What Is the Uterus?

Uterine fibroids are the most common benign tumors in female reproductive organs and one of the most common tumors in the human body. They are also known as fibroids and fibroids. Since uterine fibroids are mainly formed by the proliferation of uterine smooth muscle cells, a small amount of fibrous connective tissue exists as a supporting tissue, so it is more accurately called uterine leiomyoma. Referred to as uterine fibroids.

Basic Information

nickname

Fibroids

English name

Hysteromyoma

Visiting department

Gynecology, obstetrics and gynecology

Multiple groups

30-50 women

Common locations

uterus

Common symptoms

Uterine bleeding, abdominal mass, compression, pain, increased vaginal discharge, infertility, abortion, anemia, increased red blood cells, hypoglycemia

Contagious

no

Causes of uterine fibroids

The etiology of uterine fibroids is still not very clear so far, and may involve more complex interactions between normal muscle layer cell mutations, sex hormones and local growth factors.

According to a large number of clinical observations and experimental results, uterine fibroids are a hormone-dependent tumor. Estrogen is the main factor to promote the growth of fibroids. Some scholars believe that growth hormone (GH) is also related to the growth of fibroids. GH can cooperate with estrogen to promote mitosis and promote the growth of fibroids. It can cooperate with estrogen to promote mitogenic effect. It is believed that in addition to the acceleration of uterine fibroids during pregnancy, HPL may also participate.

In addition, ovarian function and hormone metabolism are controlled by the high-level nerve center, so nerve center activity may also play an important role in the pathogenesis of fibroids. Uterine fibroids are more common in women of childbearing age, widowed, and uncoordinated sex. Chronic pelvic congestion caused by long-term sexual imbalance may also be one of the causes of uterine fibroids.

In short, the occurrence and development of uterine fibroids may be the result of multiple factors.

Clinical manifestations of uterine fibroids

Symptoms

Most patients are asymptomatic and only occasionally detected during pelvic or ultrasound examinations. If there are symptoms, it is closely related to the location, speed, degeneration, and complications of fibroids, but relatively small with the size and number of fibroids. People with multiple subserosal fibroids may not have symptoms, and a smaller submucosal fibroid can often cause irregular vaginal bleeding or excessive menstruation. Common clinical symptoms are:

(1) Uterine bleeding is the most common symptom of uterine fibroids, which occurs in more than half of patients. Among them, periodic bleeding is more, which can be manifested by increased menstrual flow, prolonged menstrual period or shortened cycle. It can also appear as irregular vaginal bleeding without menstrual cycles. Uterine bleeding is more common in submucosal fibroids and intermural fibroids, while subserosal fibroids rarely cause uterine bleeding.

(2) Abdominal masses and compression symptoms Fibroids gradually grow. When they enlarge the uterus for more than 3 months, the size of the uterine uterus or a large subserosal fibroid located at the bottom of the uterus can often pinch the mass in the abdomen. , More obvious when the bladder is full in the morning. The mass is solid, mobile and non-tender. When a fibroid grows to a certain size, it can cause symptoms of compression of surrounding organs. Anterior uterine fibroids can cause frequent urination and urgency if they are close to the bladder. Huge cervical fibroids can cause poor urination and even urinary retention. It is the isthmus or posterior cervical fibroids that can compress the rectum, causing poor stools and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis.

(3) Pain Under normal circumstances, uterine fibroids do not cause pain, but many patients can complain of lower abdominal bloating and back pain. Acute abdominal pain can occur when subserous fibroids have twisted pedicles or uterine fibroids undergo red degeneration. Fibroids with endometriosis or adenomyosis are not uncommon, and they may have dysmenorrhea.

(4) Increased leucorrhea Increased uterine cavity, increased endometrial glands, and pelvic congestion can increase leucorrhea. Submucosal fibroids in the uterus or cervix can cause bloody or purulent leucorrhea when ulcers, infections, and necrosis occur.

(5) Infertility and abortion Some patients with uterine fibroids have infertility or are prone to miscarriage. The impact on pregnancy and pregnancy outcome may be related to the growth site, size and number of fibroids. Giant uterine fibroids can cause deformation of the uterine cavity, impeding the implantation of the gestational sac and embryo growth and development; compression of the fallopian tube by the fibroids can cause the lumen to be unobstructed; submucosal fibroids can prevent the implantation of the sac or affect the sperm to enter the uterine cavity. Fibroid patients have a higher natural abortion rate than the normal population, with a ratio of about 4: 1.

(6) Anemia Due to long menstrual periods or irregular vaginal bleeding can cause hemorrhagic anemia, more severe anemia is more common in patients with submucosal fibroids.

(7) Others Very few patients with uterine fibroids can produce erythrocytosis and hypoglycemia, which is generally considered to be related to the production of ectopic hormones by the tumor.

2. Signs

(1) Abdominal examination The uterus is enlarged for more than 3 months. The size of the pregnancy or the larger subserosal fibroids can be above the pubic symphysis or in the middle of the lower abdomen and the mass. It is solid, without tenderness. Fibroids are irregularly shaped outside the mass.

(2) Pelvic examination The double gynaecology and triple gynaecology examinations show that the uterus is enlarged to varying degrees and is irregular. The surface of the uterus has irregular protrusions and is solid. If there is degeneration, the texture is soft. The signs of uterine fibroids during gynecological examination vary according to their different types. If the pedicled subserosal fibroids are long, parenchymal masses can be palpated by the uterus and they can move freely. This situation is easily confused with ovarian tumors. The submucosal fibroids descend to the cervical canal, the cervix is loose, and the examiner's fingers can reach the cervical mouth to touch the smooth spherical tumor. If the tumor has been pulled out of the cervical mouth, the tumor can be seen, the surface is dark red, and sometimes there are ulcers. Necrosis. Larger cervical fibroids can shift and deform the cervix, and the cervix can be flattened or moved up behind the pubic symphysis.

