Symptoms and treatment of anterior uterine fibroids

Uterine fibroids are a common benign tumor that often occurs on the anterior wall of the uterus. However, most women still do not know much about uterine fibroids and do not seek timely treatment when symptoms occur, thinking that they are just common gynecological diseases. Today, we will break everyone's perception and make most women pay attention to their health. Today, we will talk about the knowledge of anterior uterine wall fibroids to sound the alarm in the hearts of most women. Now let us understand what is going on.

Uterine fibroids, also known as uterine leiomyoma, are the most common benign tumors of the female reproductive system. Most cases are asymptomatic, while a few may present with vaginal bleeding, abdominal masses, and compression symptoms. It may cause pain if the pedicle is twisted or other conditions occur. Multiple uterine fibroids are common. The exact cause of this disease is unknown. Modern Western medicine uses sex hormones or surgical treatment, and there is no other ideal treatment. Uterine fibroids are prone to occur in women aged 30 to 45 with strong ovarian function. After the age of 50, due to the obvious decline in ovarian function, most fibroids shrink on their own.

1. Symptoms

Most of them have no obvious symptoms and are only occasionally discovered during pelvic examination. The onset of symptoms is closely related to the location, growth rate and degeneration of the fibroids, and has little to do with the size and number of the fibroids.

(1) Menstrual changes: the most common symptom. Large intramural fibroids increase the area of ​​the uterine cavity and endometrium, resulting in poor uterine contractions or excessive endometrial hyperplasia, which can lead to shortened menstrual cycles, increased menstrual flow, prolonged menstrual periods, irregular vaginal bleeding, etc. Submucosal fibroids often cause menorrhagia, and as the fibroids grow larger, the menstrual period becomes longer. Once the fibroids become necrotic, ulcerated, or infected, there will be persistent or irregular vaginal bleeding or purulent discharge. Subserosal fibroids and small intramural fibroids often have no obvious menstrual changes.

(2) Abdominal mass: Patients often complain of a distended abdomen and a mass felt in the middle of the lower abdomen. It is easier to palpate in the early morning when the bladder is full and pushes the uterus upward. It is hard and irregular in shape.

(3) Increased vaginal discharge: Intramural fibroids increase the area of ​​the uterine cavity, increase the secretion of endometrial glands, and are accompanied by pelvic congestion, resulting in increased vaginal discharge. Submucosal fibroids suspended in the vagina are susceptible to infection and necrosis, producing a large amount of purulent and bloody discharge and necrotic tissue discharge with a foul odor.

(4) Abdominal pain, backache, and lower abdominal distension: Patients usually do not have abdominal pain, but acute abdominal pain occurs when the pedicle of the subserosal fibroid is twisted. When the fibroids turn red, there is severe abdominal pain and fever. Lower abdominal distension and back pain are common and worsen during menstruation.

(5) Compression symptoms: Fibroids compress the bladder and cause frequent urination, urination difficulties, urine retention, etc. Compression of the ureter can cause hydronephrosis. Compression of the rectum can cause difficulty in defecation, etc.

(6) Infertility: 25% to 40% of cases are reported in the literature. It may be that the fibroids compress the fallopian tube, causing it to twist, or deform the uterine cavity, hindering the fertilized egg from implanting.

(7) Secondary anemia: Long-term menorrhagia leads to secondary anemia. In severe cases, there are symptoms such as general fatigue, pale complexion, shortness of breath, and palpitations.

2. Physical signs

It is related to the size, location, number and presence or absence of degeneration of the fibroids. Larger fibroids can be felt as hard, irregular, nodular masses in the abdomen. During gynecological examination, the uterus with intramural fibroids is often enlarged, with irregular surface, single or multiple nodular protrusions; subserosal fibroids can be felt as hard, spherical masses connected to the uterus with a thin pedicle and are movable; the uterus with submucosal fibroids is mostly uniformly enlarged, sometimes with dilated cervix, the fibroids are located inside the cervix or prolapsed into the vagina, are red, solid, and have a smooth surface. If infected, the surface is covered with exudate or ulcers are formed, and the discharge has a foul odor.

Treatment must be comprehensively considered based on the patient's age, fertility requirements, symptoms, size of the fibroids, etc.

1. Follow-up observation

If the fibroids are small and asymptomatic, usually no treatment is required, especially for patients near menopause. Estrogen levels are low and the fibroids may shrink or disappear naturally. Follow-up is required every 3-6 months. If the fibroids are found to be larger or the symptoms are obvious during the follow-up period, further treatment should be considered.

2. Drug treatment

For patients whose fibroids are smaller than the size of a 2-month pregnant uterus, whose symptoms are mild or not obvious, and whose patients are near menopause and whose general condition cannot allow surgery, symptomatic drug treatment can be given.

(1) Androgens: They can counteract estrogen, causing the endometrium to shrink, and directly act on smooth muscles to cause them to contract and reduce bleeding, and can also cause premature menopause in perimenopausal patients. Commonly used drugs: testosterone propionate 25 mg intramuscular injection, once every 5 days, 25 mg intramuscular injection during menstruation, once a day for a total of 3 times, the total amount per month should not exceed 300 mg to avoid virilization.

(2) Luteinizing hormone-releasing hormone analog (LHRHα): It can inhibit pituitary and ovarian function and reduce estrogen levels. It is suitable for the treatment of small fibroids (≤2 months of uterine size), heavy menstrual flow or shortened menstrual cycle, and menopausal or peri-menopausal patients. LHRHα is injected intramuscularly 150 mg daily for 3 to 6 months. After using the drug, the patient's menstrual volume decreases or becomes amenorrhea, anemia is gradually corrected, and the fibroids shrink, but they gradually increase again after stopping the drug and return to their original size. Side effects include symptoms of perimenopausal syndrome, such as hot flashes, sweating, vaginal dryness, etc. LHRHα should not be used continuously for a long time, as long-term use can cause estrogen deficiency and lead to osteoporosis.

3. Surgical treatment

If the fibroid is larger than the size of a 2.5-month gestational uterus or the symptoms are obvious and cause secondary anemia, surgical treatment is often required. The surgical methods include:

(1) Myomectomy: Suitable for unmarried patients under 35 years old or married patients without children who wish to preserve their fertility. Myomas are usually removed abdominally or laparoscopically. Submucosal fibroids protruding from the cervix or vagina can be removed vaginally or hysteroscopically. The base of the pedicle can be sutured with intestinal thread or clamped with a vascular clamp for 24 to 48 hours and then the clamp can be removed, or it can be directly removed.

(2) Hysterectomy: If the fibroids are large, the symptoms are obvious, drug treatment is ineffective, there is no need to preserve fertility, or there is suspected malignant transformation, subtotal hysterectomy or total hysterectomy can be performed. Women under 50 years old with normal-looking ovaries can keep their ovaries.

After reading the above description, have you learned something new? Therefore, women should pay attention to this aspect in daily life, maintain hygiene, and have regular check-ups. Married women should pay more attention and take extra care of their bodies. The body is the capital of revolution. If you have uterine fibroids, don't panic. We will treat it according to the doctor's steps. I hope the above knowledge can help everyone.