1.What are the causes of uterine fibroids?
The exact cause of uterine fibroids is still unclear, but it is clinically clear that fibroids are a hormone-dependent disease, closely related to estrogen and progesterone. In general, fibroids in postmenopausal women will shrink with the decline of hormone levels. In addition, women with a family history of uterine fibroids are also high risk factors for developing fibroids.
2.What are the treatment methods for fibroids?
The most effective treatment for uterine fibroids is surgery. There are also many Chinese herbal medicines used to treat uterine fibroids clinically, but they are not effective. There is a class of western medicine called gonadotropin-releasing hormone agonist (GnRH-a) that can be used to treat fibroids, which can effectively reduce fibroids, but it is expensive and can cause side effects such as menopausal symptoms, and the fibroids will continue to grow after stopping the medicine, so it is less clinically used. Surgical treatment methods are mainly divided into myomectomy with uterus preservation and hysterectomy without uterus preservation, which is mostly performed by minimally invasive laparoscopic surgery.
3.Uterine fibroids need treatment under what circumstances?
The incidence of uterine fibroids is high, and it is estimated that 20% to 25% of women between the ages of 35 and 50 have fibroids, but not all patients need surgery. However, not all patients need surgery. Generally, you need to consult your doctor for surgery only if one of the following conditions occurs
(1) Uterine fibroids that cause increased menstrual flow or even secondary anemia.
(2) Uterine fibroids that are large and grow on the anterior wall of the uterus and cause urinary symptoms such as frequent and urgent urination due to pressure on the bladder.
(3) The fibroids are large and grow on the posterior wall of the uterus, causing constipation or difficulty in defecation due to pressure on the rectum.
(4) Uterine fibroids grow rapidly in a short period of time and cancer is suspected.
(5) Uterine fibroids are very large and usually the uterus is enlarged beyond 12 weeks of pregnancy, which needs to be treated.
(6) Those who have a history of infertility, miscarriage or premature delivery and other bad pregnancies, suspected to be caused by fibroids.
4.What kind of surgery is chosen to treat fibroids?
(1) Should I choose open surgery or laparoscopic surgery?
At present, laparoscopic surgery is mostly used for the treatment of uterine fibroids, but for those whose fibroids are too large (more than 10 cm) or who have a history of previous surgery and are considered to have heavy pelvic and abdominal adhesions, general laparoscopic surgery cannot be completed and open surgery is required. In addition, for those who have multiple fibroids (ultrasound suggests more than 5 fibroids) and require preservation of the uterus, open myomectomy is usually chosen to reduce the risk of recurrence soon after surgery due to unclean fibroids. This is because the laparoscopic procedure lacks the tactile sensation to detect small fibroids in the deeper parts of the uterus.
(2) Under what circumstances can the uterus be preserved?
In general, the uterus can be preserved in patients with single fibroids and a normal cervix. For multiple fibroids, the uterus can be preserved if the cervix is not cancerous, but the chance of recurrence of fibroids after surgery is high, with a recurrence rate of about 25%-35% reported in the literature. For patients with intraepithelial neoplasia in the cervix and without fertility requirements, total hysterectomy is recommended. For patients who do not preserve the uterus, the decision of whether to preserve the cervix or not is mainly based on whether there are lesions in the cervix. Those who have precancerous lesions or frequent intercourse bleeding for fear of cancer are recommended not to preserve the cervix.
For patients with no cervical lesions and those who are not too old to have normal sexual needs, it is recommended to preserve the cervix to reduce the damage to the normal supporting structures of the pelvic floor. The main advantage of hysterectomy with preservation of the cervix, called subtotal hysterectomy, is that it preserves the normal anatomy of the tip of the vagina and does not affect sexual life, whereas the length of the vagina is slightly shortened in those with total hysterectomy (including the cervix), and psychologically, it may have an impact on the sexual life of the couple, depending on the psychological state of each individual.
(3) What is the difference between open and laparoscopic surgery?
