(I) Basic concepts about uterine fibroids
Moderator: What is the prevalence of uterine fibroids? Why is it called the “number one tumor” in gynecology?
Chen Chunlin: There is no uniform data on the prevalence of uterine fibroids internationally. However, in autopsies, 20% of women over 30 years of age have fibroids. In recent years, with the popularization of ultrasound, color ultrasound and other advanced equipment, scholars at home and abroad believe that the figure of 20% is more realistic, that is to say, one in five women over 30 years old has uterine fibroids, so it is not too much to call uterine fibroids “the first tumor of gynecology”.
Moderator: What kind of people are prone to uterine fibroids?
Chen Chunlin: After a lot of research, it is believed that the cause of uterine fibroids is still the elevated estrogen and the high utilization of estrogen by the body. There are many kinds of hormones in the human body, and estrogen and progesterone are the main hormones in women. When estrogen secretion is too high, it will lead to a series of diseases, one of which is uterine fibroids.
For the high prevalence group is divided into five categories.
The first group is those who are affected by genetic factors, which are manifested in racial differences and family aggregation. For example, the incidence of the disease is 2 to 3 times higher in blacks than in whites or Asians, and also in people whose immediate family members or sisters have had fibroids, the chance of having the disease is 4.2 times higher than in those without a family history of the disease.
The second category is people who have factors that cause ovarian hyperfunction, such as polycystic ovary syndrome; and diseases with ovarian endocrine function, such as granulosa cell tumor and ovarian granulosa cell tumor, which can lead to fibroids.
The third category is related to the number of births, and the incidence of uterine fibroids is inversely proportional to the number of births. Nowadays, women in their 70s have had at least four children in their lifetime, which explains why women rarely suffered from this disease in the past. This is because the ovaries do not ovulate and hormone production is at a low level during this time, which protects the health of the uterus. If you have four children, you have five years of low estrogen levels, and the human reproductive cycle is between 15 and 45 years old, which protects the uterus during the high incidence of uterine fibroids.
The fourth category is influenced by the body type. Why eating the same food, or why a sister is sick and she is not, it is all related to the individual’s constitution. Because hormone action needs receptors, some people have more sensitive receptors, easy to be affected by hormones, then relatively easy to suffer from fibroids.
The fifth category is related to life. First is the obesity factor, research shows that for every 10 kg increase in weight, the risk of fibroids increases by 21%, because the obese physique is more likely to synthesize estrogen.
The next factor is exercise. According to statistics, college students who are not athletes are 1.4 times more likely to develop fibroids than those who exercise regularly, and exercise makes the prevalence less likely.
In addition, women who smoke are not prone to fibroids because cigarettes have substances that antagonize estrogen, but because of this, women who smoke regularly are also prone to aging, and estrogen cannot be too much or too little in the body.
Finally, do not abuse birth control pills. Excessive use of birth control pills increases estrogen in the body, which can easily lead to fibroids.
Moderator: What are the characteristics of the current incidence?
Chen Chunlin: The incidence of uterine fibroids has two characteristics: one is a significantly higher incidence, and the other is a significantly younger age.
Why is the incidence of uterine fibroids significantly higher now?
This is because there are several reasons: ① the average life expectancy of people is longer; ② the detection technology is more advanced, so it is easy to detect fibroids with ultrasound; ③ modern people have fewer births and breastfeeding; ④ the content of estrogen in the environment has increased, that is, there is estrogen pollution.
Why is there a significant rejuvenation of fibroids?
The trend towards younger fibroids is also particularly evident. In the past, there was a traditional age distribution of fibroids patients, with the prevalence rate of 50% between 41 and 50 years old, 28% between 31 and 40 years old, less between 21 and 30 years old, and very few below 20 and above 60 years old. Now, although there is no exact statistical data, but in the clinic do see patients younger trend is obvious, some people just married, then check out the uterine fibroids, this is due to: First, the girls now develop early, before the girls 16, seven years old before the first menstruation, but now eleven years old also menstruation; Second, the dietary factors, now our daily life of the main food: chicken, duck, fish, etc. growth cycle The growth cycle of the main foods in our daily life: chicken, duck, fish, etc. is significantly shorter, mainly fed with hormone added feed, and our daily consumption of these foods is equivalent to taking a small amount of estrogen for a long time, which leads to a series of diseases, including the high incidence of hormone-dependent diseases such as uterine fibroids.
Moderator: How old is the youngest patient with uterine fibroids in the literature or that you have diagnosed?
Chen Chunlin: In foreign countries, patients with uterine fibroids can be as young as 10-14 years old, and the youngest in China is 15 years old, while the youngest I have diagnosed clinically is 19 years old. This onset is related to familial nature, but in terms of diet, she especially likes to eat fatty meat and meat products, which should be one of the important triggers for the onset.
