First of all, I recommend that you watch a video made specifically for the Popular Doctor website. The 12-minute video talks about the disease of uterine fibroids and all the main methods of treatment in a simple, understandable language.
This video discusses in detail (but understandable and accessible) the method of uterine artery embolization: history, features and myths. In 12 minutes you will get a complete understanding of the method and find answers to most questions.
Uterine fibroids - for many women, this diagnosis sounds like a bolt from the blue, and it often happens that a misconception about this diagnosis dooms the patient to difficult experiences and completely unjustified surgical interventions.
What I would like to talk about below are the main theses:
- uterine fibroids - it's not scary at all (again dispelling myths)
- there are modern techniques to avoid surgery and organ loss
- uterine fibroids cannot be treated with Duphaston
- there is a prevention of the development of uterine fibroids
- with uterine fibroids, you can get pregnant and give birth
- about 80% of all operations in gynecology are performed for uterine fibroids - 90% of these operations are removal of the uterus
- every third woman after 55 years of age had her uterus removed due to a diagnosis of uterine fibroids
- the average age of women who have their uterus removed because they have uterine fibroids is 42 years
Why everyone is offered to operate on myoma?
If all operations for uterine fibroids are removed from the work of the gynecological department, then in fact doctors will sit without work and categorically not carry out the terrible plan of “surgical activity”. “Surgical activity” reflects how many patients were operated on from among those admitted. This indicator should be high - otherwise they swear very much ...
And some of the doctors are simply not interested in new technologies and do not know that they can be treated differently.
So to myoma...
What is uterine fibroids and why is it so scary?
Uterine fibroids have long been considered as a true benign tumor that can transform into a malignant neoplasm. And since any tumor must be removed, and preferably together with the organ in which it grows, there was no alternative to removing the uterus for this disease. The only compromise was organ-sparing fibroid nodule surgery – this womb-sparing option was mostly reserved for nulliparous women to give them a chance to have a baby. Sooner or later, these women, having fulfilled their reproductive plan, found themselves on the operating table for removal of the uterus due to a relapse of the disease.
Attitudes towards the nature of fibroids began to change in the mid-1990s. New opportunities for scientific research have shown that although it looks similar, it is not a benign tumor. It became known that fibroids degenerate into a malignant tumor so rarely that, in general, this probability is comparable to the development of a malignant tumor in the uterus, without the presence of myomatous nodes in it. And finally, in terms of their characteristics, fibroids were compared with a common wen on the skin, an atherosclerotic plaque in a vessel, and a keloid scar, which made it possible to significantly reduce oncological alertness in relation to this disease.
As a result of special studies, it was possible to show that myoma has a greater prevalence than previously thought. If earlier it was thought that it occurs in 30% of women over 35 years old, now it is known that fibroids develop in more than 80% of women, but in most women this disease is asymptomatic.
At the moment, uterine fibroids appear to be a kind of reaction of an organ (uterus) to damage. The main damage to the uterus is menstruation, or rather a large number of periods.
There is an ancient Russian proverb “If you don’t give birth to Yerema, you will give birth to fibroids” - and the ancients, as usual, were right, but they could not explain it from a scientific point of view.
The body of a woman was conceived by nature for procreation. It was supposed to be in the reproductive cycle from the moment of maturity. Pregnancy, breastfeeding, one or two periods and again pregnancy. So for the life of a woman it was supposed to survive 30-40 menstruations, and most likely the uterus is adapted to this. In practice, it happens that a woman gives birth to 1-2 children, usually by the age of 30 and rarely breastfeeds for more than 1 year. In this mode, a woman experiences about 400 menstruations in her life.
Like any frequently repeated process, menstruation negatively affects the woman's body in general, and her genitals in particular. Think about it: how could it be provided by nature that every month you have to experience a whole set of negative sensations, in their effect on the body, comparable to a disease. Headaches, pain in the abdomen and body, bleeding, bad mood, decreased performance, changes in appetite, etc. This list can be continued for quite a long time. This is how the body responds to its unfulfillment.
