Uncovering the secret of the "troublemaker" in the uterus - uterine fibroids

The physical examination report came out these days, and 32-year-old Xiaomei was in an extremely bad mood because the report showed: multiple uterine fibroids and the possibility of degeneration.

Xiaomei was confused. I was still so young, how could I have a tumor? I haven’t gotten married yet, haven’t had a baby yet, and I still have loving parents who I haven’t repaid. Am I going to... I suddenly lost my appetite and couldn’t sleep at night.

Actually, there is no need to panic! One in five people has a tumor, so don't panic too much.

So , what exactly is uterine fibroids? Introduction to uterine fibroids

Uterine fibroids are the most common benign tumors of the female genitalia, and are common in women aged 30 to 50. According to autopsy statistics, about 20% of women over 30 have uterine fibroids. Although uterine fibroids are benign in most cases, they may cause many uncomfortable symptoms and affect the patient's quality of life.

The exact cause of uterine fibroids is still unknown. Fibroids are more common during the reproductive period, less common before puberty, and may shrink or disappear after menopause. Combined with medical research, it is considered that the occurrence and development of uterine fibroids are related to estrogen and progesterone.

According to the relationship between uterine fibroids and the uterine muscle wall, they are generally divided into: intramural fibroids (60-70%), subserosal fibroids and submucosal fibroids. The so-called multiple uterine fibroids refer to multiple uterine fibroids, including different types of fibroids.

Doctor, my report is different. It is possible that the fibroids may have degenerated after the injection. This is so scary. Do I have cancer?

Don’t panic! Most cases of myoma degeneration are benign lesions

Degeneration of uterine fibroids

Degeneration of uterine fibroids means that uterine fibroids lose their original typical structure. Most of them degenerate into benign changes, including hyaline degeneration, cystic degeneration, calcification and red degeneration. Most fibroid degeneration is asymptomatic, but red degeneration may cause severe abdominal pain accompanied by nausea, vomiting, fever, increased white blood cell count, and examination reveals enlarged and tender fibroids. This type is more common during pregnancy or the puerperium and is a special type of necrosis of fibroids. In addition, fibroids still need to pay attention to malignant transformation - sarcomatoid degeneration , and be vigilant when fibroids enlarge after menopause.

What are the common symptoms of uterine fibroids?

Uterine fibroids symptoms

Uterine fibroids usually have no obvious symptoms and are only discovered during physical examinations. Symptoms are related to the location, size, and degeneration of the fibroids. Common symptoms include:

1. Increased menstrual volume and prolonged menstrual period (most common), often seen in submucosal fibroids and large intramural fibroids;

2. Abdominal mass (fibroids enlarge and the uterus becomes larger than 3 months of pregnancy and can be felt from the abdomen);

3. Increased leucorrhea;

4. Fibroids compress the bladder and rectum, which may cause symptoms such as frequent urination, urgency, and constipation;

5. There may also be a feeling of heaviness in the lower abdomen, abdominal pain, back pain, etc. In addition, some patients may experience infertility or miscarriage.

Doctor, I checked online later and found that this disease can be cured after menopause and we don’t need to worry about it. Is that right?

It is possible, but not necessarily. Whether it can be cured or not cannot be left to fate . You should take medicine when necessary and have surgery when necessary.

If you have uterine fibroids, the treatment method should be comprehensively considered based on the patient's age, symptoms and fertility requirements, as well as the type, size, and number of fibroids.

Conservative treatment of uterine fibroids

1. Observation: Asymptomatic fibroids generally do not require treatment, especially in women near menopause. After menopause, fibroids often shrink and symptoms disappear. Follow up every 3 to 6 months, and if symptoms occur, further treatment may be considered.

2. Drug treatment: Suitable for patients with mild symptoms, near menopause or whose general condition is not suitable for surgery. Common medications:

1) Gonadotropin-releasing hormone analogs (GnRH-a): such as leuprorelin, goserelin, etc. They can reduce estrogen to postmenopausal levels to relieve symptoms and inhibit the growth of fibroids to shrink them, but they will gradually increase again after stopping the medication. The medication can cause menopausal syndrome, and long-term use can cause side effects such as osteoporosis, so long-term medication is not recommended.

