1.What is uterine fibroids?
With the continuous updating and development of ultrasound and other examination means, many lesbians often find uterine fibroids during physical examination or routine gynecological examination, and some patients panic when they hear “tumor”, they are depressed, restless and go around to doctors. Some families are separated from each other because of this conflict. What is uterine fibroids? Uterine fibroids, also known as uterine smooth muscle tumors and uterine fibroids, are the most common tumors of women’s reproductive system, with an incidence rate of up to 20%-30% in women of childbearing age, which is the first tumor in women. The incidence of fibroids is related to female estrogen and progesterone, for example, fibroids increase rapidly during pregnancy, stop growing and gradually shrink after menopause; exogenous estrogen can accelerate the growth of fibroids, so fibroids are sex hormone dependent tumors.
2.How many types of fibroids are there?
The shape of uterus is like an inverted pear, the mucous membrane layer is like the shell of pear nucleus, the muscle layer is like the fleshy part of pear, and the plasma membrane layer is like the skin of pear. Fibroids originate in the myometrium and can develop in different directions when they continue to increase in size. Generally, we divide them into the following categories according to the different parts of the uterus where they are located: the most common ones are located in the myometrium and are called intermyometrial fibroids, accounting for 60% to 70% of the fibroids surrounded by the myometrium. Those protruding to the outer layer of the uterine wall are called subplasma leiomyomas (20%), while those protruding to the uterine cavity are called submucosal leiomyomas (10%), which may protrude into the uterine cavity and gradually enlarge and deform the uterine cavity, and often have a tip connected to the uterus, and if the tip is long, it may block the cervical opening or protrude into the vagina. These different types of fibroids vary in size, from small ones like corn grains to large ones weighing more than 20 kg, and can occur in the same uterus at the same time, which is called multiple fibroids. In addition, there are some rare types such as: subplasma fibroids growing towards the broad ligament next to the uterus called broad ligament fibroids, growing in the cervix called cervical fibroids.
3.Can fibroids become malignant?
Uterine fibroids are chronic benign diseases, but different degeneration often occurs when the fibroids grow fast and have poor blood supply, when the fibroids are too large or when pregnancy occurs. The benign degeneration includes red degeneration (often during pregnancy and delivery), mucinous degeneration, cystic degeneration, fatty degeneration and calcification. The most important degeneration is malignant into uterine sarcoma, fortunately it is very rare, the real probability is less than 1/1000, mostly seen in older people with large and fast growing fibroids, especially in patients with rapid growth of fibroids after menopause or postmenopausal reappearance of fibroids, uterine sarcoma is highly malignant and can metastasize to other parts of the body through blood circulation in early stage, the prognosis is poor, but there is no effective screening means to distinguish uterine This is the reason why patients with uterine fibroids should have regular follow-up examinations and the indications for choosing surgical treatment in case of the above-mentioned conditions.
4. Do all fibroids need to be treated?
In fact, only less than half of the fibroids have symptoms that require treatment. For 70%-80% of patients with fibroids without clinical symptoms found during routine gynecological examinations, conservative treatment, including expectant therapy and medication, can be used. The prerequisites are: it is determined that the pelvic mass is benign, the patient can be followed up regularly, and the fibroids do not compress the surrounding tissues, especially the ureter. Otherwise, surgery should be an option. Modern high-resolution ultrasound and MRI provide a strong guarantee for conservative treatment of many asymptomatic patients. Regular follow-up and vaginal ultrasound can be performed for monitoring.
Surgical treatment of symptomatic fibroids remains a widely used and effective tool. The decision to operate is based on the clinical symptoms and severity associated with the fibroids, which are related to the type, location, size and degeneration of the fibroids. In fact the location of the fibroids is more relevant than the size. If located in the horn of the uterus, it is difficult to distinguish from ovarian tumors, which are the most fatal disorder in women, and this is where conservative treatment needs to be weighed. Over the past 100 years, advances in gynecologic surgery have led to effective control of this common, but painful and fatal condition. Deaths caused by fibroids have largely disappeared, a milestone in women’s health care.