Every month, the whole body of a woman tunes in to pregnancy, all organs and systems are prepared. In the second phase of the cycle, these processes are accelerated, the uterus increases slightly in size, preparing to quickly begin to grow in response to the onset of pregnancy. Pregnancy does not occur and again the whole body begins to return its “settings” to its normal state.
It is obvious that repeated repetition of a complex multi-level process begins, on the one hand, to wear out the entire system, and on the other hand, “to form errors”, the number of which increases many times when combined with various diseases. Infections and medical interventions. This is how most gynecological diseases are formed, including uterine fibroids.
A monthly maturing follicle in the ovary will sooner or later form into an ovarian cyst, a constant increase and rejection of the uterine mucosa - polyps or hyperplastic processes; endometriosis - there is no menstruation at all.
Myoma is formed at the beginning in the form of tiny rudiments located in the muscular membrane of the uterus. These are groups of ordinary muscle cells of the uterus, but in their properties they correspond to cells that are in the period of pregnancy. As one American scientist said, “uterine fibroids are a single-cell pregnancy.” Indeed, each myomatous node grows from one cell.
Under conditions of repetitive menstrual cycles, accompanied by fluctuations in hormones, the rudiments of myomatous nodes begin to grow. At the same time, some grow faster, others slowly, and others may even regress and disappear. Various damaging factors accelerate the growth of the rudiments of myomatous nodes, which include:
- medical interventions (curettage, traumatic childbirth benefits, operations)
After all, it is known that after inflammation or abortion, myomatous nodes begin to grow.
There are also juvenile fibroids that occur in young girls under 25 years old. It is believed that damage to the cells of the uterus, which leads to the growth of these nodes, occurs in them during intrauterine development. The progenitor cells of the muscular membrane of the uterus take a very long time to develop during pregnancy and have a long unstable period. In this unstable state, they are most susceptible to various damaging factors. Thus, if cells receive a defect in the prenatal period, then they only need a hormonal stimulus in the future to start growing. This hormonal stimulus is the onset of menstruation.
At a time when ultrasound was practically unavailable, and the quality of the devices left much to be desired, it was almost impossible to detect small myomatous nodes. Basically, doctors had to deal with already large nodes that could be found by hand or with patients who complained of heavy menstruation. In fact, these were already running cases. It was then that indications for the removal of the uterus were formulated, which exist to this day. In these indications, apart from other items, there are two very subjective criteria: "the size of the uterus corresponding to more than 12 weeks of pregnancy" and "the rapid growth of fibroids"
When myomatous nodes begin to grow in the uterus, the uterus itself increases in size accordingly. Since the uterus normally increases in size only during pregnancy, the increase in the uterus due to myomatous nodes began to be measured by weeks of pregnancy. For example, "uterine fibroids 7-8 corresponding to 7-8 weeks of pregnancy."
Estimating the size of uterine fibroids in weeks of pregnancy is an extremely subjective thing. The uterus with myomatous nodes, as a rule, increases unevenly - the nodes grow in different directions, some stretch in width, some in length. In addition, the thickness of the subcutaneous fatty tissue of the anterior abdominal wall and the height of the uterus are important in assessing the size of the uterus. All this leads to the fact that one doctor can look at a woman on a chair and say that she has uterine fibroids for 8 weeks, and another, after looking, will say that there are all 12 weeks. In fact, during the operation, it turns out that the size of the uterus barely reaches 6-7 weeks of pregnancy.
"Rapid growth" is also a very subjective criterion, as it is directly related to the desire or ability to correctly determine the size of the uterus in the weeks of pregnancy. The criterion of "rapid growth" was introduced due to the concern that the rapid growth of myomatous nodes is highly suspicious in relation to malignant transformation of fibroids. This fact has been repeatedly refuted, since it has been shown that in the vast majority of cases, the rapid growth of myomatous nodes is not associated with malignant degeneration of fibroids, but is a consequence of secondary degenerative changes.
