Myoma (also fibromyoma, leiomyoma) is a hormonal noncancerous formation in the muscle layer of the uterus. This is the most common type of tumor in women. According to statistics, uterine fibroids are found in every fourth woman of childbearing age, mostly after 30 years. The frequency of diagnosing uterine fibroids during pregnancy was especially increased due to a more thorough examination during this period. Recently, with a shift in the age of the mother, they are more likely to experience fibroids and pregnancy after 35.
Varieties of fibroids
The following are distinguished:
- Subserous - a myoma growing outside the uterus, protrudes into the cavity of the abdomen or pelvis. It leads to compression of the bladder and intestines.
- Intramural (intramuscular) is the most common type of fibroid. It is formed in the muscle layer of the uterus. Causes bleeding.
- Submucous (submucosal) grows inside the uterine cavity. It causes prolonged menstruation requiring hospitalization and blood transfusion.
- Interstitial (intramuscular) is localized inside the muscles of the uterus. Causes heavy menstruation.
- Fibroids on the cervix.
Symptoms of uterine fibroids
Uterine fibroids are often asymptomatic. And for the first time, a woman can detect a tumor only by ultrasound.
The most common symptoms for uterine myoma are:
- Heavy menstrual bleeding.
- Pain concentrated mainly in the lower abdomen. They can be different: weak, cramping, cutting, give to the abdominal cavity, bladder, appendages and lower back. The nature and intensity of pain depends on the location of the tumor and its size.
- Painful intercourse.
- Rapid urination.
- Constipation
- Stomach enlargement.
- Fullness in the lower abdomen.
- Recurrent urinary tract infections.
When the first symptoms appear, you should definitely contact your doctor for further examination.
Diagnostics
Myomas are usually detected by chance during a routine gynecological examination, but they may not be noticed. Symptoms may also be mistakenly attributed to other diseases, such as adenomyosis or ovarian cysts. For this reason, if a woman has abnormal bleeding, an ultrasound scan is performed. This is the most informative method for detecting a tumor, its size, location, number of nodes, their condition, the exact location of the foci and structure of the tumors. Ultrasound examination itself is painless and takes several minutes.
There are other methods for diagnosing fibroids:
- tests for microflora, infections, cytology;
- complex hormonal blood test;
- MRI (magnetic resonance imaging) ;
- diagnostic laparoscopy;
- CT scan (computed tomography).
Regardless of the method chosen, as soon as the diagnosis of fibroids has been confirmed, you need to consult your doctor to select the optimal treatment option.
Typically, the size of fibroids during pregnancy is measured in centimeters and weeks, which corresponds to the growth of the fetus during pregnancy:
- Small - up to 2.5 cm. Corresponds to the size of the uterus up to 5 weeks of pregnancy.
- Medium - up to 5 cm. Corresponds to the size of the uterus for 10-12 weeks.
- Large - from 8 cm. Corresponds to the size of the uterus 12-15 weeks.
Possible causes of fibroids. Risk factors
The exact causes of the occurrence and growth of myomas are unknown. They are common in women predominantly over 30 years old, grow at different rates until the onset of menopause, during which they decrease in size.
Age, lifestyle and genetics can play a role in the development of fibroids. There are several known risk factors:
- Family history. If the mother had a fibroid, the risk of its occurrence in the daughter is about 3 times higher than the average.
- Inflammatory diseases.
- Diseases of the mammary glands.
- Trauma to the uterus.
- Lack of thyroid function.
- The first pregnancy and childbirth after 35 years.
- Early onset of menstruation.
- Diabetes.
- Age. The risk of developing fibroids increases in late reproductive age.
- Obesity. The risk of developing fibroids in overweight women is 2-3 times greater than in women with average weight.
- Polycystic ovary syndrome.
- Hypertension.
Treatment
As a rule, if there are no symptoms with myoma, it does not cause any problems and does not increase in size, then treatment is not required.
