Myoma: risk factors of
Several years ago the diagnosis “uterus myoma“ sounded as a sentence. It doomed the woman to painful expectation of operation. Fortunately, today the situation essentially changed: myoma can be cured!
If the tumor increased or became the reason of other complications, doctors usually suggested to delete a uterus. Meanwhile in the nature of “excess“ bodies does not happen, and removal of the principal women`s organ involves violation not only physiological, but also psychological balance. Long time myoma of a uterus was considered as a benign tumor which, as well as any similar new growth, can regenerate in malignant over time. Therefore fought against it in the radical way - operated, most often completely deleting body.
B 90 - x years as a result of researches scientists found out that as the cages forming it myoma of a uterus is not a typical benign tumor and, respectively, in a malignant tumor not changed uterus tissue regenerates also seldom, as well as.
So, in most cases does not have need for urgent operation. Then there were methods of early diagnosis of a disease and prevention of development of myoma of a uterus and not operational ways of treatment. And now scientists are unanimous in what myoma of a uterus is possible and it is necessary to treat. And the earlier to begin treatment, the result will be better. Operation on removal of a uterus is necessary only in the most started cases.
of the Reason of developing of myoma
of Violation of a hormonal background not always matter: myoma of a uterus is formed also at women with absolutely normal hormonal background.
the Nature created the woman for a reproduction. Her life had to consist of series of pregnancies, feedings and childbirth. Ideas of mission of the woman changed, but every month the organism of the woman is adjusted on pregnancy. In the second phase of a cycle the uterus increases in sizes a little, preparing for the forthcoming pregnancy. But pregnancy does not come, and the “disappointed“ organism comes back to a usual state. Repeated “failures“ of this difficult process lead to accumulation of “mistakes“. Diseases, infections and medical interventions only aggravate a situation.
one more opinion Is: emergence of myoma is connected with traumatizing a uterus repeatedly repeating periods. According to the plan of the nature the woman needed to endure no more than fifty periods about all life. The modern woman endures them ten times more.
of Figure and the factswas considered Earlier that myoma of a uterus occurs at 30% of women 35 years are more senior. Now it is known that myoma of a uterus develops at more than 80% of women, but in most cases the disease proceeds asymptomatically. Nearly 80% of all operations in gynecology are performed concerning uterus myoma. In 90% of cases the uterus is removed. At every third Russian woman after 55 years the uterus in connection with the diagnosis “uterus myoma“ is removed. Average age of women which the uterus from - for existence at them of myoma is removed, - 42 years.
Symptoms and diagnosis of myoma
Most often at an initial stage the disease proceeds asymptomatically. But at this stage it will best of all respond to treatment. Therefore annual visits to the expert have to become a norm of life. At later stages typical symptoms can appear:
- long and plentiful periods,
- acyclic (that is occurring besides periods) uterine bleedings,
- the pain in the lower departments of a stomach “giving“ to a waist.
. Large (it is more than 3 - 4 cm) miomatozny knots can be found usual probing of a uterus. Small (less than 2 cm) are visible when carrying out ultrasonography. By means of ultrasonography it is possible to measure the size of each miomatozny knot, to count them and to define localization.
to Observe or treat?If small (no more than 2 - 2,5 cm) knots are incidentally found by
when carrying out ultrasonography and have not an effect in any way, it is possible to do temporarily without treatment and to watch behavior of knots. At this ultrasonography it has to be carried out at least once a year. If knots grow, then it is necessary to begin at once treatment and not to wait for their further increase even if symptoms of a disease are absent.
However, also the second option is: to appoint drug treatment at once. Modern hormonal contraceptives successfully contain growth of small miomatozny knots which size does not exceed 2 - 2,5 cm. The intrauterine hormonal system of “Mirren“ can become alternative to oral contraceptives. It is a usual intrauterine spiral, but it contains the container with hormone which in small doses is gradually released in a uterus cavity within 5 - 6 years.
of Figure and the facts4% of pregnancies proceed against uterus myoma. At the same time in 50 - 60% of cases minor changes in the sizes of miomatozny knots are observed: according to different scientists, at 22 - 32% of pregnant women growth, and at 8 - 27% - reduction is noted them. At the pregnancy proceeding against myoma of a uterus, complications are observed in 10 - 40%. This interruption of pregnancy, premature birth, damage of a fruit and a hypotrophy (lag in growth). And still the majority of pregnancies with myoma of a uterus proceeds normally. Quite often knots interfere with the correct reduction of a uterus in the course of childbirth therefore about a half of pregnant women with myoma of a uterus are directed to Cesarean section
by Methods of treatment of myoma of a uterus
Myoma of a uterus can be reduced, stabilized in a size and to remove.
can Reduce miomatozny knots two types of treatment: medicamentous preparations and embolization of uterine arteries (EUA). But absolutely the knot cannot disappear, everyone has the limit. The general rule is as follows: big knots give in to “reduction“ worse. In them the share of connecting fabric which is not giving in to regression (the return development) is, as a rule, big. Here the analogy to apple which is turned in sukhofrukt is pertinent: the more apple, the big will turn out from it sukhofrukt, the it was more juicy, the more it will decrease when drying.
