In gynecological clinics, many women take ultrasound results to consult the condition, of which uterine fibroids are particularly common.
"Doctor, my fibroid is so big that I need surgery?"
"Doctor, are there uterine fibroids that affect pregnancy preparation?"
"Doctor, will fibroids change if they don't deal with them?"
......
When it comes to fibroids, women's problems go far beyond that, what are your concerns? Today, Zhimei will come to answer a few questions that you are most concerned about.
Uterine fibroids are the most common benign tumors of women's genitals and occur in women aged 30-50 years.
The yellow part on the left is a uterine fibroid
The right side is a normal uterus
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The prevalence of uterine fibroids can reach 25% in women of childbearing age, which means that 1 in 4 women may have the disease [1].
However, the actual prevalence of fibroids is much higher than this, and some people may not know of their existence for a lifetime because they are small and have no symptoms.
There is some truth to this.
Studies have shown that the more pregnancies there are, the lower the risk of developing uterine fibroids. Women with at least one gestation of more than 20 weeks may reduce the chance of fibroid formation.
In this respect, having a baby is good for the uterus.
However, women who have given birth to children, the chance of getting fibroids is not small, you can not feel that you have entered the safe because you have given birth, and you should have a regular physical examination when you should check it.
The upper part of the uterus is the uterine body and the lower part is the cervix. If classified according to the growth site of fibroids, they can be divided into uterine fibroids (90%) and cervical fibroids (10%)[2].
(Source: today.com)
From the perspective of tissue structure, the uterine body can be divided into serous layer, muscle layer and endometrial layer from the outside to the inside.
If you think of the womb as a cantaloupe, it is the three parts of the skin, the flesh, and the melon.
As you can imagine, fibroids growing out of the outer skin are subserous fibroids, fibroids that grow in the pulp are myoids between the walls, and fibroids with peduncles growing in the guar are submucosal fibroids.
Many times fibroids are detected during a physical examination.
However, some of the less honest fibroids may have hurt your body, and the most common symptoms are the following [2,3]:
(1) Increased menstrual volume and prolonged menstruation: excessive menstrual volume causes anemia, which is the most common clinical manifestation of uterine fibroids;
(Source: sheknows.com)
(2) Abdominal mass: as the fibroids grow, the uterus exceeds the size of 3 months of pregnancy, which can be touched in the abdomen;
(3) increased vaginal discharge;
(4) Compression symptoms: fibroids compressing the bladder can cause frequent urination, compression of the ureter can cause dysuria, compression of the intestine can cause constipation, etc.;
(5) Cause infertility or miscarriage.
When sisters have the above symptoms, they should be vigilant and seek medical treatment in time.
Look at age!
The growth of fibroids is inextricably linked to female hormones, especially estrogen and progesterone, which act as "nutrients" for fibroids, and as long as they are secreted, they may make uterine fibroids grow larger [4].
If you want fibroids to disappear, hormone problems are key!
For women of childbearing age, estrogen and progesterone are essential for maintaining normal physiological functioning.
If there is a growth of fibroids at this time, we cannot block hormones for fibroids, and it is not realistic to want fibroids to disappear on their own.
For women who are perimenopausal, or who have already had menopause, due to the decline of ovarian function, hormone secretion falls off a cliff, and the growth rate of fibroids will slow down or even stop.
The growth of larger fibroids may stop here, and some of the smaller fibroids may disappear.
not necessarily.
Most subserosal fibroids do not affect pregnancy, with submucosal fibroids having the greatest impact.
(Source: britishfibroidtrust.org)
As for whether intermural fibroids affect pregnancy, it also depends on its impact on the uterine cavity and intima, such as whether it causes deformation of the uterine cavity.
In addition to the factor of fibroid location, the size and number of fibroids can also affect the success rate of pregnancy.
Even with successful pregnancies, submucosal fibroids and interidional fibroids may increase the risk of miscarriage, fetal abnormalities, preterm birth, placental abruption, postpartum haemorrhage, and lower and larger fibroids may block the birth canal.
Most cases, small fibroids or when there are no obvious symptoms, can be observed, checked regularly, without treatment.
Minimally invasive or surgical treatment should be taken when the following situations occur.
(1) Uterine fibroids cause menorrhagia or abnormal bleeding or even lead to anemia; or compress the urinary system, digestive system, nervous system, etc. Related symptoms appear, and drug treatment is ineffective;
(2) Uterine fibroids combined with infertility;
(3) If the fibroids are ≥ 4cm in diameter when preparing for pregnancy, it is recommended to remove them;
(4) Hormone replacement therapy was not performed after menopause, but fibroids still grew [3].
For older women without fertility requirements or with multiple uterine diseases, total hysterectomy or subtotal hysterectomy can be taken, and relatively large and isolated fibroids can be performed, and minimally invasive radiofrequency ablation surgery can be done;
For women of childbearing age who have fertility requirements, fibroid removal is more often done, and pregnancy can be obtained after full recovery after surgery.
Postoperative contraception is recommended for 6 months for subserosal fibroids, 1 to 2 years after intermuscular fibroids, and 2 years for those who enter the uterine cavity during fibroid removal [5].
postscript
Uterine fibroids are common, and the questions about them are so varied that one article can't answer all the questions.
If you still have anything else you want to know, you can come to the message area, and zhimei will wait for everyone to arrive.
bibliography
Ye Mingzhu,Deng Xinliang,Xue Min. Treatment of perimenopausal uterine fibroids[J].Chinese Journal of Practical Gynecology and Obstetrics,2016,32(02):126-131.
Xie Xing,Duan Tao,Kong Beihua. Obstetrics and Gynecology (Ninth Edition)[M].People's Medical Publishing House, 2018.
[3] Lang Jinghe. Chinese expert consensus on the diagnosis and treatment of uterine fibroids[J].Chinese Journal of Obstetrics and Gynecology,2017,52(12):793-800.
[4] Islam MS，Protic O，Stortoni P，et al. Complex networks of multiple factors in the pathogenesis of uterine leiomyoma[J]. Fertil Steril，2013，100(1)：178-193.
Zhang Dandan,Lu Meisong. Uterine fibroids and fertility and pregnancy safety[J].Chinese Journal of Practical Gynecology and Obstetrics,2019,35(08):864-869.
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