I. What is uterine fibroid?
It is also known as uterine smooth muscle tumor, which is the most common benign tumor of female genitalia.
According to the different parts of the uterus where the fibroids are located, they are divided into the following categories.
1.Interstitial fibroids are located in the muscle wall and surrounded by the muscle layer, so they are the most common type of fibroids when they first develop, accounting for about 60-70%.
2.Subplasma leiomyosarcoma develops towards the plasma membrane and protrudes from the surface of the uterus and is in direct contact with the plasma membrane layer, accounting for about 20%. If it protrudes between the two lobes of the broad ligament, it is a leiomyoma within the broad ligament.
3.Submucosal leiomyosarcoma grows into the uterine cavity, protrudes into the uterine cavity and is in direct contact with the mucosal layer, accounting for about 10%-15%. This tumor can gradually enlarge and deform the uterine cavity, and it often has a tip connected with the uterus, and if the tip is long, it can block the cervical opening or prolapse into the vagina.
4.Cervical fibroids are less common. They grow in the cervical area and can be embedded in the pelvic cavity because of the low growth area, resulting in pressure symptoms, difficult to remove surgically and easy to damage the ureter and bladder. Uterine fibroids are often multiple, and the above different types of fibroids can occur in the same uterus at the same time, called multiple fibroids.
What are the symptoms of uterine fibroids?
1. Menstrual changes: The most common symptoms are shortened menstrual cycle, increased menstrual volume, prolonged menstrual period, irregular vaginal bleeding, etc.
2, abdominal mass: abdominal distension, lower abdomen and swelling, accompanied by a feeling of falling.
3.Increased leucorrhea: increased leucorrhea, sometimes producing large amounts of pus and blood discharge and flesh-like tissue discharge with odor.
4. Pain: Generally, patients do not have abdominal pain, but often have lower abdominal cramps, back pain, etc. When the subplasmalemma myoma is twisted, acute abdominal pain can occur when the myoma is red, abdominal pain is severe and accompanied by fever, which is usually relieved by Chinese medicine, stone intestine cream.
5. Compression symptoms: Myoma growing forward or backward may compress the bladder, urethra or rectum, causing frequent urination, difficulty in urination, urinary retention or constipation. When myoma grows to both sides, it forms broad ligament myoma, which can cause ureteral or pelvic effusion when it compresses ureter; if it compresses pelvic vessels and lymphatic vessels, it can cause lower limb edema.
6, Infertility: Myoma may distort the fallopian tubes or distort the uterine cavity to prevent the fertilized egg from being laid, resulting in infertility.
7. Secondary anemia: If the patient has prolonged excessive menses, it may lead to secondary anemia and symptoms such as general weakness, pallor, shortness of breath and panic. 8. Hypoglycemia: Hypoglycemia associated with uterine fibroids is also rare. The main manifestation is low fasting blood sugar, loss of consciousness and shock. Hypoglycemia disappears completely after the tumor is removed.
How are fibroids formed?
Modern medical research has found that the amount of estrogen receptors in fibroid tissues is more than that of normal uterine muscle tissues. It is suggested that the occurrence of uterine fibroids is related to the endocrine disorder caused by the long-term high estrogen content. At the same time, hormone metabolism is regulated by higher nerve centers, so nerve center activity may also play an important role in promoting this disease. In addition, cytogenetic studies have shown that some fibroids have cytogenetic abnormalities.
Can uterine fibroids cause non-pregnancy?
Uterine fibroids can affect pregnancy, which is related to the size of fibroids and the growth site. Such as.
1, fibroids in the horn of the uterus can cause distortion and deformation of the fallopian tubes, which can affect the passage of sperm or fertilized eggs and reduce the chance of conception.
2. Submucosal fibroids occupy the uterine cavity, which is not conducive to fertilization of the egg.
3.Large interstitial fibroids can change the normal shape of the uterine cavity and compress the fallopian tubes, which can deform the uterine cavity, thus affecting the passage of sperm and the fertilization of the egg and fetal development.
4. Broad ligament fibroids may distort the fallopian tubes and squeeze the lumen, affecting their patency, or distort the ovaries and widen the distance between the ovaries and the fallopian tubes, hindering the egg collection function of the umbrella end of the fallopian tubes.
5. Uterine fibroids in the cervix can compress the cervical canal, obstruct the passage or change the orientation of the cervical opening, which is not conducive to the entry of sperm into the cervical opening.
The incidence of infertility among patients with uterine fibroids is about 22-32%, with the highest incidence of infertility in submucosal fibroids. Generally, small or solitary subplasmic and interstitial fibroids do not affect conception and pregnancy. Therefore, patients with infertility due to fibroids should seek medical attention promptly.