Now imagine how convenient the situation is when the indication for surgery is a subjective criterion in the form of the size of the myomatous uterus over 12 weeks or “rapid growth”. That the true size of the uterus may be slightly larger than normal.
Who needs it and why?
There are several reasons:
1. Dispensary registration in antenatal clinics
Each women's consultation has a dispensary record of women for various diseases. Most of the women are in the dispensary for fibroids. They are regularly invited to an appointment and observe the dynamics of the growth of myomatous nodes. The number of such women is increasing year by year. It is possible to remove a woman from dispensary registration after the disease has actually been cured, and the only radical method of treatment is amputation of the uterus. Therefore, after observing for some time, it is possible to write down on a card at one of the appointments that the uterine fibroids grew up to 12 weeks of pregnancy, while “quickly” and sent for surgical treatment. After the removal of the uterus, the woman is removed from the dispensary. Again, reporting is required.
2.Surgical treatment of uterine fibroids - profit for the clinic and the implementation of the "surgical activity" plan
Monitoring a patient with fibroids is a troublesome and costly task. Any operation is always more expensive, whether it is the funds of an insurance company or personal gratitude from citizens. Now, when laparoscopic operations are performed in almost every major medical institution, the removal of the uterus by this method is put on stream. The technique of the operation is debugged, the intervention is relatively well tolerated. Here is what is proposed to quickly and efficiently solve the problem. If a woman no longer has reproductive plans, then convincing her that this is the simplest and easiest way to treat fibroids costs nothing. Polyclinics honestly direct, surgeons honestly cut off. In this case, the only indication for amputation may simply be the presence of uterine fibroids, even if it does not give any symptoms, even if the myomatous node is small and does not interfere with anything.
The main idea of all that I have written above is that the patient with uterine fibroids is actually being misled. Taking advantage of the fact that the patient is not oriented in matters of medicine, she is not told about all the available methods of treatment for her disease, or is provided with negative and false data about the effectiveness of alternative methods of treatment - either intentionally or simply out of ignorance.
How to treat uterine fibroids?
First, I would like to list all currently available treatments for uterine fibroids:
- Drug treatment: GnRH agonists (zoladex, buserelin, diphereline, lucrine, etc.), progesterone receptor blockers (mifepristone)
- Embolization of the uterine arteries
- Conservative myomectomy (hysteroresectoscopy)
- Amputation of the uterus
Thus, in addition to removal of the uterus and passive dynamic observation, there are other methods of treatment.
Dimensions of uterine fibroids
Despite the fact that the classification of uterine fibroids by weeks of pregnancy is accepted all over the world, in my opinion, in the era of ultrasound diagnostics, this approach to determining the size of uterine fibroids is somewhat outdated.
Using ultrasound, you can measure the size of each myomatous node, count their number and determine the localization. Such a detailed description of the uterus, modified by myomatous nodes, is more informative than the conclusion - "uterine fibroids 8-9 weeks."
In addition, the choice of treatment method, the prognosis of the disease and the conclusion about the possibility of pregnancy depends on the size of the nodes and their localization.
Choice of treatment for uterine fibroids
Before describing each of the treatments listed above, let's discuss in what situations it is possible to allow a simple observation.
A very important thought! The myomatous node appears in the uterus not immediately large, it grows from the rudiment and at the very beginning it cannot be detected even with ultrasound. Further, it increases in size and then the paths of all nodes diverge. Some nodes reach a certain size and stop growing, others slowly but surely continue their growth, and others can grow rapidly.
If there was only one node in the uterus, besides this node, new nodes may not appear. But there is another situation when the number of nodes increases.
No one knows how the node will behave - whether it will grow, stabilize, or disappear altogether. But you need to understand that fibroids have staging, and small nodes are actually the earliest stage of the disease, and large and very large fibroids are already advanced forms of the disease.
