Uterine fibroids, short for uterine smooth muscle tumors, are the most common benign tumors in women of childbearing age and have become the “number one tumor” in gynecology. Uterine fibroids are the most common benign tumors of the female reproductive system, with an incidence of 25-30% in women over 35 years of age. According to the relationship between fibroids and the uterine wall, they can be divided into: subplasmic fibroids (20%-30%), submucosal fibroids (10%-15%), and interstitial fibroids (60%-70%). The common symptoms are frequent menstruation, excessive menstruation and prolonged menstrual period, which lead to secondary anemia and decrease in physical fitness of patients. It can lead to infertility or miscarriage, and the literature reports that 20-40% of patients with fibroids are infertile. Most leiomyosarcomas do not cause pain, but severe acute pain occurs with torsion of subplasmic leiomyosarcomas that grow with a tip, and submucosal leiomyosarcomas can stimulate spasmodic pain induced by contractions. The tumor exits the uterus and hangs in the vagina while the tip remains in the body of the uterus, making it very easy to form an endometrium. Some patients may experience dysmenorrhea and some patients may experience lumbosacral pain. It can cause obstructive obstructed labor during pregnancy and delivery, which brings much pain and danger to mother and child.
Diagnosis: The diagnosis of uterine fibroids is not difficult. The diagnosis can be made or suggested by the increased menstrual flow and the enlarged uterus during gynecological examination, combined with ultrasound, scraping, hysteroscopy, CT, MRI, etc.
Treatment: Although there are more treatment methods for uterine fibroids, it is not easy to make the right choice. The choice of treatment options should be based on the patient’s age, symptoms, fertility status and desire to preserve fertility, the size and location of the tumor, and general condition. Below we introduce the advantages and disadvantages of various treatments for uterine fibroids, which you can use as a reference to make a choice.
1.Surgical treatment: surgical removal of uterus or myoma excision. This treatment method requires open abdomen, is traumatic, has many complications and slow recovery. Some patients also have to remove the uterus or ovaries, losing their physiological functions leading to a decrease in the quality of survival, shortening the vagina and sexual life may be affected. Laparoscopic myomectomy or myomectomy, on the other hand, preserves the uterus, does not affect ovarian function, and allows for the chance of pregnancy. However, for multiple fibroids that are difficult to remove completely and are more likely to recur, there is a risk of uterine rupture during postoperative pregnancy and delivery.
2.Medication: The use of female hormone suppressing agents such as androgen, mifepristone and GnRH-A can shrink fibroids and normalize menstruation. However, after discontinuation of the drug, the fibroids recur and increase in size, and menstruation reappears at a disrupted rate, which is unsatisfactory and unstable. In addition, long-term use of sex hormone inhibitors may produce menopausal symptoms such as hot flashes, impatience, amenorrhea, and osteoporosis.
3.Uterine artery embolization: Embolization of the blood supplying artery of the fibroid, causing complete necrosis of the fibroid. It can be applied to all types and sizes of fibroids except for individual types of fibroids (subplasmaline fibroids with thin tissues, broad ligament fibroids and free fibroids). Its advantages are: less trauma, low recurrence rate, less complications, preservation of uterus and normal fertility, fast recovery, and no influence on other treatments after treatment.
4.Ultrasound Focused Knife: It causes necrosis of fibroid cells through the instantaneous high heat effect produced by ultrasound focus. This method is also a kind of minimally invasive therapy, but its treatment is incomplete and easy to damage the surrounding normal tissues.
5.Radiofrequency ablation: The treatment mechanism is to make the local tissue ions move at high speed through the high frequency electricity issued by the frequency oscillation current. Generate biological hyperthermia effect, and make the lesion tissue necrosis. This method has the advantages of being simple and minimally invasive, but the treatment is incomplete and excessive, and also affects the compliance of the uterus after treatment due to the formation of scar tissue.
If you learn that you have fibroids, further treatment is needed if conservative treatment has not worked and there is a tendency for them to increase in size. If you are older, have significant symptoms, and do not wish to preserve your uterus, you may opt for surgical removal treatment. If you are interested in preserving your uterus and fertility and are afraid of surgery, you can choose the minimally invasive treatment method, uterine artery embolization, which we will introduce to you here.
Uterine artery embolization refers to selective insertion of the catheter into the uterine artery under the guidance of medical imaging equipment to embolize the blood supplying artery of the fibroid, which causes ischemia and necrosis of the fibroid, resulting in the shrinkage and disappearance of the fibroid, thus achieving the treatment purpose.
1.Changes of myoma after uterine artery embolization: Both uterus and myoma are in a state of acute ischemia, but later they have distinctly different pathological changes. The myoma tissue is necrotic due to continuous ischemia, firstly, the superficial layer of active growth is necrotic, and then the necrosis gradually develops inward, and finally the myoma tissue is completely necrotic, which is absorbed by the body and discharged, while the submucosal myoma can be discharged through the vagina. The opposite is true for the normal tissue of the uterus. The distal vessels of the uterus are richly supplied with communicating arteries, which are not open under normal conditions, but after embolization these communicating arteries are open and can obtain a small amount of blood through the ovarian artery and the internal pubic artery, which is sufficient to maintain the uterus. By these two opposite pathological changes, the purpose of treating the myoma and preserving the uterus at the same time is achieved.
2. Indications for uterine artery embolization therapy: uterine artery embolization therapy is suitable for all types and sizes of fibroids (except for subplasmic fibroids with tip growth), for huge and multiple fibroids, for fibroids that recur after surgery, and for fibroids for which other methods of treatment are ineffective, and is the treatment of choice for patients who require preservation of the uterus and reproductive function. Interventional treatment of uterine fibroids has the following advantages.
(1) The use of arterial cannula for drug injection, with minimal surgical trauma.
(2) Avoiding removal of the uterus and preserving the reproductive function and secondary female sex characteristics.
(3) Less pain, fewer side effects, faster recovery and shorter hospital stay (5-6 days).
(4) simpler and cheaper than traditional surgical treatment, without blood transfusion
(5) Significantly higher pregnancy rate after treatment.
(6) A series of symptoms are obviously improved or disappeared after treatment.
3, the efficacy of uterine artery embolization: we have used postoperative follow-up, imaging examination, confirmed that 90% of the patients’ symptoms significantly improved or disappeared, imaging examination found that the myoma significantly reduced or disappeared, and the recurrence rate is very low.
Uterine artery embolization, which has achieved satisfactory results, has relieved the majority of patients with fibroids, and there have been no cases of recurrence, and many patients who have not had children have successfully become pregnant after treatment. In addition to treating fibroids and adenomyosis, interventional therapy is also a good treatment for other gynecological diseases, such as infusion chemotherapy with embolization for gynecological malignancies (including endometrial cancer, cervical cancer and malignant trophoblastic tumor), interventional tubal revascularization for infertility, interventional ectopic pregnancy (ectopic pregnancy) inactivation, embolization of uterine artery for a variety of obstetrical and gynecological bleeding such as postpartum hemorrhage, gynecological tumor hemorrhage, traumatic pregnancy, and gynecological tumor hemorrhage. Gynecologic tumor bleeding, traumatic bleeding, etc.