Uterine fibroids are the most common benign tumors in the female reproductive system, commonly found in women aged 30-50 years. In the early years, foreign literature reported that about 20% of women ≥30 years old suffered from uterine fibroids, while the increasing prevalence has been evident in recent years in domestic clinical work. Many patients have the presence of fibroids found by ultrasound during pregnancy preparation, and sometimes doctors suggest to observe and wait without treatment, do you have a trace of nervousness and doubt in your mind? What kind of tumor is fibroid? Do they need to be treated during pregnancy preparation? Here is a brief introduction of the disease.
Factors associated with the onset of the disease
Uterine fibroids are highly estrogen-sensitive, which is why they tend to occur in childbearing age, but are rare before puberty and shrink or recede after menopause.
Classification
1. Subplasma fibroids: about 20% of fibroids grow towards the plasma surface of the uterus (outside) and protrude from the surface of the uterus. If it continues to grow outward and has only a tip attached to the uterus, it is called leiomyoma with a tip.
2.Interstitial myoma: 60%-70% of them are located between the uterine wall and surrounded by the muscle layer.
Submucosal fibroids: 10%-15% of the fibroids grow in the direction of the uterine cavity and protrude from the uterine cavity. If it grows like a foreign body in the uterine cavity, it often causes contraction of the uterus.
Symptoms
1.Increased menstrual flow and prolonged menstrual period.
2.Increased leucorrhea.
3, pressure symptoms: pressure on the bladder – urinary frequency and urgency; cervical fibroids – difficulty in urination, urinary retention; posterior uterine wall fibroids – lower abdominal cramping and discomfort, constipation, etc.
4. Others: including lower abdominal cramping, back pain, aggravated during menstruation. Huge fibroids may also be palpable from the abdomen or prolapse outside the vagina.
Diagnosis
Diagnosis is confirmed based on medical history and signs, and then combined with auxiliary examinations.
1.B ultrasound (vaginal ultrasound, 3D ultrasound of uterus + adnexa): the most commonly used ancillary test to assess the size, number and location of fibroids.
2.MRI: It is more suitable to evaluate the distribution of fibroids and the prominence of submucosal fibroids.
3.Hysterosalpingogram: mainly used to assess whether the endometrium is damaged.
4.Hysteroscopy and laparoscopy, if needed, to assist in diagnosis and treatment.
Treatment for those who are preparing for pregnancy
Treatment is closely related to the location, size, nature and symptoms of fibroids. Generally, subplasmalemmal fibroids do not affect pregnancy and delivery; oversized interstitial fibroids may deform the uterine cavity or cause miscarriage due to insufficient endometrial blood supply; submucosal fibroids may affect the fertilized egg implantation and lead to infertility or miscarriage; low growth position of fibroids may cause abnormalities during late pregnancy and delivery. Therefore.
Surgical removal of submucosal leiomyoma/interstitial myoma protruding into the uterine cavity/diameter >5 cm is advisable. After surgery, young women with good ovarian reserve function should preferably prepare for pregnancy after 1 year, as surgery may affect ovarian reserve function and increase the risk of uterine rupture. In advanced age, with reduced ovarian reserve and combined with myomas (myomas that significantly interfere with implantation or continued pregnancy), IVF is recommended, with embryo freezing and 1 year of rest after surgical removal of myomas, followed by resuscitation and transfer of embryos.
Those who are not eligible for surgical treatment do not need special treatment and can continue to prepare for pregnancy. Regular observation of the growth of fibroids and attention to the presence of symptoms is sufficient and will not affect the pregnancy outcome.