As you know, any disease is easiest to treat at an early stage - the treatment of uterine fibroids is no exception. Therefore, even if a woman accidentally discovers small myomatous nodes (no more than 2-2.5 cm) during ultrasound, letting such a patient go with the words: “we will observe, if fibroids grow, we will treat” is equivalent to the situation. When a patient goes to the doctor with complaints of coughing, and instead of treatment, the doctor says: “we will observe, pneumonia will develop, then we will treat it.” Absurd, isn't it?
It has long been known that modern hormonal contraceptives are able to inhibit the growth of small myomatous nodes, the size of which does not exceed 2-2.5 cm. body).
Thus, when small myomatous nodes are detected, even in the absence of symptoms of the disease, the patient should be offered to take modern monophasic contraceptives. In the same case, if they are contraindicated to her, or the patient categorically objects to taking them, dynamic monitoring of the growth of myomatous nodes can be allowed, but ultrasound should be performed at least 1 time per year. If the nodes began to grow, then treatment should be started immediately and not wait for their further increase, even if there are no symptoms of the disease.
Reception of oral contraceptives can be replaced with a special intrauterine hormonal system "Mirena". This is actually an ordinary intrauterine device, but containing a container with a hormone that is released in small doses into the uterine cavity for 5-6 years. It is for this period that this system is put. She, as well as oral contraceptives, inhibits the growth of myomatous nodes.
In what other cases can you observe fibroids and do nothing?
There is no single answer here, the decision must be made individually. Too many criteria should be taken into account when making such a decision (and the localization of the node, its size, the age of the patient, the degree of blood supply, the presence of reproductive plans, the presence of other diseases, etc.)
Thus, it is possible to allow dynamic monitoring of uterine fibroids only by evaluating many facts.
Before proceeding to describe the methods of treating uterine fibroids, it is necessary to tell what nodes are and what is the main idea of treating this disease.
What are uterine fibroids?
Myoma nodes can be located in different parts of the uterus.
- Actually outside the uterus, "grow on a stalk"
- Part of the node outside the uterus, and part in the wall
- In the wall of the uterus
- In the wall of the uterus, but grow towards the cavity
- And nodes that protrude into the uterine cavity to varying degrees, some nodes can be completely in the uterine cavity “on a leg”
There are also other localizations, but they are extremely rare.
The closer the node is to the uterine cavity, the more likely it is to cause symptoms of the disease in the form of heavy long periods, pain and interfere with the development of pregnancy. Accordingly, the more external the node, the less it manifests itself, except when the node is large enough and squeezes neighboring organs (bladder or rectum)
Further, the closer the node to the uterine cavity, the more significant its size. I explain - even a small nodule in the uterine cavity can cause prolonged heavy menstruation, while a large nodule outside the uterus can remain asymptomatic for a long time.
Therefore, the choice of treatment method depends not only on the size and number of nodes, but also on their localization.
What is the main idea of the treatment of uterine fibroids
The uterine fibroid nodule can be reduced, fixed in size, and removed.
Reduces the size of fibroids Two types of treatment - drugs and uterine artery embolization (indirect, focused ultrasound)
Each node has its own limit, below which it cannot decrease. In other words, "dry residue". I often give the example of an apple that is turned into a dried fruit - the larger the apple initially, the more dried fruit it will turn out, the juicier it was, the more it will decrease when dried.
With a myomatous node also. Large nodes, as a rule, decrease worse and mainly due to the fact that the content of connective tissue begins to prevail in their structure, which is practically not amenable to regression. However, there are also small nodes, almost entirely consisting of connective tissue - fibromyomas. Fibromyomas also shrink poorly, with juicy large ones regressing to more than 80% of their original size.
On average, after the treatment, the myomatous node decreases by 40%. When choosing a treatment method, this should be taken into account. It is not rational to medically reduce the size of the 8 cm node, since the remainder will be a 5 cm node, which will also remain clinically significant, especially if this node grows towards the uterine cavity.
Medical treatment of uterine fibroids
Important! Uterine fibroids cannot be treated with Duphaston. Progesterone (duphaston is its analogue) is the main factor in the growth of fibroids (this has been proven more than 10 years ago) - who does not believe, see Western scientific publications.
