Fibroids are benign tumors of the reproductive organs common in women of childbearing age and are the main cause of uterine loss in women. Many patients have various misunderstandings because they do not understand the nature of fibroids and often choose the wrong or inappropriate treatment plan. This article introduces some of the problems we encountered in our clinical work. One of the misconceptions: drug treatment The incidence of fibroids has increased substantially due to subjective and objective reasons. The first thing you should do is to ask your physician for “medicine” to eat. The purpose is clear: the patient wants to “eliminate” the fibroids or make them “shrink”. 1, Chinese medicine: Chinese medicine treatment of fibroids is only symptomatic, that is, it can relieve some symptoms due to fibroids, for excessive menstruation, back pain, etc. It is effective. However, Chinese medicine cannot inhibit the growth of fibroids, at least not yet. As for some proprietary Chinese medicines (X capsule, Y pill, Z agent), I personally have a negative attitude towards these medicines, not only because Chinese medicine treatment is based on “diagnosis and treatment” and individualized prescription, but also because such “one for all” proprietary Chinese medicines are really difficult to understand the mechanism and effects. The mechanism and role of these medicines are difficult to understand. 2, hormones: there are a variety of hormones used in the treatment of uterine fibroids, such as triamcinolone, hibiscus, testosterone, Dafirin, Reynold’s and so on. Hormonal drugs for the treatment of fibroids can be summarized in four sentences: long duration of medication, effective during treatment, side effects throughout the course of medication, and rebound after stopping medication. The idea of hormonal treatment of leiomyosarcoma comes from three sources: absence of leiomyosarcoma before menarche, decreased incidence of leiomyosarcoma with increasing number of pregnancies, and shrinkage of leiomyosarcoma after menopause. These phenomena suggest to us that anti-estrogen and progesterone drugs can suppress myomas. Hormonal treatment of leiomyosarcoma may appear to shrink, but it is not a reduction in the number of leiomyosarcoma cells, but a reduction in the size of the cells, and the cells grow rapidly after stopping the medication, resulting in a “rebound” phenomenon. As an analogy, leiomyosarcoma is like a sponge that absorbs water, and the effect of drugs is only to squeeze out the water and reduce the size. In view of the above treatment effects and results, my view is that hormone drugs can be used for some special patients or special circumstances, such as young and childless, serious symptoms but can not receive surgery in the short term, close to the age of menopause hormone may be able to allow patients to transition to recent menstruation, thus avoiding surgery. 3, personal opinion: there is no drug that can “eliminate” the fibroids, the medication for fibroids is only symptomatic treatment. The second misconception: non-mainstream technology There are some new technologies used in the treatment of leiomyoma, such as “self-coagulation knife (coagulation knife)”, radiofrequency ablation, ultrasound focus. These technologies are “similar” in terms of treatment mechanism, they all produce local high temperature through energy conversion, causing myoma necrosis. The simple understanding is to “burn” the fibroids to death. Since these techniques have a common feature (highlight): no incision! Therefore, it is liked and accepted by some patients. In recent years, the scope of application of these techniques is on the rise, which cannot exclude some commercial hype factors. In fact, these techniques have great limitations of application. Strictly speaking, a reasonable grasp of indications and rational application can allow some patients to obtain good outcomes, otherwise they may bring some treatment complications. Therefore, caution should be exercised in selecting these non-mainstream technologies. Personal views are as follows. 1, why the technology is rarely carried out in some large formal hospitals? I think it is certainly not a problem of investment in equipment, but the key lies in the narrow indications. This is the reason why I call these techniques “non-mainstream techniques”. 2, the myoma is not a square sphere, but an oval, or lobed shape, without a central point. Therefore, when inserting the electrode or designing the focus, it is impossible to reach the ideal center of the circle, so when the treatment starts, the heat will spread from the electrode point to the periphery, and there are only two results: either the fibroid cannot be completely denatured by heat, and the phenomenon of “half-baked” will occur; or the surrounding normal tissues will be damaged, and the heat will spread to the abdominal cavity, which may If the heat spreads to the abdominal cavity, it may damage the bladder or intestines, and if it spreads to the uterine cavity, it may damage the endometrium. Complications of endometrial injury are often seen, with patients experiencing excessive vaginal bleeding, or permanent amenorrhea after treatment. Myth #3: Hysterectomy and hysterectomy Hysterectomy remains the main modality of surgical treatment for uterine fibroids at present. The main advantage of removing the uterus is that there is no future risk of recurrence of fibroids and other uterine diseases, while the disadvantage is the loss of the uterus. The advantage of having a subtotal hysterectomy, i.e., preserving the cervix, is that the integrity of the pelvic floor structure is maintained; the