Uterine myoma or uterine fibroid is a benign tumour arising from the smooth muscle cells of the original organ. Myoma remains among the most common gynaecological pathologies and reaches 25% in the structure of all the female diseases.
According to autopsy datas, myomas of different size are identified in 80% of women. Meanwhile, clinical signs are present in just 35% of patients suffering from this disease.
Exact causes of uterine myoma remain unknown. Two main theories exist explaining the origin of the tumour. First one says, myoma is a defect of the embryonic development. The second one presupposes pathological changes in the cells of a mature uterus and is more pathogenically justified.
Risk factors of uterine myoma:
65% of women don’t have any symptoms because of the small size of the tumour and absence of the clinical picture of the disease. It doesn’t influence fertility and it doesn’t violate the quality of one’s life.
35% of patients have manifested symptoms like:
Frequent bleedings lead to iron deficiency anaemia manifested by the following symptoms: pallor of the skin, shortness of breath, tachycardia (rapid pulse).
If the tumour grows significantly larger in size, the symptoms of bladder or rectum compression occur. Bladder compression is evidenced by the frequent need to urinate. Rectum compression is manifested by constipations up to intestinal obstruction.
Ultrasound is the main method for diagnosing uterine myoma. It can not only detect myomatous nodes, but also determine their characteristics:
Except for the ultrasound of the pelvic organs there are also improved and more informative diagnostics measures with the use of ultrasound. The following techniques are among them:
Therapeutic tactic is determined by a number of factors. The main ones are:
If a woman does not plan on having children then conservative therapy is applied directed at the bleeding stop and anemia correction. Conservative treatment is used if nodules size is up to 3 cm. If myoma is larger than that, then surgery is indicated even if a woman doesn’t plan on childbirth.
Surgical treatment techniques are:
Hysterectomy is the removal of the uterus which is the most effective method of treating fibroids. This does not affect the quality of one’s sexual life. There may be a deficiency of estrogen after surgery, but it is compensated with hormonal drugs. This method of treatment is unacceptable for women who want to maintain fertility.
Indications for the removal of one’s uterus removal with myoma:
Surgery can be performed through the laparotomic (by open access) or laparoscopic (introduction of the optical system and surgical instruments through small incisions) access.
Specialists in German hospitals prefer laparoscopic procedures. They are harder to perform and require the advanced equipment, though it’s a win-win situation:
Laparoscopy cannot be performed if the uterus is of a large size (more than 17-week-pregnancy), the location of the myomatous node is on the back wall of the uterus, and if there are some accompanying gynaecological diseases.
At the momentthere are many effective techniques of radical or symptomatic uterine myoma treatment. New therapeutic approaches are being developed regularly, directed at the reduction of tissue trauma while removing the tumour.
Radiofrequency ablation is a high-tech, minimally invasive method for treating uterine myoma, which does not require surgical intervention. A needle device is inserted into the myomatous node through the abdominal wall. Myoma tends to warm up to a high temperature and then its destruction occurs.
Distant thermocoagulation of nodes is an innovative method of treatment, which is used in some German hospitals for the treatment of uterine myoma. The procedure is performed under the visual control of a magnetic resonance imaging. The focused energy of ultrasonic waves is used to heat the nodes, resulting in necrosis (death) and rejection of the tumour.
Benefits of such a treatment technique are:
The effectiveness of distant thermocoagulation of myomatous nodules is about 75%. The need for another procedure occurs in 20% of women. At the moment, studies are continuously aimed at obtaining more accurate information about the effectiveness of using focused high-frequency ultrasound in uterine myoma treatment.
Life and work capacity prognosis for uterine myoma is favourable. The worst possible outcome is the malignancy of the tumour. But, it turns into sarcoma only in about 0.1% of patients.
Reproductive function depends on the nodule size, its location, presence of the accompanying pathology. One of the possible consequences is infertility. If pregnancy indeed comes, the risk of miscarriage sharply increases and reaches up to 10-40%.
Uterine myoma increases the risk of following complications while pregnant:
Uterine myoma doesn’t change its size during pregnancy in 50% of cases. 20% of patients experience regression of the tumour, while 30% of patients experience the progression on the tumour. The volume of malformation grows at a rate of 12-25%. Small myomatous nodes are more likely to regress, larger tumours are likely to increase in size.
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