Uterine fibroids are the most common benign tumors of the female reproductive organs, which are caused by the proliferation of smooth muscle cells in the uterus, hence the name smooth muscle tumors of the uterus. They are classified into subplasma, interstitial and submucosal fibroids depending on the site of occurrence. Uterine fibroids are hormone-dependent tumors, and estrogen is the main factor contributing to the growth of fibroids, which is also related to progesterone. They mostly occur at the age of 30-50 and gradually shrink or even disappear after menopause; they grow faster under the effect of pregnancy and exogenous high estrogen; they often coexist with endometrial hyperplasia and endometriosis. Growth hormone and some growth factors are also related to the growth of fibroids. In addition, abnormal chromosome structure is related to the occurrence and development of fibroids.
Clinical manifestations
The symptoms of uterine fibroids are often related to the location of fibroids and the presence of degeneration, but not to the size and number of fibroids.
(1) Increased menstrual flow and prolonged menstrual period. Long-term increased menstrual flow may cause anemia, weakness and palpitations.
(2) Lower abdominal mass: located in the middle of the lower abdomen, solid, mobile, no pressure pain, slow growth.
(3) Increased leucorrhea: often caused by submucosal myoma; once infected, there may be a large amount of purulent leucorrhea, and if there is ulceration, necrosis, or bleeding, there may be bloody or pus-blood foul-smelling vaginal overflow.
(4) Compression symptoms: anterior wall fibroids close to the bladder can produce bladder irritation symptoms such as frequent and urgent urination; posterior wall fibroids (isthmus or posterior wall) can cause lower abdominal cramps and constipation, etc. If a broad ligament leiomyoma compresses the ureter, it may cause ureteral dilatation or even hydronephrosis.
(5) Other: leiomyoma may cause infertility or miscarriage; red degeneration of leiomyoma may cause acute lower abdominal pain with vomiting, fever and local pressure pain; subplasma leiomyoma with torsion may have acute abdominal pain.
Differential diagnosis
(1) Pregnant uterus: especially cystic fibroids should be differentiated from pregnant uterus. It can be differentiated by history of menopause, early pregnancy response, blood or urine HCG measurement and ultrasound imaging.
(2) Ovarian cysts: pay attention to the relationship between the mass and the uterus, and differentiate them according to ultrasound and laparoscopy, especially between solid ovarian tumors and subplasma myomas with tissues, and between cystic myomas and ovarian cysts.
(3) Uterine adenomyosis: It also manifests as enlarged uterus and increased menstruation; however, it has a history of secondary progressive dysmenorrhea, and the uterus is mostly uniformly enlarged, and those larger than 3 months are rare; ultrasound is helpful for diagnosis, and sometimes myoma and adenomyosis can coexist.
(4) Malignant tumors of the uterus: uterine fibroids occurring in the perimenopause or postmenopause, with rapid growth, abundant blood flow on ultrasound, or with abnormally elevated tumor markers, should be alerted to the possibility of sarcoma; if accompanied by abnormal vaginal bleeding, cervical lesions and endometrial lesions must be excluded.
(5) Others: such as chocolate cyst, pelvic pseudocyst and uterine malformation can be identified according to medical history, physical signs and ultrasound examination.
Treatment principles
It should be considered according to age, fertility requirements, symptoms and the location, size and number of fibroids.
(1) Expectant therapy: It is suitable for women with small, asymptomatic fibroids, especially near menopause. Follow-up every 3 to 6 months, and surgical treatment can be switched at any time for significant increase or symptoms.
(2) Drug therapy: Those with uterus less than 2 months in size, such as those with mild symptoms, near menopause or systemic conditions that are not suitable for surgery can be treated with drugs, such as gonadotropin-releasing hormone analog (GnRHa), mifepristone, with recurrence problems after stopping the drug. It is more reasonable to create conditions for surgery with short-term medication.
(3) Other non-surgical treatments: uterine artery embolization, high-energy ultrasound focusing, etc., Hepatitis B treatment
(4) Surgical treatment.
Indications include: uterus larger than the size of 10 weeks of pregnancy; excessive menstruation secondary to anemia; symptoms of bladder or rectal compression; fast-growing fibroids; failure of conservative treatment; infertility or recurrent miscarriage except for other reasons.
The procedures are based on age, fertility requirements and the characteristics of the fibroids, with different routes (open, cathodic, laparoscopic, hysteroscopic) for myomectomy and total hysterectomy.