With minor isolated neoplasms, hormonal drug therapy is used, the purpose of which is to reduce the level of estrogen in the body of a woman. Some hormone treatments can be used to temporarily relieve heavy menstrual bleeding and pain. These treatments can also reduce the size of the fibroids, but the tumor cannot completely disappear. Hormones are usually used for a short time due to the risk of side effects. But as soon as the therapy is over, the fibroid can again begin to increase. Hormone treatment is most often used to reduce fibroids before surgery.
The most extreme treatment option for fibroids is a hysterectomy - a surgical procedure that completely removes the uterus. Although hysterectomy eliminates tumors, symptoms, and the likelihood of relapse, it also prevents any chance of pregnancy.
A procedure similar to a hysterectomy, but eliminating the removal of the uterus, is a myomectomy, an abdominal incision, and surgical removal of the fibroids. The disadvantage of myomectomy is that the risk of fibrotic relapse is high. About 50% of patients require reoperation within five years. Also, after myomectomy, a number of other complications may arise, such as the risk of uterine rupture, as well as the growth of the placenta.
A third method for uterine fibroid embolization is a newer alternative to hysterectomy or myomectomy. This is a minimally invasive procedure used to treat uterine fibroids. During embolization, the myoma under the fluoroscope (real-time x-ray) is filled with blood, which causes it to contract. The reduction process takes from several days to several months. During this time, the tumor shrinks by about 40 to 50%, and the uterus - from about 30 to 40%. Experience and scientific research indicate that symptoms pass through about 80-90% of patients. Uterine embolization does not adversely affect a woman's reproductive system.
Serious complications occur in less than 4% of patients. They are:
- vascular injuries;
- uterine infections;
- ovarian damage;
- bleeding at the puncture site;
- hematomas;
- menopause.
One way or another, most often doctors use wait-and-see tactics if the myoma is small and does not cause any problems. Its growth is determined by the hormone estrogen, therefore, after menopause, when its level decreases, fibroids stabilize or decrease.
Pregnancy planning
Many women, having heard this diagnosis, ask: "Is it possible to get pregnant with a myoma?" In the presence of fibroids, pregnancy is possible, and the chance of having a healthy baby is high. However, when planning, you need to take into account the location, size of nodes and a predisposition to progression.
For the most part, only those fibroids that are adjacent to the uterine cavity affect fertility. Exceptions are large intramuscular fibroids, which block the openings of the fallopian tubes in the uterus, and where multiple fibromas cause abnormal uterine contractions.
If the nodes are small and do not affect the uterus, then the probability of becoming pregnant is high.
If the tumor is large or there are many nodes, there is a risk of limiting uterine distension during pregnancy as the fetus grows, which can provoke a miscarriage and / or premature birth.
Is myoma dangerous during pregnancy?
Most women who have been diagnosed with uterine fibroids during pregnancy do not experience any symptoms. But for about 10-30% of them, fibroids during pregnancy can cause some complications of the course, gestation and delivery. Therefore, if you knew about the presence of fibroids before planning, you need to discuss with your doctor your possible risks.
What is the risk of fibroids during pregnancy?
The most common complications caused by myoma during pregnancy are:
- pelvic presentation;
- premature birth;
- placental abruption;
- placenta previa;
- cesarean section;
- miscarriage;
- weakness of labor ;
- bleeding;
- pain;
- fetal malnutrition.
Symptoms and manifestations of fibroids depend on three main factors: size, quantity and location. Myoma in early pregnancy can in itself lead to a miscarriage. If the tumor size is 3 cm or more, there is a risk of premature birth at a later date due to deformation of the uterus, changes in blood flow and impaired implantation. The closer the fibroid is located to the placenta, the higher the risk of bleeding during early pregnancy.