V. Can fibroids become cancer?
Uterine fibroids are the most common female genital tumor, and the possibility of malignant transformation is extremely low, according to domestic data, the possibility is only 0.4%-0.8%. However, older women need to pay more attention to the possibility of malignancy if the fibroids increase rapidly within a short period of time or if there are symptoms of irregular vaginal bleeding. In addition, postmenopausal women with fibroids should be alerted to the possibility of malignancy if they find that the fibroids have increased in size.
What treatments are available for fibroids?
The first thing that needs to be mentioned is that most fibroids do not require treatment, but only regular checkups, whether it is medication or surgery, only for some patients who have symptoms or who are inconvenienced by fibroids. The following treatment methods are commonly used.
1.Drug treatment.
Commonly used drugs include GnRHa, Danazol, androgens, progestins, etc.
2.Surgical treatment.
Uterine fibroid removal or total hysterectomy, the surgical routes are transabdominal, transvaginal, trans-laparoscopic, trans-hysteroscopic, etc.
3.Chinese herbal medicine.
Discriminatory treatment, acupuncture treatment, etc.
7. Is the surgery going to leave a long scar on the stomach?
At present, there are many ways and means of surgery, only traditional transabdominal surgery will leave a long scar, while laparoscopic, hysteroscopic or negative surgery will basically leave no scar or only a few small scars, for example, laparoscopic myomectomy or laparoscopic total hysterectomy will only leave 2-3 scars about 1-2cm long, while transhysteroscopic submucosal myomectomy or transcatheter hysterectomy will only leave 2-3 scars about 1-2cm long. There is no scar in the abdomen for hysteroscopic submucosal fibroid removal or transvaginal myomectomy or total hysterectomy, but of course there are indications for each procedure. Take our hospital, at present, almost all fibroids that need surgical treatment can be completed by several minimally invasive surgeries introduced above.
Can I choose laparoscopy for fibroid surgery?
Laparoscopy is a kind of minimally invasive surgery developed in recent years, which only requires 2-3 small openings of about 1-2cm in size on the stomach, and then the surgery is completed by instruments, which has the advantages of small trauma, fast recovery and aesthetics, etc. In our hospital, the technology is quite mature, and almost 95% of fibroids can be completed through laparoscopy, only less than 5% of patients need open or other surgical methods for various reasons. Less than 5% of patients need open or other surgical procedures for various reasons, such as: submucosal fibroids, extensive pelvic adhesions, multiple giant fibroids, etc.
Can fibroids recur?
As mentioned earlier, fibroids are benign tumors related to female hormone levels, which have a strong regenerative capacity and are prone to recurrence after surgery, and also because they are related to hormone levels, they may shrink or even disappear after menopause, but if they continue to increase after menopause, we should consider whether they are degenerative or cancerous, which needs attention.
X. What is the attention to diet after having fibroids?
To prevent uterine fibroids, we should start with controlling hormone secretion. In fact, the medical community has conducted experiments through animals, tests have shown that long-term consumption of high-fat food will tend to promote the production and release of certain hormones.
1.Keep your diet normal, on time and in the right amount. Sudden overeating is likely to cause metabolic disorders.
2, try to eat less greasy food, adhere to eat more fish, eggs and vegetables and fruits.
3, often eat peanuts, melon seeds and sesame seeds, such as dried fruit-type food is rich in nutrients.
4, soy can regulate the body’s hormones, eat more soy products can maintain endocrine balance.
5, eat less spicy fried and barbecued food, do not smoke and alcohol abuse.
Eleven, fibroids after surgery need to pay attention to what?
1.Post-operative cleaning: pay attention to cleaning the vulva, maintain personal hygiene, and keep the incision dry and clean.
2.A light diet should be taken after surgery.
3, post-operative should be prohibited from sex: uterine fibroid removal should be prohibited from sex for at least one month after surgery, uterine subcision, uterine total excision to be two months, three months, and this also depends on the patient’s own situation to decide, must be in the hospital after the review of no abnormalities before you can have sex. If you are trying to get pregnant, larger fibroids removal may be safer 1-2 years after removal.
Do I have to have a cesarean section if my fibroids are found during pregnancy?
Some patients with fibroids believe that a cesarean section is necessary for pregnancy combined with fibroids. In fact, if the pregnancy is asymptomatic and generally does not affect the fetal head descent and uterine recovery during delivery, vaginal delivery can be considered. The woman with fibroids can also give birth naturally, so there is no need to intervene urgently, and the fibroids will increase in size under the effect of high levels of estrogen and progesterone during pregnancy, and will gradually shrink after the recovery of hormone levels after delivery, so there is no need to blindly use cesarean delivery to “remove fibroids”. If the uterine fibroids are large and multiple, they may affect the fetal head descent, and a cesarean section with myomectomy may be considered at this time. Although most fibroids found during cesarean delivery can be removed, large fibroids near the uterine arteries, ureters, and interstitial tubules should be treated with caution. If done hastily, they may cause rupture of large blood vessels and damage to the ureters and fallopian tubes, which may not be worth the loss.