disadvantage is the loss of the uterus and the risk of residual cervical disease (mainly cervical cancer). The following situations are often encountered in our clinical work. 1. Some patients believe that removal of the uterus is equivalent to “sex change”, or that it will immediately “age”. This view is wrong. Removal of the uterus does not cause “sex change” and “aging”. It is the ovaries, not the uterus, that are closely related to sex change or aging. Of course, there is one phenomenon that should be recognized: some data suggest that women may enter menopause 1-2 years earlier after hysterectomy than normal women, suggesting that hysterectomy has some effect on ovarian function. In fact, this is quite understandable, as the ovaries and the uterus are grown in the same system and are “blood-linked”. When the uterus is removed, the ovaries are naturally in a “lip-lock” situation, and it is possible that their function is affected. We have recently studied this clinical phenomenon and indeed found that hysterectomy has an effect on the ovarian reserve function of the patient. 2. Patients with preserved cervix often believe that they will not have gynecological diseases anymore and tend to ignore the risk of residual cervical disease, which mainly refers to cervical cancer but also includes other types of cervical diseases such as cervicitis. The incidence of residual cervical disease is basically the same as that of the normal cervix. Therefore, postoperative cervical screening is required to be done routinely and at least once a year for gynecological examination. 3. Personal opinion is to preserve the uterus as much as possible. There are many advantages of preserving the uterus, despite the risk of uterine disease. However, I think it is a very incomprehensible and unacceptable choice if the uterus is surgically removed only to prevent future uterine disease. Two typical events in the history of medicine are the “appendectomy” and the “tonsillectomy”. In the 1950s and 1960s, many people had their good appendixes removed to prevent future “appendicitis”, and similarly, children’s tonsils were removed to prevent recurrent tonsillitis. Both of these are typical cases where surgery was used to prevent the disease. Nowadays, of course, there is no such option. In fact, is it not a “repeat” to remove the uterus in order to prevent future uterine diseases, especially cervical cancer? Myth 4: Myoma growth characteristics The growth of uterine fibroids has some characteristics, such as the size, location and number of fibroids. These characteristics vary from person to person, and are directly related to the fate of fibroids and the choice of treatment options. 1, myoma size: the size of myoma is easy to understand, the bigger the symptoms the more serious, more than 5cm may need surgery. However, the growth rate of myoma has a certain regularity. We found in our clinical follow-up work that there are time periods for myoma growth. In some patients, the fibroids may not grow for a long period of time (months or even years) after they are found, or they may not grow significantly, but once they start to grow, they grow very fast, often reaching the standard for surgery within a few months. This is the temporal nature of the growth of fibroids. There are also some patterns in this temporality, women tend to find fibroids around the age of 35 and grow rapidly around the age of 45. This is why there is a clinical phenomenon of “myoma at 35 years old and myoma at 45 years old”. 2, myoma location: the location of the myoma and the patient’s clinical symptoms have a close relationship, some people myoma is very large, but no symptoms; some people myoma is very small, but the symptoms are very serious. Clinically, leiomyomas are classified according to their location: subplasma leiomyoma, interstitial leiomyoma, submucosal leiomyoma, and leiomyoma of special sites (broad ligament leiomyoma, cervical leiomyoma). Subplasmacytoma is a myoma that grows in the direction of the abdominal cavity and can be asymptomatic even though it is large. Submucosal fibroids are fibroids that grow into the uterine cavity, even if they are small, but can cause severe menorrhagia. This is like a grain of sands falling into your eye, which can be very uncomfortable, and the back of your hand, which may be unconscious. In addition, special sites of leiomyosarcoma should also be taken seriously. Surgery for leiomyosarcoma in this location is very difficult because of the complex local anatomy and the tendency to damage large blood vessels and ureters during surgery. In particular, patients who need to choose minimally invasive surgery (laparoscopy) to preserve the uterus should advance in choosing the surgery time once they are diagnosed with fibroids in special locations. 3, the number of fibroids: most fibroids are multiple, and 70% of patients with one fibroid are found to have a second, or over multiple fibroids. Therefore, do not feel “lucky” because the clinical diagnosis is single, and “painful” because of multiple. This is mainly related to the method of examination, generally the limit of ultrasonography commonly used for the diagnosis of leiomyosarcoma is 2 cm; CT or MR techniques can detect leiomyosarcoma of 1 cm; therefore, different methods of examination may result in different numbers of leiomyosarcoma. 70% of multiple cases are based on pathological diagnosis (microscopy). Therefore, we usually call the large ones “dominant myomas”. 