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Uterine fibroids, monitors their progress

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Miomatosis uterina

Fibroids, or leiomyomas, are benign tumors that form as a result of altered proliferation of muscle fibers of the myometrium (muscle layer of the uterus), and are the most common benign female genital tract neoplasia.
Fibroids may be asymptomatic and what it is uncertain of its actual impact, but estimates show that one in four women of reproductive age, affecting 20-40% of women over age 30.
Uterine fibroids usually diagnosed in the third and fourth decade of life. Fibroids are very rare before puberty and after menopause did not show new fibroids and having the patient at the time, are likely to diminish in size but did not disappear. If they grow after menopause is a sign that is occurring secondary degeneration, which in some cases (at least) could be a malignant tumor transformation (leiomyosarcoma).

Causes of fibroids

The causes of fibroids appear are not known, although there have been certain predisposing factors uterine fibroids as:
  • Blacks (50% versus 25% in whites).
  • Nulliparous women.
  • Heredity. It seems that there may be some sort of hereditary influence, because often occur in women of the same family.
  • Hormonal factors. The amount of estrogen is increased in women with uterine fibroids.

Types of fibroids

The characteristics of the fibroids are:
  • Number: can be single or multiple, which is more common.
  • Size: highly variable, from very small to some that weigh several kilos (the largest removed weighed about 60 kilos).
  • Location: usually located in the uterine body, but could be in any area of the uterus.
Uterine Fibroids body formed by a pathological proliferation of the muscle layer, but its growth can develop into the abdominal cavity (subserosal fibroids), to the uterine cavity (submucosal fibroids), or stay in the thickness of the myometrium (intramural fibroids ). These are the types of fibroids:
  • Subserosal fibroids: up 40% of uterine fibroids. They can reach a considerable size without producing symptoms, or disclosed by a mechanical complication to compress adjacent organs.
  • Intramural myomas: are the most common (55%), proliferating in the central portion of the myometrium, and producing an enlarged uterus.
  • Submucosal fibroids: are the least common but most symptoms are given, as they often cause increased menstrual bleeding, which in some cases can be very abundant, and cause problems for the patient and iron deficiency anemia. Moreover, these are the ones most likely to become malignant.

Symptoms of fibroids

Fibroid symptoms depends on the location, size and direction of tumor growth. About half of the cases are asymptomatic and do not constitute any risk for women. In other women, these symptoms are usually present:

Bleeding

It is the most common symptom of a uterine fibroid and is characterized by more abundant and prolonged menstruation, presence of clots often; however, the losses between periods other are rare, except submucosal fibroids, or in case that no other alterations in the associated endometrium.
bleeding can cause anemia of greater or lesser importance, depending on the amount of bleeding.

Pain

It occurs in 30% of cases. It may be acute, more or less intense and persistent, although it can also occur in chronically with a heavy feeling, especially when the woman is long standing.

Compression events

The increase in uterine size due to fibroids causes a pressure on neighboring organs such as rectum, bladder, ureters and intestine; well, discomfort may occur when urinating, urinary incontinence, constipation ...

Sterility and Infertility

Usually fibroids have no effect on fertility, but there are times when sterility compression and impaired functioning of the fallopian tubes occurs if the fibroids are very large, or in other cases they alter the endometrial cavity, preventing successful implementation and growth of the embryo.

Diagnosis of fibroids

The diagnosis of uterine fibroids is based on clinical history, physical examination, and imaging tests such as ultrasound.

Medical record

The patient may have bleeding, menstrual disorders and painful episodes. Occasionally, they may also appear or intestinal transit disorders of urination.

Physical Examination

With the scan can detect the size, shape and consistency of the uterus, and the presence of one or more fibroids, although obese, or that women do not relax enough, these scans can be difficult to assess. However, the findings should be confirmed with imaging tests.

Imaging tests

Ultrasound
Ultrasonography is the most useful for the diagnosis of myoma method because it allows us to specify its size, location and many of its complications
. transvaginal ultrasound (through the vagina) is what provides more information, but in cases where have large nodules, abdominal ultrasound helps to complete the exploration and sometimes is required.
's myoma easily located and, in cases of fibroids, the uterus may be so deformed that it is difficult to define its contour and cavity; Additional ultrasound to measure the size of the fibroid very accurately recognize the number of fibroids and make an overall assessment.
Abdominal and pelvic CT scan
The best is the clarity with which the anatomic relationships with adjacent organs are determined, and its possible negative impact on those bodies.
Nuclear Magnetic Resonance
Is the imaging technique most accurate for the detection and localization of uterine fibroids and displays very small tumors.
however, ultrasound remains the method of choice for uterine fibroids due to the high cost of MRI, and also not all centers have this method.

