Uterina fibroid is one of the most common tumors from which women of a reproductive age can suffer. Often the doctors consider the gynecological symptoms as a result of a fibroid. But usually it is not so. So, in each case it should be defined if it is fibroid or mioma that causes the symptoms, because usually it is an indication that a hysterectomy is needed.
A risk of a mioma developing is higher if any relatives suffer from it, and if the woman has never parturiated.
For many years the fibroid had been treated by a transabdominal hysterectomy and myomectomy. Last year when ultrasonic scanning developed and the disease can be detected at an earlier phase. Moreover, new methods of therapy have appeared. They include gonadotropin-releasing hormone agonist analogues (gnrha), additional therapy, and embolization. Sometimes it allows preventing a surgery. In some cases, such methods as a husterecomy or myomectomy are used that are performed, without abdominal incisions, but through the vagina or endoscopy.
Fibroids are the tumors dependent on oestrogene and progesterone. Their number can vary from 1 to 100. Genetic research has proven that each fibroid is developed from one separate cell and is not a metastasis.
The developing of these fibroids are not symptomatic. But if the fibroid is big, then it is easily detected, because it compresses other organs. This type of fibroids can cause repeated and late spontaneous abortion. It can also cause a premature birth, the malposition of the fetus, and postpartum hemorrhage.
The fibroid develops only in 15 - 20 per cent of pregnant women. But its degeneration can occur and cause pains and fever. Rarely it is concerned with polycythemia.
Obviously a compensation hormonal therapy does not influence asymptomatic fibroids.
Diagnostics. A diagnostics test is based on the detailed anamnesis and physical examination. The details will focus on the menstrual cycle, sex life, and functioning of the bowels. Additional methods of investigation are transabdominal and vaginal investigation, and ultrasonic scanning. It is the most informative diagnostic method.
Treatment. If there are no symptoms, treatment is not necessary, excluding the cases where the fibroids are very big and disturb other organs. A risk of malignization, degeneration during pregnancy, and potential fertile disorders is not an indication for surgery. But it is recommended to control the condition by ultrasonic scanning and regular gynecological examinations.
In the case of degeneration during pregnancy, the treatment should be conservative, i.e. a rest cure, intravenous introduction of fluids and analgetic therapy. Rarely is a myomecctomy needed during the period of pregnancy, but, it is usually effective. When the symptoms are not obvious nonsteroidal medications are recommended.
If there is metrorrhagia, when the uterine enlargement is less than 12 weeks size and the woman is not going to have a child but wishes to save the uterine an endometrial ablation is possible.
Gonadotropin-releasing hormone agonist medications, gonadotropin hormone and hormone agonist about gnrha, taken during a three month period, can reduce the fibroids size by 50 per cent. Such a therapy should not continue for more than six months because of the risk of osteoporosis and cardiovascular system pathology. Six months after the end of gonadotropin-releasing intake the fibroid recovers its size.
In 10 per cent of cases, there is not a beneficial effect after two months of gonadotropin-releasing hormone agonist intake. In this case the treatment is stopped and an investigation is performed to define adenomyosis or sarcoma.
But for women who have any contradiction from surgery, or who are in menopause, the treatment using gonadotropin-releasing hormone agonist for three months, and oestrogene and progesterone intake can be very effective.