What You Need To Know About Uterine Fibroids

What you need to know about uterine fibroids

Uterine fibroids are found in every fourth Russian woman over 30 years old and every third woman over 40.

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Uterine fibroids are found in every fourth Russian woman over 30 and in every third over 40. And more and more often, the disease affects very young women, endangering the ability to bear and give birth to a child. Despite the fact that myoma is a benign tumor, you cannot close your eyes to it, doctors warn.

“I would blow up this plant. For young women, this is a quiet death. A patient came to me today - just a girl - 24 years old, and she already has fibroids”, - Irina Ivanovna, a gynecologist with almost 40 years of experience, works in a medical unit of one of the chemical plants near Moscow and wants to blow up her employer. According to her statistics, almost half of the employees of the enterprise have fibroids.

Every third

It is impossible to name the absolute number of Russian women with fibroids, because there is no summary statistics, says the president of the International Public Organization “Society of Physicians Studying and Treatment of Uterine Fibroids. MIOMM ", Professor of the Department of Obstetrics and Gynecology, Faculty of Medicine, Moscow State Medical University named after A. I. Evdokimova Alexander Tikhomirov. Many patients are not examined at all or go to private centers, which also complicates the calculations.

“If we summarize the information from all published works in Russia, it turns out that every fourth woman over 30 has uterine fibroids and every third woman is over 40,” Tikhomirov notes. - However, there may be many more. One of the proofs is the autopsy studies carried out by us in conjunction with forensic medical morgues, which revealed that almost 70% of women had no uterine fibroids. Perhaps she was at the histological stage when the doctor did not see her.

The exact reasons for the development of uterine fibroids have not yet been established. Scientists are aware of several factors that influence the development of a tumor, including: hereditary predisposition, obesity, and most importantly, low reproductive function. Every month, a woman's body tunes in to pregnancy, and when it does not occur, it becomes something of a program failure. In addition, the ovaries do not rest at all, which are "turned off" only during pregnancy and breastfeeding. “I would call the uterine fibroids the result of irrational use of organs,” says Tikhomirov. "If a woman had 140 periods, then she is already at risk."

Irina Ivanovna, a gynecologist near Moscow, adds to this work in hazardous production. And also the constant stress in which her patients live - because of the disorder, lack of money and grievances against the men who turned out to be "wrong".

Don't miss the disease

It is difficult to change external circumstances, the doctor agrees, but it is elementary to monitor her health, at least once a year every woman should come for a preventive examination to a gynecologist. “It happens that the disease is asymptomatic for a long time, until the fibroid reaches a large size. During this time, it would be possible to identify the disease and eliminate it with minimal consequences. But this is provided that the woman is observed by a gynecologist. Previously, we constantly carried out prophylactic examinations, sent women to an ultrasound scan in Moscow - this was in those ancient times when there was no ultrasound scan in our city, "says Irina Ivanovna.

Despite the fact that myoma is a benign tumor, one cannot close one's eyes to its presence. In more than half of the cases, doctors observe the rapid growth of myomatous nodes, and this can lead to severe complications, infertility and even death of a woman.

In the practice of Irina Ivanovna, there were cases when a woman had to be urgently operated on, and at the same time it was impossible to do this. “I had a patient who first came to an appointment when the myoma was already at the level of the navel - this is 18-20 weeks,” the doctor said. - And at the same time, terrible anemia - hemoglobin is about 75. On the one hand, it had to be urgently operated on, to stop uterine bleeding. On the other hand, any operation, even a very well performed one, is accompanied by a loss of at least 700-800 ml of blood. They barely saved her then."

Unfortunately, there is no culture of visiting a doctor for preventive purposes in Russia at all. And although the situation is best with the observation of a gynecologist, only less than a third of Russian women of reproductive age undergo a prophylactic examination every six months - as recommended by experts. As shown by the All-Russian poll "Index of Women's Health" Gedeon Richter ", almost half of Russian women do not go to the doctor immediately, even when alarming symptoms appear, expecting that they will go away by themselves. As for fibroids, according to a sociological study, although at least 94% of the women surveyed had heard about it, only 15% knew the symptoms of the disease well, and another 49% were able to describe them in general terms.

In addition, the disease is not always accompanied by some specific symptoms, sometimes it does not manifest itself at all, and is discovered quite by accident during an ultrasound examination, says Tikhomirov. And yet there are a number of signs indicating the presence of myomatous nodes. First of all, a woman should be alerted by acyclic (not during menstruation) uterine bleeding, sometimes not even blood, but watery discharge without color and odor. Another sign of the disease may be profuse menstruation, as well as uncharacteristic pains unrelated to it. In addition, fibroids may be indicated by an increase in the size of the abdomen, impaired urination, constipation, pain during sexual intercourse, which were not there before.

Modern capabilities

For more than 100 years, hysterectomy - removal of the uterus - remains the main method of treating uterine fibroids. In Russia alone, almost a million uterus surgeries are performed annually, while, in most cases, in connection with a benign disease. But the possibilities of modern medicine make it possible to reverse this situation. According to Tikhomirov, today in the overwhelming majority of cases it is possible to carry out organ-preserving treatment. “It is customary for us to remove the uterus in 80% of cases, despite the fact that the reason is benign fibroids,” the expert admits. “Of course, it’s easier to remove the organ, but it’s much more important to preserve the female reproductive function as much as possible.”

Moreover, although traditionally fibroids are considered the lot of older patients, today they are "getting younger": according to the Ministry of Health, over the past 40 years, the incidence of fibroids in women under 30 has increased from 2% to 12.5%. Therefore, treatment should be aimed at ensuring that a woman can give birth in the future, says Tikhomirov.

And even if a surgical method of treatment is chosen, it is not necessary to remove the entire uterus - it is enough to remove only the myomatous nodes. After such an operation, a young woman will be able to bear and give birth to a child, and an older patient will not develop posthysterectomy syndrome associated with early menopause (a combination of neuropsychiatric and metabolic disorders).

The type of intervention is selected depending on the location, size and number of nodes. It can be an abdominal or laparoscopic operation, as well as a sparing surgical technique that allows to eliminate many intrauterine pathologies - hysteroscopy. New minimally invasive approaches are increasingly being used today, such as uterine vessel embolization, the essence of which is to stop the supply of fibroids. During this operation, through the femoral artery, they approach the uterine arterial vessels that supply blood to the fibroids. With the help of a special preparation, the blood flow is blocked in the nodes, and they gradually "dry up".

Another innovative technique is associated with highly focused ultrasound exposure to myomatous nodes, which is performed under MRI control. Under the influence of a focused ultrasound beam, the vessels around the node are cut off, and the temperature in it rises to 65-70 degrees. As a result, myoma regression occurs.

According to experts, the future belongs to such gentle and effective methods. But so far, the high cost of equipment and the lack of qualified personnel do not allow them to be introduced into wide practice.

As for drug treatment, so far it has been used only for preoperative preparation. However, today scientists are setting a more ambitious goal - a complete rejection of surgical treatment. “We already have drugs in our arsenal that can effectively affect a number of growth mechanisms of uterine fibroids,” Tikhomirov said. "They allow you to avoid surgery and removal of the uterus, which means that a woman can have children."