Despite this, Duphaston continues to be prescribed everywhere for patients with uterine myoma - well, how can you? Below it will be said about the drug Mifepristone (progesterone receptor blocker) - this drug reduces the size of uterine fibroids only due to that. What prevents progesterone from exerting its effect on uterine fibroids. That is, no progesterone - no growth of fibroids.
Duphaston is categorically contraindicated for the treatment of uterine fibroids! Duphaston grows fibroids, and after you are sent for an operation under the sauce “treatment did not help, the nodes grow, it is necessary to cut it off, no matter how bad it is.”
These drugs (Zoladex, Buserelin, Diferelin, Lucrin-depot, etc.) introduce a woman into artificial menopause, against which there is a decrease in myomatous nodes. In addition, they have a direct effect on uterine fibroids. GnRH agonists block the local production of hormones in the nodes (supporting the growth of nodes) and the synthesis of connective tissue (the accumulation of which also leads to an increase in size).
The drugs are administered intramuscularly once every 28 days. Usually the course of treatment is from 3 to 6-7 months. Side effects develop differently for everyone - from mild "hot flashes" to relatively severe conditions. After the end of treatment, the myomatous nodes may begin to grow again, therefore, such drugs should not be prescribed in isolation. To stabilize the results achieved after a course of therapy with GnRH agonists, hormonal contraceptives are prescribed or the Mirena spiral is introduced.
It is advisable to use GnRH agonists for only small myoma nodes up to 3-5 cm, then after reduction, the size of the nodes will remain clinically insignificant, and it will be easier to stabilize them with the help of contraceptives or Mirena. Prescribing GnRH agonists to large nodes is not rational; there are other treatments for such nodes.
GnRH agonists should not be given at all before surgery to remove fibroids. It is believed that after such preparation, the volume of surgical blood loss decreases and the reduced node is easier to remove. In fact, the volume of blood loss is indeed reduced, but at the same time, the myomatous node is, as it were, “soldered” into the surrounding muscle tissue of the uterus, which makes it difficult to exfoliate. The most negative consequence of the preoperative administration of GnRH agonists is that, during treatment, small myoma nodes become even smaller and cannot be detected during surgery and, accordingly, removed. It is from these left small nodules that new nodes are subsequently formed and the disease recurs.
GnRH agonists should be given after fibroid surgery to allow the uterus to fully recover and suppress any remaining fibroid buds.
Progesterone receptor blockers
Currently, there is only one drug from this group - mifepristone. It is known that it is the female sex hormone progesterone that is the most powerful factor in the growth of uterine fibroids. Mifepristone blocks all binding sites of this hormone on uterine fibroid cells, thus preventing it from realizing its effect.
Against the background of taking this drug, the size of myomatous nodes decreases in the same way as with the use of GnRH agonists. The drug is better tolerated. It is also advisable to prescribe mifepristone only in the presence of small myomatous nodes.
Embolization of the uterine arteries
What is uterine artery embolization?
The term "embolization" means blockage of the blood vessels that feed the organ, which leads to the cessation of its blood supply.
The essence of the technique of uterine artery embolization (UAE) is as follows: the uterus is mainly supplied with blood by four arteries: the right and left uterine arteries and the right and left ovarian arteries.
The share of uterine arteries in the supply of the uterus with blood is the main one. Now imagine that you will drastically reduce the watering of your favorite ficus to a minimum - it is obvious that very soon it will simply dry out. Similarly, an organ that has lost a significant share of its blood supply gradually begins to decrease in size, only there is one caveat. Uterine fibroids also feed from the uterine arteries, but since it was formed later than the uterus grew, the system of blood vessels in it is not perfect and vicious (“made hastily and not thought out in case of any violations”).
Thus, the cessation of blood supply to the uterus through the uterine arteries becomes “lethal” for fibroids, but not for healthy uterine tissue. Since the presence of a normal circulatory network in it allows it to “exist” due to the flow of blood through the ovarian and other small arteries. In other words, the cessation of blood flow in the uterine arteries leads to the “shrinkage” of fibroids, but practically does not affect the functioning of healthy uterine tissue.
