Myomas

What is fibroid?

Fibroids – This is a benign tumor that occurs in the muscle layer of the uterine wall. Fibroids come in different sizes and can even become large, causing displacement of the uterus and surrounding organs. Often, several fibroids can develop in the same uterus. Depending on their location in the uterine wall, fibroids are divided into three types.

How common are fibroids?

This pathology affects 20 to 40% of women over 35 years of age!

What are the causes of fibroids?

Doctors still do not know the reasons for their appearance, but studies indicate a connection with the following factors:

• heredity: the risk of occurrence increases if there is a family history of fibroids;
• early onset of menstruation;
• obesity;
• diet high in fat and low in vegetables and fruits;
• vitamin D deficiency;
• hormones, especially estrogen and progesterone, influence the size of fibroids, and there is evidence of an excess of receptors for these hormones in tumor cells. Size is influenced by other growth factors (such as the insulin-like growth factor IGF1 and the extracellular matrix ECM).

What are the symptoms of fibroids?

• bleeding, sometimes profusely, especially during menstruation;
• in 2-10% of cases, fibroids lead to infertility;
• pain and heaviness in the pelvic area;
• urinary problems, such as urgency and incontinence, and urinary tract infections;
• constipation;
• pain in the back and legs.

How are fibroids diagnosed?

• sometimes the diagnosis is made by chance during a gynecological examination;
• When symptoms of fibroids appear, the gynecologist sometimes requests additional tests:
  • Ultrasound (ultrasound sonography allows you to get a good image of the entire uterine cavity and the features of fibroids);
  • MRI (a study that provides a reliable picture of the size and location of fibroids, which helps plan treatment);
  • hysteroscopy (examination using a small optical instrument, a hysteroscope, inserted into the uterine cavity);
  • Additional tests, such as blood tests, to rule out anemia due to bleeding

What treatment options are common today?

If the fibroids are small and without significant symptoms, then further observation is the best option.

If the symptoms are severe and the fibroids need to be removed, most patients are usually offered options such as partial or complete surgical removal of the uterus. This carries the risk of complications after anesthesia, a long recovery period, and the inability to conceive a child in the future. Moreover, from 10 to 30 percent of cases after surgery are accompanied by recurrence of fibroids.

Are there other options besides fibroid resection?

Yes!

• Drug treatment. It is offered to women suffering from heavy bleeding. To reduce bleeding, hormone replacement therapy and intrauterine hormonal systems are used. However, this will not eliminate fibroids completely.
• Coagulation with ultrasonic waves under MRI control allows you to eliminate the tumor.
• The goal of this minimally invasive option – cut off the blood supply to the tumor and thus actually cause it to shrink in size until it disappears completely. This occurs when the artery supplying the tumor is blocked by small particles. The operation is performed by catheterization through a small puncture in the groin or arm under imaging guidance, which provides real-time monitoring of the procedure and does not require general anesthesia. The operation lasts from an hour to an hour and a half.

What happens during the procedure?

The patient lies on an operating table and is connected to screens that monitor her pulse, blood pressure and blood oxygen levels. The surgery is performed by an invasive radiologist who uses local anesthesia to numb the access site, usually in the groin area. Mild sedatives may also be used. Then the doctor creates an access through which he inserts a thin tube (catheter) into the artery and delivers it to the treatment site. A small amount of contrast agent is injected so that the invasive radiologist can clearly see the arteries supplying the fibroid on the x-ray and determine where they should be closed (embolized).

When the doctor sees the arteries supplying blood to the fibroid, he releases tiny particles of a substance that cause embolization of the desired arteries.

Once the arteries supplying the fibroid are blocked, the blood flow to it stops, and in the future it will gradually decrease. After completing the procedure, the catheter is removed and a pressure bandage is applied to the puncture site.

How is the recovery process going?

After embolization, you will be able to be discharged home the next day or the day after, and after a few more days you will be able to return to work. A dull pain in the lower pelvis is expected for several days after the procedure. In the first 24 hours after the procedure, pain can be significant, so the patient usually remains under observation in the department for pain relief. Before the procedure, a method will be chosen to relieve this pain. One of the options is to install an epidural catheter (as during childbirth) and administer an anesthetic through it on the first day after treatment.

Fibroids decrease gradually over several months, which leads to significant improvement and even disappearance of symptoms.

What are the advantages of this method?

Firstly, it allows you to avoid surgery and subsequent long-term hospitalization, promotes rapid recovery and return to your normal lifestyle.

Second, it is estimated that pain and bleeding are successfully controlled in approximately 90% of cases.

Finally, it helps to maximize the preservation of normal uterine tissue and preserve the chance of becoming pregnant in the future.