(2) Diagnosis of uterine fibroids
Moderator: What are the symptoms of uterine fibroids?
Chen Chunlin: There are several main symptoms, and the common symptoms are.
(1) Menstrual disorders. (1) Menstrual disorder. This is manifested by unrestrained menstrual cycle, but prolonged periods or increased menstrual flow. For example, interstitial fibroids may cause increased menstrual flow; submucosal fibroids may cause prolonged menstruation and constant vaginal bleeding; and subplasmal fibroids may cause less menstrual symptoms.
(2) Causes mass and pressure symptoms. If the fibroid grows to a certain extent, it will cause compression symptoms. If it presses on the bladder, it will cause urinary symptoms such as frequent urination, urgent urination and increased nocturia; if it presses on the rectum, it will cause constipation, or a feeling of bowel movement without defecation; if the fibroid grows to one side and presses on the sciatic nerve on one side, the patient will experience numbness and pain in the lower limbs.
(3) Increased vaginal discharge. If the fibroids are not large and not many, it will show as increased leucorrhea more after the end of menstruation.
(4) The appearance of abdominal pain. Abdominal pain may occur if the fibroid is degenerated, or if the fibroid has a twisted tip.
(5) Secondary anemia. Due to increased menstrual flow, patients are prone to anemia, mostly moderate but also severe anemia.
(6) Causes infertility. There are two types of infertility: the first is the inability to conceive, and the second is the failure of the embryo to settle after pregnancy, resulting in miscarriage.
There are also rare symptoms, such as erythrocyte hyperplasia, which occasionally occurs in some patients; hyperglycemia or hypoglycemia, which is restored after the fibroids are removed because the fibroids promote the secretion of hormones that affect blood sugar; and hypertension, which has many causes, but can be improved after the fibroids are removed.
Moderator: How can you detect fibroids early?
Chen Chunlin: The most important thing is that individuals should be aware of health care, for example, after the age of 20, they should have some basic knowledge and pay attention to some symptoms such as increased menstrual flow, increased nocturnal urination, or enlarged abdomen, so they should be alert to whether they are suffering from fibroids. In 2003, I met a college student who had an enlarged abdomen for more than a year and thought it was due to obesity, so she kept dieting and taking diet pills, but her abdomen got bigger and bigger, and when she went to the hospital, it was found to be a huge fibroid. In addition, it is best for married women to go to the hospital for gynecological examination once a year for early detection and early treatment.
Moderator: What types of fibroids are there?
Chen Chunlin: There are many ways to classify uterine fibroids, there are three types of classification, the first is according to the growth in the uterus, divided into uterine body fibroids and cervical fibroids, of which uterine body fibroids account for 90%. The second is based on the number of fibroids, single growths are solitary fibroids and more than two are multiple fibroids. The third type is based on the growth site of fibroids at the base, which is also the most common method, and is divided into interstitial fibroids, which account for 60-70%, subplasmic fibroids, which account for 20%, and submucosal fibroids, which account for 10-15%.
Moderator: How to diagnose uterine fibroids in clinical practice?
Chunlin Chen: The first step is clinical symptoms. The initial diagnosis is based on the clinical symptoms asked to the patient, such as menstruation (including menstrual cycle, period, and whether there is an increase in menstrual flow), constipation, infertility, excessive leucorrhea, and other symptoms.
The doctor will then perform a gynecological examination. An experienced doctor will be able to determine the possibility of fibroids by palpating the enlarged uterus and nodules on the uterus.
Thirdly, the doctor will conduct auxiliary examinations, usually using B-ultrasound to determine whether there are fibroids and the location of the fibroids; if there are doubts about the B-ultrasound results, the doctor can choose color ultrasound and preferably MRI to confirm the diagnosis, because MRI can clearly check the location and size of the tumor, the relationship with the endometrium and whether it will affect pregnancy.
Moderator: Can uterine fibroids become malignant? How high is the rate of malignancy?
Chen Chunlin: The majority of uterine fibroids are benign tumors, and the malignancy rate is about 0.13~2.02%. First of all, it depends on the age. The age of malignancy in foreign countries is 50~56 years old, while in China it is 44.5~54 years old.
The second thing to look at is the rate of growth of fibroids. Uterine fibroids generally grow at a rate of 1~2mm per year. If they grow particularly fast in a short period of time, for example, from 3cm to 8cm, then malignancy is highly suspected.
Thirdly, if the clinical symptoms change significantly, then we should also be careful of malignant change, which requires timely visit to the hospital for MRI and diagnostic scraping, which can help determine the nature of the tumor, and if necessary, puncture biopsy to clarify the diagnosis.
Moderator: We are very grateful to have Prof. Chen Chunlin as our guest. As the incidence of uterine fibroids is getting younger, young women, especially post-80s women, should pay more attention to uterine health and prevent it early.