Treatment of fibroids

In the presence of fibroids, treatment is usually set up in the following cases:
  • When symptoms occur.
  • When you have a very large (more than 6 cm in diameter).
  • When they grow quickly.
Fibroids do not produce clinical and are of small size do not require any treatment and controls is only required every six months.

Medical treatment of uterine fibroids

Hormone treatments are used to reduce the size of fibroids and temporarily reduce symptoms. As estrogens influence the increase in the size of fibroids, is induced by drugs (GnRH agonists) similar to the hypoestrogenic state of menopause.
treatment with GnRH agonists lasts three to six months and is able to reduce the volume of fibroids between 30 and 60%, and about 50% uterine volume. However, after three or four months the fibroids return to their original size, so that treatment is indicated before surgery, to facilitate the same by reducing the size of fibroids, and perinenopáusicas women, which symptoms are relieved pending menopause.
To reduce symptoms such as bleeding are used progestogens and oral contraceptives . For pain NSAIDs are administered.

Surgical treatment of fibroids

Today, advances in endoscopic surgery have dramatically changed the surgical techniques in the treatment of these tumors, improving outcomes and decreasing the recovery period.
Hysteroscopic resection
It is the procedure of choice, especially in young women, and those who want to preserve reproductive function; Additional postoperative's quick, and hospital stay is usually less than 24 hours if there are no complications (such as bleeding or perforation). Also keep in mind that leaves the uterus restored, no scars, so you can regain functional capacity.
Laparoscopic operations
The laparoscopic approach allows extraction of myomas and coagulation thereof similar to those described in cases hysteroscopic resection, and also allows hysterectomies (removal of the uterus), and vaginal hysterectomies in cases where the patient has reproductive desire fulfilled.
Traditional surgery
Through an incision and opening in the abdomen or the vagina is made the extraction of fibroids.

Uterine fibroids during pregnancy

Between 0.5 and 4% of pregnancies coincide with fibroids, which tend to be unique but must be evaluated, as during pregnancy fibroids usually grow, are subject to more complications and can alter the development of pregnancy and during delivery.

Causes of fibroids during pregnancy

It seems that placental hormonal factor promotes the growth of fibroids during pregnancy, but only occurs in 20% of cases.

Diagnosis

The existence of the fibroid can be known before pregnancy. However, the diagnosis of myoma, and its growth is by physical examination and ultrasound, as in cases that occur outside of pregnancy.
During routine examination of pregnant might suspect the existence of fibroids when the uterus is larger than that of the length of gestation, and in some cases by palpating them.
Ultrasound, which is now a routine method, to see the number and size of fibroids and specify its location, and evolution during pregnancy. In particularly difficult cases, MRI can be used as it is safe for the fetus, and could allow a more accurate diagnosis.

Evolution of pregnancy, childbirth and puerperium

Fibroids, even those that are very large, are compatible with normal pregnancies and deliveries, but complications can occur naturally in any of the three trimesters of pregnancy, childbirth and after.
Complications in pregnancy
The greater the incidence of abortions by the difficulties of the fertilized egg to implant in the uterus.
  • Increase in premature deliveries (for the same reason as in the case above).
  • You can alter fetal development.
  • Fibroid degeneration may occur, and modified the positioning of this.
Birth complications
  • Bleeding.
  • Alterations in expulsion, if the fibroid blocks the birth canal.
  • Alterations in uterine contractility.
  • Changes in the presentation of the fetus.
Evolution after pregnancy
Fibroids usually decrease significantly in size to almost nothing, with the involution of the uterus after delivery. If this does not happen, we must evaluate the possibility of eliminating them before a new pregnancy.

Treatment of fibroids during pregnancy

During pregnancy, the conduct must be expectant, stepping in only in case of force majeure, if conservatively, ie the possible less invasive, not to affect the course of pregnancy.
At birth there is an increase in the number cesarean due to alterations in uterine contractions (ie, contractions), increased placenta previa and changes in the position of the fetus and the birth canal obstructions, as has been discussed.
Article contributed for educational purposes
Health and Wellness

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