- of of the Embolization of Uterine Arteries (EUA)
the Term “embolization“ means a blockage of the blood vessels feeding body that leads to the termination of its blood supply. Blood supply of a uterus is provided by four arteries. Two of them - uterine - feed also miomatozny knots. The termination of blood supply of a uterus through uterine arteries becomes pernicious for myoma, knots “dry out“, and healthy tissue of a uterus continues to eat normally due to intake of blood on two other arteries - yaichnikovy - and to other small arteries. Main plus of this method: after carrying out EMA there is no need to take medicine and procedures - you solve a uterus myoma problem once and for all. Removal of knots of myoma of a uterus This operation is known to
more than hundred years, but doctors resort to it infrequently and rather reluctantly: technically it is quite difficult and not in all clinics there are surgeons owning such equipment.
Most often carry out a miomektomiya to the young not giving birth women to keep a uterus. There are two options of operation: laparoscopic when it is carried out through a small cut with use of special tools under control of a video camera, and laparotomichesky, or strip when operation is carried out by the surgeon hands.
Unconditional advantages of a laparoscopic method - smaller blood loss and fast restoration after operation. But he demands very great skills of the surgeon. The most difficult - “qualitatively“ to sew a uterus that seams did not disperse during pregnancy and childbirth. In Russia, doctors, only several tens surgeons who are masterly carrying out this operation at difficult located knots recognize.
When carrying out band operation the surgeon has an opportunity to accurately sew a uterus. Besides small miomatozny knots are often probed and there is an opportunity to remove also them. The tool it turns out not so effectively.
- the High-frequency focused ultrasound
the Essence of this recently appeared method is that under control of MRT (tomography) aim an ultrasound stream at miomatozny knot. In the center of knot there is a warming up of fabrics to high temperature, and he perishes. Plus method: contactless influence. At the same time there is a set of restrictions, contraindications and inconveniences.
Try to keep a uterus
the Uterus expediently to delete only in very started cases when it “is stuffed“ with knots - so that it is impossible to find healthy fabric.
Idea of a uterus as about the body intended only for a child-bearing also became hopelessly outdated long ago. Removal of a uterus does not take place completely for an organism as it influences the hormonal status of the woman. After removal of a uterus the risk of development of cancer of dairy and thyroid glands increases, the syndromes similar to those which are observed at women in the climacteric period develop. After removal of a uterus the woman begins to grow old quickly, the mass of her body increases, sexual life often worsens and quality of life in general decreases. Therefore for prevention of development of a syndrome of early aging from the next day after operation it is necessary to begin to accept a special hormonal preparation (the doctor appoints).
the Comment of the expert
Dmitry Lubnin, the doctor the obstetrician - the gynecologist, to. m of N, consultant of clinic of a reproduction “Children from a test tube“.by
When resolves an issue of need of removal of knots at the woman planning pregnancy, each concrete situation the doctor considers individually. There has to be a clinical expediency in purpose of surgical intervention, it is very important to define a ratio of advantage and risk. Removal of miomatozny knots though restores integrity and functionality of body, but at the same time is accompanied by the known complications and consequences for reproductive system: the solderings which appeared as a result of operation can become the infertility reason, and the set of the seams on a uterus which appeared during removal of a large number of knots, to have an adverse effect at childbirth. For the woman in whom small external knots are found and there were no pregnancy attempts yet, there has to be a chance of pregnancy without preliminary surgical intervention. whetherInformation to reflection Interferes with
pregnancy myoma? Scientists and doctors finally agreed in opinion that myoma in itself cannot be the reason of infertility. Another thing is that removal of myoma increases probability of conception in case all other possible causes of infertility are removed. Small knots, as a rule, do not interfere with conception and normal course of pregnancy. And even at women with knots of the big sizes there comes pregnancy which quite safely proceeds and comes to the end. The main thing - the woman has to be under constant medical control.
the Main indications to carrying out operation on removal of miomatozny knots at the women planning pregnancy is a habitual not incubation of pregnancy big knots with the expressed growth towards a uterus cavity, existence of myoma as an alleged cause of infertility, late reproductive age.by
If in the women planning pregnancy found multiple mixed knots, approach in two stages is more preferable: at the beginning EMA is carried out, and in 6 months the issue of carrying out operation on removal of knots is resolved. At such approach small knots disappear, and large become available to accurate carrying out a conservative miomektomiya.