4. Personal opinion: patients with leiomyosarcoma should be concerned not only about the size of the leiomyosarcoma, but also about the number and location of the leiomyosarcoma. These indicators can guide the choice of treatment plan. Most patients with fibroids know that fibroids can shrink after menopause, so “hoping for menopause” has become a “thought” in the patient’s mind. With this “thought”, the patient enters a long follow-up period. The reason is that myomas are sex hormone (estrogen and progesterone) growth-dependent tumors, and after menopause, the estrogen and progesterone in women’s body decreases, so the growth of myomas is inhibited. 1, menopausal fibroid changes: after menopause most fibroids growth is inhibited, but some patients with blood fibroids not only do not shrink but grow, some patients appear more serious symptoms (heavy bleeding). The reason for this is not very clear, but it may be related to sex hormone disorders during menopause. At the beginning of menopause, the secretion of follicle-stimulating hormone (FSH) from the pituitary gland will continue to rise for a period of time, and the continued high level of FSH may drive the ovarian secretion of sex hormone depletion to rise, thus promoting the growth of fibroids and uterine bleeding. Therefore, patients with fibroids should not only relax their vigilance after menopause; on the contrary, they should increase the number of follow-up visits appropriately and pay close attention to the final dynamics of the fibroids until they shrink, which may take several years. In addition, the growth of fibroids after menopause is a bad sign and often requires surgical treatment. 2. Postponement of menopause: The general age of menopause for women is 50 years old, which is an average concept, not every woman is 50 years old to the point of menopause. Some people can go to 55 years old or even older. This is a very interesting phenomenon, myoma patients often menopause more than 50 years old. Some patients are diagnosed with leiomyosarcoma at the age of 40 or even earlier, and during the long follow-up process, some psychological changes may occur under the influence of the psychology of “looking forward to menopause”, which we call “leiomyosarcoma psychology”. It is a very complex psychological reaction. Some patients show myoma sensitivity, gynecological disease sensitivity and disease sensitivity. When she hears or sees some relevant information (colleagues talking, neighbors chatting, media reports, etc.), she will associate it with her “fibroids” and “get emotional” and “think about it”. Tomorrow she will go to the hospital for a follow-up visit and be concerned about her “fibroids”, even if they were repeated just before today. Some patients have the opposite psychological phenomenon, and because of the “thought” of “menopause”, they “carry on” despite the aggravation of fibroid symptoms (such as excessive menstruation), thus leading to severe This leads to severe anemia and even more serious “secondary harm” to the organism. 4, personal opinion: myoma patients should correctly treat the “post-menopausal myoma shrinkage” viewpoint, in the follow-up process to accept the advice of physicians, in accordance with the principles and indications of myoma treatment reasonable disposal of myoma, not blindly listen to bias. Myth No. 6: Myoma malignancy 1, uterine fibroids are rarely malignant, the malignancy rate is less than 1%, which is a small probability event. Nevertheless, malignancy is always a major concern for patients, as it is a “life and death” event. In leiomyosarcoma clinics, patients often ask, “Will my leiomyosarcoma become malignant?” It is very difficult for physicians to give an accurate and satisfactory answer to patients. First of all, the probability of leiomyosarcoma malignancy is a statistical concept based on the population; it is not a 1% rate for a particular patient, she is either not malignant or 100% malignant, which are the only two possibilities. So you cannot accurately tell a patient that you will not or will not have malignancy. Secondly, there are no warning signs before a fibroid becomes malignant and you will not be told in advance to “get an operation or it will become malignant”. The following information is considered as malignancy-related factors, which can help patients to make treatment choices. 2. Factors associated with myoma malignancy: a) myoma with diameter greater than 10cm, submucosal myoma; b) rapid growth of myoma within a short period of time; c) significant growth of myoma after menopause; d) lobulated growth, heterogeneous myoma (liquefaction); e) elevated tumor-related indicators (CA125, etc.). The above factors and indicators are considered to be indicators of malignant transformation associated with leiomyosarcoma. Patients with malignant change-related factors should consider early surgical treatment to avoid encountering small probability malignant events. 3.Personal opinion: the event of malignant change of leiomyosarcoma should be treated scientifically, not too “worried”, but must be “concerned”. Myth No. 7: Infertility 1, due to the general increase in the reproductive age of modern women, some patients postpone the age of childbirth to more than 30 years old, or even greater. The number of patients with fibroids before giving birth is high. As a result, the issue of the impact of fibroids on pregnancy has attracted attention. 2. In most cases, fibroids do not affect pregnancy and do not lead to effects on the fetus, such as miscarriage and malformation; conversely, in most cases, pregnancy does not cause significant changes in fibroids, such as enlargement and degeneration. 3. Only in the following 3 cases, myoma treatment is considered to be performed first to clarify that infertility and miscarriage are caused by myoma.