The growth of fibroids occurs in approximately one third of patients, and it is impossible to predict which fibroids and in which patients will increase. Most often, fibroids in early pregnancy increase. The progression of tumor growth can lead to clinical complications, primarily pain. The pain most often intensifies at the end of the first and second trimesters, since the uterus is intensively stretched during these periods.
The risk of premature birth, violation of the integrity of the membranes of the membranes and placental abruption increase depending on the relationship of fibroids to the placenta. Large fibroids deform the normal contour of the uterus and reduce muscle contractility. If the fibroid is located inside the cavity itself, then this can lead to deformation of the fetus due to a decrease in space. Uterine fibroids during pregnancy can cause weak labor, as a result of which the risk of cesarean section increases. Pelvic presentation of the fetus can be caused by a myoma located in the lower segment of the uterus, which also often leads to cesarean section. Given all the potential risks, fibroids are not treated during pregnancy. Surgical intervention (myomectomy) during pregnancy is contraindicated because of the risk of uterine rupture.
With rare exceptions, myomectomy can be performed in the first and second trimesters of pregnancy due to the following factors:
- persistent severe pain;
- rapid growth of fibroids;
- the size of the fibroids is more than 5 cm, located in the lower segment of the uterus.
Pain associated with myoma, if necessary, as prescribed by a doctor, is stopped by painkillers. Nonsteroidal anti-inflammatory drugs should be used with caution, especially if they are used for more than 2 days in the third trimester, as this is associated with many complications, including oligohydramnios.
Effects
If uterine fibroids cause excessive blood loss during or between periods, a woman may fall hemoglobin and develop anemia. This disease is characterized by shortness of breath, pallor and a feeling of fatigue.
Other complications affect the bladder and intestines. This occurs in cases when the myoma increases so much that it begins to put pressure on the pelvic organs, causing a feeling of heaviness or discomfort, constipation, frequent urination or incontinence.
In addition, fibroids can affect fertility by blocking the fallopian tubes or preventing proper implantation of the placenta into the uterus.
In very rare cases, fibroids can become malignant. This occurs under the influence of the following factors: alcohol, smoking, irregular eating, fast food, obesity, overheating, tanning beds, severe stress, uterine injuries during abortion or other surgical interventions, human papillomavirus, oncogenic type.
Subsequent pregnancies
After surgical removal of small fibroids, there should be no complications in future pregnancy. Due to the large size of the fibroids or the large number of nodes during childbirth, a weakening of labor can occur (violation of the contractile function of the uterus, characterized by weak contractions or their absence). As a result, you will need to have a cesarean section. There is also a risk of premature birth.
After embolization of fibroids, you can start planning pregnancy after 6 months. With surgical intervention - myomectomy - pregnancy is allowed after about 12 months. The term depends on the size and location of the removed myomatous nodes. Sutures after surgery should be consistent and complete. If the uterus was completely removed due to a large tumor or there were several nodes, then it becomes impossible to become pregnant and the woman becomes infertile.
Pregnancy and fibroids: reviews
Women note that myoma is not a sentence at all. Pregnancies with a small number of myomatous nodes, with small tumors are most often asymptomatic. Rarely, when they hurt. Childbirth with myoma also usually goes well. Many patients are given a cesarean section and the tumor is already removed during the operation. If a woman finds out about the presence of fibroids during pregnancy planning, it is better to remove it immediately so that there are no consequences during gestation and delivery. If the fact of the presence of fibroids was discovered by ultrasound or during a gynecological examination already during pregnancy, then, provided that the progression of the tumor is observed and monitored, everything should be successful.
Finally
Myoma is a widespread type of tumor in women and is most often found during pregnancy or a routine examination. In most women with fibroids, the course of the disease is asymptomatic. Uterine fibroids during pregnancy lead to the risk of the following complications: pain, premature birth, placental abruption, bleeding, and an increased risk of cesarean section. Currently, there are several methods of treating fibroids, which are caused by the symptoms of the disease, as well as the characteristics of the myomatous nodes.