The main difference between open surgery and laparoscopic surgery is the size of the abdominal wound, which is larger in open surgery. Laparoscopic technology is a surgical method that has become popular in the past 20 years. It is a surgical method to remove fibroids through special surgical instruments by making 3 to 4 incisions of 0.5 to 2 cm in diameter on the abdominal wall, which is popular among patients because of fast recovery and small scars left on the abdominal wall after surgery. Some people may ask, “How to take out the fibroids if they are so big? Now there is an instrument called myoma crusher, which can crush the fibroids and remove them from the small hole. Laparoscopic surgery has become a major treatment modality for uterine fibroids nowadays because of the light pain and quick recovery after surgery, and therefore it has gained popularity among patients.
(4) How are submucosal fibroids treated?
Submucosal fibroids, i.e. fibroids inside the uterine cavity, are mainly removed by hysteroscopic surgery, but the larger ones (≥5cm) cannot be completed by hysteroscopic surgery, mainly because of their small electrodes, which make removal of large fibroids difficult, time-consuming and complications, so it is still necessary to enter the abdominal cavity to cut open the uterine muscle wall for removal.
5.How to treat fibroids in young women who have not had children?
For young women who have not had children, there is no unified understanding of how large the fibroids should be considered for surgery if they have the requirement to have children, but personally I think that for interstitial fibroids ≥5cm, surgery is recommended before pregnancy, but for subplasma fibroids, surgery is not recommended, while for fibroids in the horn of the uterus, lower uterine segment, cervix or submucosa, even if they are <5cm, surgery should be performed before pregnancy. . The main concern during pregnancy is the red degeneration that occurs during pregnancy and causes pain and miscarriage during pregnancy, but the chances are small and a number of people can have pregnancy with tumors. The fibroids may grow in size during pregnancy.
If there is no need to have children, small asymptomatic fibroids may not need to be treated at all, as they have little chance of becoming malignant. My opinion is that surgery should not be done because of the risk of surgery and because after myomectomy, more serious adhesions often occur, such as adhesions to the bladder, intestines and pelvic wall, which may or may not produce symptoms of abdominal pain, but have a greater impact on secondary surgery. laparoscopic surgery to manage them.
Therefore, if it is possible not to perform surgery, do not do surgery, if you want to operate, it is possible to solve the problem at once as much as possible at once surgery.
6.Does the removal of the uterus lead to aging?
The youthfulness of women is maintained by female hormones, mainly estrogen, which is secreted by the ovaries and has nothing to do with the uterus. The uterus has two roles, one is to give birth to children, and the other is to have menstruation. The uterus has nothing to do with aging.
7.Do I need to pay attention to anything after fibroid surgery?
If the fibroids are not large and not deep, the contraceptive time can be shorter, about 3 months to 6 months to get pregnant; however, if the fibroids are large and deep, the contraceptive time is longer, usually 1 to 2 years before pregnancy, so that the uterus does not rupture during pregnancy. The uterus should not rupture during pregnancy.
In addition, there is a risk of uterine rupture during pregnancy if the uterus is scarred after myoma surgery, although it is not significant, it is still worth being alert. Once abdominal pain is detected during the pregnancy, go to the hospital in time. There is no special emphasis on diet after surgery. The etiology of uterine fibroids is unclear, and there is no method to prevent the recurrence of fibroids.
8.Is there a high chance of fibroids becoming cancerous?
The chance of malignant transformation of uterine fibroids (i.e. sarcoma transformation) is not high, and the chance is about 0.4-0.8%.
(1) The recent increase of myoma is obvious, especially for postmenopausal women should pay more attention;
②Ultrasound suggests that the myoma is rich in blood flow;
(3) Elevated blood LDH.
9.Is there any way to prevent fibroids?
Because fibroids are a hormone-dependent disease, for patients after myomectomy, to reduce the chance of recurrence after surgery, try to avoid using contraceptives, avoid food or nutrition containing sex hormones, and consume less soy products such as soy milk. In particular, health supplements promoted in the market to maintain youthful and young appearance mostly contain estrogen, so try not to take them.
Some drugs, such as GnRH-a, progesterone and mifepristone, can reduce the size of fibroids before surgery and facilitate the surgery, but they will increase in size after stopping the drugs, so conventional treatment is not recommended. However, there is no clear evidence that they are effective.