As a result of this procedure, already after three months, the volume of fibroids decreases by an average of 43%, and in a year - by 65%. Abundant long painful periods with clots by the second or third month after UAE in 90% turn into short moderate or even meager, painless periods. Most importantly, after this procedure, uterine fibroids rarely recur. EMA is a self-sufficient method. After this procedure, there is no need to take any medications and procedures - you solve the problem of uterine fibroids once and for all.
How does this procedure take place?
It is interesting!
How uterine artery embolization works in the Perinatal Medical Center (video from the operating room). Now you can see everything with your own eyes.
Under local anesthesia (this is more than enough), a puncture of the right femoral artery is performed (the same as an intravenous injection only on the leg), and a catheter is inserted.
Then, under the control of a special X-ray machine, they alternately enter the right and left uterine arteries, and a suspension of microparticles (balls with a size of 300-700 microns) is injected into each of them. These particles will block the blood flow in the uterine arteries.
This procedure usually takes from 15 to 40 minutes and occurs without anesthesia - as it is simply not needed. Throughout the procedure, the patient does not experience any pain.
After the procedure is over, the patient returns to her room, where she remains until the morning. Some time after the procedure, pain (drawing character) appears, resembling pain during menstruation. The severity of pain is different - from mild to moderate, sometimes quite strong. Painkillers are prescribed to relieve pain. By morning, the pain usually disappears completely. In the next 5-7 days, a condition resembling a mild cold may be observed, that is, fever, weakness, drowsiness. Most often, women spend this time at home and after it they can go to work. Already after one menstrual cycle, you can feel the effect of the procedure.
Embolization of the uterine arteries can be performed for any size and localization of myomatous nodes. It is advisable to perform this procedure even in the presence of small nodes, in fact, for a preventive purpose, so as not to take contraceptives and not worry that one day the nodes will begin to grow. For large nodules, embolization alone may be enough (the nodules in the uterus may remain large enough, but they will not grow further and there will be no profuse bleeding) or embolization will be the initial step before surgery to remove fibroids, especially in women. Planning pregnancy.
The combination of uterine artery embolization with subsequent removal of the remaining nodes is an approach that allows you to restore reproductive function in women with the most complex variants of uterine fibroids.
These are situations when the uterus is actually “stuffed” with fibrous nodes of various sizes and it is not possible to remove all the nodes without risk for the uterus and the patient. 6-8 months after embolization of the uterine arteries, the number of nodes decreases, the remaining nodes are clearly delimited from the surrounding myometrium, the contour of a normal uterus begins to be drawn, and the cavity is leveled. It becomes easier to remove nodes from such a uterus, blood loss is sharply reduced, after removal of all nodes, the uterus quickly acquires its original size.
Is it possible to get pregnant after uterine artery embolization and is this procedure performed on nulliparous women?
Yes, you can! And this is proved by the increasing number of children around the world every year, born to women who have undergone uterine artery embolization.
Already within a few months after embolization, the blood flow in the uterus is restored in full. Ovarian function in young women does not suffer, despite the fact that during embolization, emboli enter the bloodstream of the ovary.
A decrease in ovarian function can be observed in women mainly over 45 years of age. The radiation dose during the procedure does not exceed the allowable values (this has been shown in large Western studies)
Of course, after embolization of the uterine arteries, not so many children are born, but this is due to the fact that the vast majority of women with uterine fibroids are over 35 years old, and many have already given birth to children or by this age they have additional factors of infertility (for example. Obstruction of the uterine tubal or male infertility).
Uterine artery embolization and submucosal uterine fibroids (submucosal)
The effect that uterine artery embolization has on submucosal myoma nodes can be called unique. Submucosal nodes are nodes that grow into the uterine cavity and deform it to varying degrees.