Indications:

① Reduce fibroids to facilitate pregnancy;

② Preoperative medication to control symptoms and correct anemia;

③ Preoperative medication can reduce the size of the fibroids, reduce the difficulty of surgery, or make vaginal or laparoscopic surgery possible;

④ For women approaching menopause, transition to natural menopause in advance.

2) Mifepristone can be used as a preoperative medication or for early menopause, but because it antagonizes progesterone, the endometrium is stimulated by estrogen for a long time, increasing the risk of endometrial lesions, so long-term use is not recommended.

Surgery for uterine fibroids

Indications:

1. Excessive menstruation due to fibroids, leading to secondary anemia;

2. Severe abdominal pain, dyspareunia or chronic abdominal pain, acute abdominal pain caused by torsion of pedunculated myoma;

3. The large size of the fibroid compresses the bladder, rectum, etc. and causes corresponding symptoms;

4. Infertility or repeated miscarriage caused by fibroids;

5. Suspected sarcomatous changes.

Way:

1. Uterine myoma resection (suitable for patients who wish to retain their fertility, including transabdominal myoma resection, hysteroscopic resection of submucosal myoma and intramural myoma protruding into the uterine cavity, and intravaginal resection of submucosal myoma protruding into the vagina);

2. Hysterectomy (suitable for those who do not require to preserve fertility or suspected of malignant transformation).

Laparoscopic minimally invasive surgery (myomectomy or hysterectomy) has been widely used in clinical practice due to its small trauma, mild pain and short hospitalization time.

Will uterine myoma recur after removal?

Recurrence is possible, so regular follow-up is required even after the myoma is removed.

Can you get pregnant directly after myomectomy ? Generally speaking, after myomectomy , you need to use contraception for more than one year before you can get pregnant ****. Even if the uterine fibroids are removed minimally invasively, the uterus will be traumatized and scarred. Pregnancy again will increase the risk of uterine rupture, and in severe cases, it may endanger the lives of mother and child. If you get pregnant in a short time, the uterus will not recover well and the risk of uterine rupture will increase significantly, so it is generally recommended to use contraception for at least one year. Of course, it depends on the location and size of the removed fibroids. For pedunculated subserosal fibroids or very small fibroids, the contraception time can be appropriately shortened, or even without special requirements. The specific contraception time needs to be communicated with the surgeon. In short, when you get pregnant again after uterine fibroid surgery, be sure to be careful of the risk of uterine rupture. If you experience abdominal pain, vaginal bleeding, etc. during pregnancy, you must see a doctor in time to exclude uterine rupture.

Are there other treatments for uterine fibroids?

Other treatments for uterine fibroids

It is mainly suitable for those who cannot tolerate or are unwilling to undergo surgery. Methods include uterine artery embolization, high-energy focused ultrasound, endometrial resection, etc., but each has its own advantages and disadvantages, and cannot clearly determine the nature of uterine fibroids.

How to prevent uterine fibroids?

Uterine fibroids prevention

Although the cause of uterine fibroids is still unclear, following a healthy lifestyle and eating habits can help reduce the risk of developing them. Maintaining a normal weight, eating more fruits and vegetables, reducing high-fat intake, avoiding excessive drinking, exercising appropriately, maintaining a happy mood, avoiding unwanted pregnancies, and avoiding eating foods or drugs with high estrogen levels can help prevent uterine fibroids.

In short, although uterine fibroids are common, the cause is still unclear. Don't panic or be careless if you have fibroids. Stay optimistic, respond positively, follow up closely with gynecological ultrasound, and perform surgery if the indications are met. I hope that through the popularization of this article, it can help more women understand uterine fibroids, increase their attention and attention to their own health, prevent and treat diseases in a timely manner, maintain good health, and enjoy a better life.

Author: Sun Huizhen (Department of Obstetrics and Gynecology, Chongming Hospital, Shanghai Health and Medical College; Attending Physician, Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine); Zhang Lei (Director of Gynecology, Chongming Hospital, Shanghai Health and Medical College)

Reviewer: Wang Yao, Chief Physician, Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Deputy Secretary-General of the Reproductive Health Committee of the Chinese Rehabilitation Medicine Association

Editor: Jia Jing; Illustration: Li Chuan (Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine)