrasound. Treatment depends on its size.

The size of a benign tumor is determined by weeks and centimeters. This completely coincides with the obstetric period (fetal growth during pregnancy). Therefore, the size of fibroids is usually calculated by week.

• A small tumor (about 2 cm) lasts no more than 4-6 weeks. Reasons for surgery only if the fibroid stalk is twisted. May be removed due to excessive bleeding, leading to anemia. Also if a woman has been diagnosed with infertility;
• Average (from 4 to 6 cm) period is 10-11 weeks. If the nodes are not actively growing and there are no pronounced symptoms, then the operation may not be performed. Formations that are located on the outside of the uterus can disrupt the functioning of the organs located closest to it. With average fibroids, infertility or miscarriage may occur;
• Myoma exceeding 6 cm in diameter is considered large; its duration is equal to 12-16 obstetric weeks of pregnancy. Such fibroids can only be removed surgically and with drug treatment to eliminate tumors.

Size of uterine fibroids in weeks and centimeters

At an early stage, fibroids are 4 weeks old. It has no symptoms and does not bother the woman. The main thing is to identify this disease before 7 weeks. It will bring much fewer problems than in later stages of detection.

When it increases to 5 cm and a period of about 10 weeks of obstetric pregnancy, the first symptoms begin to appear.

• Menstruation with pain that does not respond to painkillers.
• Upon reaching 12 weeks, the cervix enlarges, causing bloating.
• If the diagnosis is pedunculated fibroid, then there will be a sharp pain in the abdomen.
• With large fibroids, its enlargement leads to compression of neighboring organs, which interferes with normal urination and defecation. Pain begins in the lower back and near the rectum.

Fibroids, the size of which is more than 12 weeks, entail the formation of adhesions in the tissues of the body and nearby organs.

When a patient complains, an ultrasound examination is performed and appropriate tests are taken. Ultrasound is the most accurate detection of this disease, as well as the timing of its onset. Thanks to the examination, it is possible to accurately determine whether a tumor is benign or not. The possibility of a benign tumor becoming malignant depends on the timing of its detection. Every woman needs to make it a rule that she undergoes ultrasound regularly.

After examination and further diagnosis, the doctor makes a decision on the operability of the tumor. For this, the following indicators are available:

• Uterine fibroids measure 6 cm and last for more than 12 weeks. This tumor size is life-threatening for the patient. Myoma nodes that are more than 12 weeks old must be urgently removed.
• Consistently intense pain. This feature is typical for medium and large fibroids. The myomatous node leads to compression of nearby organs and also puts pressure on the rectum. Defecation is impaired, which can lead to intestinal inflammation and intoxication of the body.
• Bleeding began. Basically, it is caused by fibroids for a period of 15 weeks or more.
• Pregnancy planning. If a woman cannot become pregnant or bear a child, medium-sized fibroids are often the cause. Hormonal levels change during pregnancy, which leads to tumor growth and poses a threat to the baby.

If uterine fibroids are more than 12 weeks old and are located on the back wall of the uterus, this can cause premature birth. Oxygen starvation of the fetus may occur.

• There is a risk of benign fibroids developing into malignant ones. This opportunity arises with the rapid growth of fibroids.

Small or medium fibroids can be treated without surgery, provided there are no complications. If the tumor is benign and even a few millimeters in size, you still should not relax and start treating it, because it may be located in a harmful area.

Tumor growth

To treat fibroids, it is important how quickly they grow. If over the course of a year the uterus has enlarged to 5 weeks or more, then this tumor is progressing. Its growth is affected by hormonal imbalance in the body. There are also the following reasons for the rapid development of this disease:

• a woman has not given birth until she is 30 years old
• gynecological pathologies
• sufficient number of abortions
• taking hormonal drugs
• long-term influence of ultraviolet radiation on the body.

Sometimes uterine fibroids grow to enormous sizes, the weight can be about 5 kg and 40 cm in diameter. This resembles late pregnancy.

The effect of fibroid size on pregnancy

With small or medium-sized fibroids, pregnancy can proceed normally. If the tumor is large, then pregnancy, as well as bearing a child, is not possible. Conception does not even occur due to the fact that the nodes block the fallopian tubes.

If a woman finds out during pregnancy that she has a large fibroid, complications may arise during childbirth. This may include bleeding, infections of internal organs, as well as unforeseen situations.

The most serious are fibroids located in the vagina. It causes infertility, as well as spontaneous miscarriages. If pregnancy occurs due to a benign tumor, then the patient is constantly under the supervision of doctors to prevent miscarriage. If the growth of the fibroid node increases rapidly, then the pregnancy must be terminated.

In some pregnant women, myomatous nodes stop growing altogether, in 10% it decreases, and only in 20% can it begin to grow at a progressive rate.

Removal of fibroids

An ultrasound examination revealed that the nodes were enlarging; the doctor ordered a full examination of the patient to begin with. Then the operation is performed. There are the following types of surgical intervention: laparoscopy, laparotomy, strip surgery, hysteroscopy, hysterectomy.

For hard-to-reach and large nodes, hysteroscopy is done - making incisions through the vagina.

Removal of fibroids 10 weeks. You cannot delay removal. The operation is performed through an incision in the anterior wall of the abdominal cavity. This rather serious operation to remove a benign tumor is called laparotomy. After it, a long rehabilitation is required.

Removal of fibroids 12 weeks. When a tumor of this size is diagnosed, surgery is performed immediately. As a last resort, hysterectomy is used - complete removal of the uterus. This operation is performed if no treatment is no longer effective. The rehabilitation period is about 2 months.

In case of a complex case, as well as widespread foci of the disease, a strip operation is performed.

Complete removal of the uterus for fibroids

The entire reproductive organ can be removed: if the size of the tumor has reached unacceptable levels, also if removal of the nodes is not possible. The main indicators for this are:

• late detected formation of nodes,
• uterine prolapse,
• prolonged blood loss,
• suspicion of a malignant tumor,
• increasing anemia.

Rehabilitation after removal

To quickly return to your normal lifestyle, you must adhere to the following recommendations:

• eliminate stress on the stomach, but try to move more;
• avoid constipation;
• do not lift heavy objects;
• Eliminate stress, which often leads to hormonal changes.

To plan a pregnancy, you should consult your doctor.

Take medications to restore the functioning of the uterus. Also, if you have any unpleasant symptoms, consult a doctor.

Every woman should regularly visit her gynecologist and monitor her reproductive system.