Before the advent of uterine artery embolization, such nodes were removed using hysteroresectoscopy (a large operation that is performed through the vagina - with a special tool, the myomatous node is cut in small pieces from the wall of the cavity). This operation is still being carried out. The maximum size of the node for the possibility of this operation is 5 cm. With large sizes, they most often insist on removing the uterus. Hysteroresectoscopy is most justified in the presence of small nodules that grow in the uterine cavity, as if “on a leg”.
After embolization of the uterine arteries, the myomatous node or nodes begin to gradually move into the uterine cavity, where it begins to disintegrate. The disintegrating myomatous node gradually flows out of the uterine cavity and then is completely pushed out of the uterus. Thus, the uterus, as it were, rejects the knot from itself, while already a few weeks after that it is impossible to find a single sign that this knot was in the uterus - complete healing occurs without a trace.
Against the background of such a disintegration of the node, a woman, as a rule, has an increase in temperature, weakness, malaise, periodic pulling pains in the abdomen. This condition can last for several weeks (depending on the size of the node or nodes), but in general it is relatively easy to tolerate. After removing the knot, the woman's condition becomes normal within one day. In my practice, the maximum size of a node that was cured in this way was 12 cm.
Who speaks badly about uterine artery embolization and why?
As a rule, bad reviews about uterine artery embolization are:
- from doctors who have only heard about this method and have never seen it (well, rumors are different)
- for doctors who are engaged in operations to remove the uterus and fibroids - this is their main income and embolization acts as a competing method
- from extremely conservative doctors who like to treat "the old fashioned way"
- in doctors who had to deal with complications after uterine artery embolization (they happen extremely rarely with the correct operation and proper management after)
- in patients who underwent this procedure poorly or had complications (as you know, there is no medicine without complications, but they are often silent about the successes of doctors, but I always talk about complications)
Thus, uterine artery embolization is a very successful self-sufficient method of treating uterine fibroids, which has already saved many women from hysterectomy and allowed them to give birth to full-fledged children.
Remember! Every time you are offered to remove the uterus for fibroids, do not rush to agree, you will always have time to remove the uterus. Embolization of the uterine arteries is a worthy alternative to this operation.
Removal of uterine fibroids or conservative myomectomy
This operation was proposed about a hundred years ago and so far the possibility of this operation is hushed up. Technically, this is a rather complicated operation, and not all gynecologists are proficient in it. Removing the uterus is much easier.
Most often, this operation is performed to realize the reproductive function. You can get pregnant 6 months after this operation. With a large number of nodes and a high risk of losing the uterus during the operation, embolization of the uterine arteries is performed six months before this operation. Then the outcome of the operation is almost always successful. In order to prevent recurrence of the disease and enable the uterus to recover better after surgery, a course of therapy with GnRH agonists is prescribed for 3-6 months.
What is the best method for removing fibroids?
There are two options for conservative myomectomy - laparoscopic and laparotomy. In the first case, the operation is performed using special instruments inserted into the abdominal cavity under the control of a video camera; in the second, the operation is performed by the surgeon's hands in the abdomen.
Laparoscopic myomectomy requires a very high skill of the surgeon, as he must sew the uterus well so that it can withstand pregnancy and childbirth. This is not an easy task. Many cases of uterine ruptures during pregnancy and childbirth after poorly performed operations have already been recorded. Laparoscopic access is most indicated in the presence of nodes growing outside the uterus "on a leg".
The advantages of laparoscopic access include a quick recovery period, less likelihood of adhesions, less blood loss during surgery. But I repeat once again, in Russia there are only a few dozen surgeons who have sufficient experience and qualifications to fully perform this operation in the presence of several nodes in the uterus and when they are located in the wall and closer to the cavity. The names of these surgeons are usually widely known. You may be offered to do such an operation in any clinic, but just remember that you can only check the quality during pregnancy and childbirth, and it may be too late there.
Still, the uterus must be sewn by hand. Neatly, layer by layer, matching all the layers. This allows you to do an abdominal operation. In addition, during abdominal surgery, there is a more complete opportunity to feel the entire uterus with your fingers and find small myomatous nodes and remove them. The tool doesn't work that well.