(1) What conditions require surgical treatment?
a. Submucosal fibroids: even if small in size, they can cause abnormal uterine bleeding, excessive menstrual flow or dribbling, resulting in anemia or hemorrhagic shock. Submucosal fibroids with tissues often protrude into the vagina, leading to necrosis and secondary infection due to obstruction of blood supply. Therefore, once the diagnosis is confirmed, transvaginal or hysteroscopic resection should be actively chosen.
b. Cervical fibroids, multiple uterine fibroids or uterine fibroids that are too large may grow forward to compress the bladder and produce frequent urination, especially in the morning when the bladder is full, and backward to compress the rectum and produce constipation or constipation. It may also compress the ureter and cause kidney damage. Cervical fibroids are low and can be embedded in the pelvic cavity, producing compression symptoms, making surgical removal difficult and easily damaging the ureter and bladder.
c. Subplasmalemmal fibroids are prone to torsion of the tumor and cause acute abdomen, myoma necrosis or severe infection.
d. Those who are old, with large and fast-growing myomas and suspected of malignant change, especially those with fast-growing myomas after menopause or those with myomas that appear again after menopause. After menopause, interstitial fibroids can turn into submucosal fibroids causing irregular bleeding, which can be easily confused with other malignant diseases of the uterus and necessitates removal of the uterus.
e. Infertility or sterility, usually fibroids do not affect pregnancy, but if the fibroids are too large or submucosal fibroids, they often lead to infertility or miscarriage or premature birth. Sometimes the fibroids are small, but they happen to press on the opening of the fallopian tubes and cause infertility. Should myomectomy be performed before pregnancy? Does it affect pregnancy after surgery? It depends on the patient’s age, physical condition, pelvic lesions, size and location of the fibroids, and the patient’s subjective desire.
f. Surgery can be performed for those who are mentally stressed and restless.
g. Those with combined adenomyosis, endometriosis, and severe dysmenorrhea that cannot be relieved.
(2) How to choose the surgical procedure?
The traditional surgical treatment is open hysterectomy or subtotal hysterectomy with myomectomy. With the development of minimally invasive techniques such as laparoscopy, hysteroscopy, uterine artery embolization, ultrasound focusing and radiofrequency ablation, which have become more and more popular in recent years, there are many methods and procedures for patients to choose besides open hysterectomy. How to choose the procedure? Which procedure is safer and more effective? Firstly, it depends on the patient’s age, whether she has fertility requirements and whether she wants to preserve the uterus; secondly, it depends on the type, location, size and degeneration of the fibroids; thirdly, it depends on the experience and proficiency of the operator; fourthly, it depends on the patient’s physical condition and whether there are other diseases that affect the operation; fifthly, it depends on the equipment of the medical unit. The treatment of uterine fibroids emphasizes the principle of individualization. The traditional open surgery has been replaced by laparoscopy and hysteroscopy in recent years in the hospitals that have the conditions, but it is still difficult to remove huge uterine fibroids by laparoscopy, and open surgery is still a very reasonable and effective procedure. Subplasma fibroids are not an indication for hysteroscopic surgery, so if you find fibroids, it’s best to find a doctor to decide whether you need surgery and help you choose the procedure according to your condition.
5. Can uterine fibroids be treated with medication?
Medication is only an adjunct to surgery or a temporary alternative to elective surgery, and so far there is no medication that can cure fibroids. The commonly used drugs are gonadotropin-releasing hormone agonists, which can inhibit ovulation and lower the estrogen level in the body, and can be applied before surgery to correct anemia and reduce the blood supply to the uterus, thus reducing the size of fibroids. It makes minimally invasive surgery easier to perform. The main side effects are menopausal-like syndrome and bone loss produced by low estrogen. Mifepristone is a progesterone receptor antagonist that resists progesterone to reduce the blood supply to the fibroids and shrink the size of the fibroids with relatively few side effects and can be taken orally for six months continuously. Nemetholone can also be taken orally for 6-12 months continuously to resist estrogen and induce myoma degeneration. However, there are androgen-like side effects such as facial acne, weight gain and impaired liver function. All of the above drugs can cause amenorrhea in patients. In addition, the Chinese medicine is very profound, and Chinese medicine can be effective in relieving the symptoms of fibroids.
Uterine fibroids are an important topic of public health and women’s health care, and it is understandable that the public is concerned about this disease. Currently, most women who require fertility or do not require fertility are willing to keep their uterus, and traditional hysterectomy and myomectomy will decline, and conservative treatment methods, including drugs and minimally invasive surgery, will be increasingly emphasized. With the development and progress of science and technology, fibroids will no longer be an affliction for women in the near future.