Uterine fibroids examination

Ultrasound examination

Is currently the most commonly used auxiliary diagnostic method. It can show enlarged uterus, irregular shape, number, location and size of fibroids, and whether the interior of fibroids is uniform or liquefied, cystic changes, etc. Ultrasonography is helpful in diagnosing uterine fibroids, providing a reference for distinguishing whether fibroids are degenerative, and distinguishing them from ovarian tumors or other pelvic masses.

2. Diagnostic curettage

Probe the size and direction of the uterine cavity with a uterine cavity probe, feel the shape of the uterine cavity, and understand whether there is a mass in the uterine cavity and where it is located. For patients with abnormal uterine bleeding, it is often necessary to identify endometrial lesions, and diagnostic curettage is of great value.

3. Hysteroscopy

The hysteroscopy can directly observe the uterine cavity shape and the presence or absence of neoplasms, which is helpful for the diagnosis of submucosal fibroids.

4. Laparoscopy

When fibroids must be distinguished from ovarian tumors or other pelvic masses, laparoscopy can be performed to directly observe the uterine size, morphology, and location of tumor growth and determine its nature.

5. Magnetic resonance examination

Under normal circumstances, no magnetic resonance examination is needed. If a differential diagnosis is needed for uterine fibroids or uterine sarcoma, magnetic resonance, especially enhanced delayed imaging, can help distinguish between uterine fibroids and uterine sarcoma. Before laparoscopic surgery, magnetic resonance examination also helps clinicians to understand the location of fibroids before and during surgery and reduce residuals.

Differential diagnosis of uterine fibroids

Fibroids are often easily confused with the following diseases and should be identified: adenomyosis and adenomyoma; pregnant uterus; ovarian tumors; uterine malignant tumors; uterine hypertrophy; uterine inversion; uterine malformations; Pelvic inflammatory mass.

Uterine fibroids treatment

Follow-up observation

If the patient has no obvious symptoms and no signs of malignancy, he can follow up regularly for observation.

2. Drug treatment

(1) GnRH-a gonadotropin- releasing hormone agonists (GnRH-a) currently used clinically include leuprolide, goserelin, triptorelin and the like. GnRH-a is not suitable for long-term continuous use. It is only used for pretreatment before surgery. Generally, it is used for 3 to 6 months to avoid causing severe menopausal symptoms caused by low estrogen. It can also be supplemented with small doses of estrogen to combat this side effect.

(2) Mifepristone is a progestin antagonist. In recent years, it has been clinically tested to treat uterine fibroids, which can reduce the size of fibroids, but they can grow up after stopping treatment.

(3) Danazol is used for preoperative medication or treatment of uterine fibroids that are not suitable for surgery. Uterine fibroids can grow after discontinuation. Taking danazol can cause liver damage, in addition to androgen-induced side effects (weight gain, acne, dull sound, etc.).

(4) Tamoxifen (Tamoxifen) can inhibit the growth of fibroids. However, the long-term application of individual patients with uterine fibroids increases, and even induces endometriosis and endometrial cancer, which should be paid attention to.

(5) Androgen drugs Commonly used drugs are methyltestosterone (methyltestosterone) and testosterone propionate (testosterone propionate), which can inhibit the growth of fibroids. Attention should be paid to avoid virilization.

During the bleeding period of uterine fibroid patients, if the amount of bleeding is large, uterine contractions (such as oxytocin and ergot) and hemostatic drugs (such as hemostatic acid, aminotoluene acid (hematoic acid)), Lizhihe, 37 tablets ), Can play a certain degree of auxiliary hemostatic effect.

3. Surgical treatment

The surgical treatment of uterine fibroids includes myomectomy and hysterectomy, which can be performed through the abdomen or vagina. Endoscopic surgery (hysteroscopy or laparoscopy) is also available. The choice of surgical method and surgical route depends on the patient's age, whether there are fertility requirements, the size and growth location of fibroids, and medical technical conditions.

(1) Fibroidectomy Surgery to remove uterine fibroids while preserving the uterus. It is mainly used for young women under 40 years of age who wish to retain fertility. Applicable to large fibroids; menstrual periods; compression symptoms; infertility caused by fibroids; submucosal fibroids; fibroids grow faster without malignant changes.

(2) Hysterectomy: Those with obvious symptoms and fibroids who may be malignant and have no fertility requirements, hysterectomy should be performed. Hysterectomy can be used for total hysterectomy or subtotal hysterectomy. For older patients, it is advisable to use total hysterectomy. The possibility of malignant cervical disease must be excluded before surgery.

(3) Uterine arterial embolization By means of radiation intervention, the arterial catheter is directly inserted into the uterine artery, and permanent embolization particles are injected to block the blood supply to the uterine fibroids, so that the fibroids atrophy or even disappear. UAE is currently mainly used for symptomatic uterine fibroids such as anemia caused by abnormal uterine bleeding. Care should be taken in the selection of interventional treatment for uterine fibroids, especially those with uncontrolled pelvic inflammation. Those who wish to preserve fertility, patients with arteriosclerosis, and patients with contraindications to angiography should be listed as contraindications for this treatment. Preoperative ovarian failure may occur in 5% of patients, and rare pelvic infections have been reported.

4. Focused ultrasound treatment

By accumulating ultrasound, the temperature inside the tumor is raised to more than 65 ° C, which causes coagulative necrosis of the tumor to play a role in treatment. The treatment can make the fibroids shrink and relieve the symptoms. For symptomatic uterine fibroids. There is no surgical scar after treatment, and quick recovery is its advantage. Side effects include skin burns, adjacent bowel damage, and hematuria.