Therefore, I believe that the removal of myomatous nodes, if these nodes are located in the wall of the uterus, they are large or there are a lot of them, should be done with an open operation. This will allow with greater confidence to guarantee the complete removal of myomatous nodes and better and more reliable suturing of the uterus.
When should the uterus be removed for uterine fibroids?
Only in very advanced cases, when the size of the uterus is very large and the uterus is completely stuffed with knots, so that it is impossible to find healthy uterine tissue in the uterus. And a few more situations that do not occur so often.
It's a shame, because many women themselves run their disease to such an extent. They see that their belly is growing, they do not visit a gynecologist for 10 years, and some even more, and actually come when their disease reaches a stage when organ-preserving treatment is no longer possible. Some women avoid going to the doctor because they are offered to remove the uterus from the very beginning without being told about the available alternatives. Afraid of losing their uterus, these women grow fibroids for years and only come to see them when the huge uterus in their stomach prevents them from leading a normal life. They come to surrender - doomed, sad and with a strong longing in their eyes. And the worst thing is that if they knew that there were other treatments, and came to the appointment a few years earlier, they could have used them and saved the uterus.
Why should you not remove the uterus and fight for it to the end?
The attitude to the uterus, as an organ that is intended only for childbearing, actually makes it so easy to make a decision to remove it. In fact, the uterus is an organ integrated into the entire reproductive system of the body and its removal does not go unnoticed.
It is known that after the removal of the uterus, the risk of breast and thyroid cancer increases. In addition, during the removal of the uterus, there is a violation of the blood supply to the ovaries, which entails the development of the so-called "posthysterectomy syndrome". This syndrome is similar to that observed in menopausal women. It often happens that after the removal of the uterus, a woman begins to “age” quickly, her body weight increases, and the quality of life changes for the worse.
Sexual life can also change. On this occasion, Western scientists have conducted a number of studies, and their results were controversial. It was noted as an improvement in sexual life after amputation of the uterus (apparently these are those women who were exhausted by the disease they had) and those who completely lost the pleasure of sexual life. There are no reliable data and this is most likely due to the fact that the formation of sexual sensations in a woman is extremely complex and it is very difficult to evaluate it from all positions.
If you still decide to remove the uterus, then you must remember that in order to prevent the development of post-hysterectomy syndrome (early aging), from the next day after the operation, you must start taking a special drug Livial. Which will allow leveling the development of this pathological condition.
High Frequency Focused Ultrasound
This method has appeared relatively recently. The meaning of this method lies in the fact that under the control of MRI (tomography) a stream of ultrasound is aimed at the myomatous node. In the center of the node, tissues are heated to a high temperature and the node dies.
On the one hand, this method is very good. The impact is through the skin, that is, generally contactless, but there are several nuances:
- the method is very expensive (this is due to the fact that the equipment for its implementation costs many millions of euros and this must be paid back)
- it is possible to act on one or at most several nodes of fibroids
- at the same time, there should not be a lot of fat, scars and scars on the anterior abdominal wall
- at the same time, the nodes should be well located - that is, there should not be large obstacles on the path between the node and the beam flow
- uterine myoma nodes have different sensitivity to this effect, some nodes do not decrease at all after this procedure
- During the procedure, the patient must lie motionless on her stomach for several hours.
Thus, the method has many limitations and inconveniences. At a time when there is embolization of the uterine arteries, in which the impact is on all myomatous nodes at once. There are no such a large number of restrictions and this method costs half as much - the use of focused ultrasound is advisable only for scientific purposes.
I don’t believe in homeopathy, dietary supplements, etc.…..
Can uterine fibroids stop being one of the most pressing problems in gynecology? - MAYBE!!! How ? - everything is very simple!
It is necessary from the earliest youth to regularly do an ultrasound scan - once a year, and if a myomatous node is detected - immediately take measures (take contraceptives, do embolization). It is absolutely unacceptable to observe how the fibroids grow.
Regular examination by a gynecologist with ultrasound is the best prevention of problems associated with uterine fibroids.