Myoma 6 mm what to do. Growth factors of benign uterine tumors and indications for surgery

06.10.2020

According to medical statistics, uterine fibroids are one of the most common gynecological pathologies among women over 35. It is at the age of 35-45 that the tumor is mainly detected, it grows slowly and gradually leads to the appearance of pronounced clinical symptoms. Without treatment, fibroids can significantly disrupt the usual course of life, cause infertility and other serious health problems.

When assessing the prognosis of the disease, special attention is paid to the size of the uterine tumor. Small nodes are easily amenable to hormone therapy and usually do not interfere with bearing a child, while large formations put an end to the woman's reproductive function. The size of the uterine fibroids is also important for the operation. The choice of a method for removing a tumor will directly depend on its diameter, location, as well as the presence of concomitant pathology of the pelvic organs. Knowing what sizes are considered acceptable for a particular method of therapy, you can choose the optimal treatment tactics and achieve good results in the shortest possible time.

Classification of myomatous nodes depending on their size

In gynecological practice, it is customary to divide all uterine tumors into three groups. The size of the node (in millimeters) corresponds to the size of the uterus (in weeks of pregnancy), the data are given in the table:

For simplicity, fibroids can be measured in centimeters. The choice of the unit of measurement does not play a significant role in the diagnosis and treatment tactics. Assessment of the size of the node is carried out using ultrasound.

Removed myomatous nodes of various sizes (from 10 to 90 mm).

The following types of fibroids deserve special attention:

The tumor is of clinically insignificant size - up to 20 mm. Such education does not bother, does not interfere with the conception of a child and does not require treatment;
The tumor is gigantic - approximately 100 mm in diameter. Differs in severe clinical symptoms and the development of complications. Such a neoplasm should always be removed and as soon as possible.

On a note

The shape and weight of fibroids are of purely scientific interest. The mass of the tumor is determined after its removal and weighing in the laboratory. Fibroids weighing 63 kg are described in the medical literature, and to date, no one has managed to break this record.

Giant uterine fibroids during surgery.

Tumor size and symptom severity: is there a relationship?

The size of the myomatous node affects not only the tactics of treatment, but also the condition of the woman. The severity of the symptoms of the disease depends on the size of the tumor:

Clinically insignificant myoma up to 2 cm in size fully justifies its name. Such an education does not hurt, does not disrupt the menstrual cycle, does not lead to the development of bleeding, does not affect the work of neighboring organs. The only exceptions are submucous nodes, which can increase the volume of menstrual flow, even at small sizes. With the cervical location of the myomatous node, the rapid appearance of clinical symptoms is also noted;
Small formations (up to 2.5 cm), localized subperitoneally, do not manifest themselves in any way. Symptoms of the disease occur when the node is located in the muscular or submucous layer of the uterus. Such formations can lead to the appearance of moderate pulling pains in the lower abdomen and increase the duration and volume of menstrual bleeding;
Medium fibroids will never go unnoticed. Reaching a value of 2.5-6 mm, the node significantly disrupts the menstrual cycle. Menstruation becomes profuse, prolonged, painful, intermenstrual discharge occurs. Pains are noted already in the lower abdomen and in the lumbar region;
A tumor of 6 cm or more is always an indication for surgery. Such a node leads to the appearance of constant or recurrent pain in the lower abdomen, perineum and lower back. Large formations provoke the development of uterine bleeding. With subserous location of the node, compression of the pelvic organs with a violation of their function is possible.

The main symptoms of the presence of uterine fibroids are profuse prolonged menstruation and pain in the lower abdomen.

It is quite simple to understand when it is time to remove fibroids. If a tumor disrupts the usual rhythm of life, creates significant discomfort and interferes with the functioning of the reproductive system, it must be disposed of. And if there are no disagreements with formations of large sizes, then with regard to small myomas, many questions arise. Let's answer the most popular ones:

Should you remove a small node if it doesn't bother you? Observation of small fibroids is allowed only if the formation does not change the menstrual cycle and does not lead to the development of bleeding;
Should myoma of medium size (3, 4, 5 cm) be removed? Yes, it is better to get rid of such a tumor: as the node grows, the likelihood of uterine bleeding and other complications increases;
Is it possible to do without surgery? Yes, fibroids up to 30 mm respond well to hormone therapy;
In what cases is uterine fibroid urgently excised? With the development of complications: tumor necrosis, torsion of the leg of the node, infection, profuse uterine bleeding;
Can a tumor grow the size of a uterus? Yes, and even more. Giant nodes reach the size of a full-term baby, significantly deform the uterus and several times exceed it in diameter;
What size node is not considered a uterine myoma? There is no such thing in gynecology. If the formation is detected by ultrasound, the history of the disease will include the diagnosis of "uterine fibroids", and it does not matter what size the tumor is - 6 mm or 6 cm;
What size should myoma node be for surgery? Surgical treatment is carried out with a node size of 30 mm, but options are possible with different localization of the tumor.

Depending on the location of the fibroid and the presence of accompanying symptoms, different treatment options are possible.

It is important to know

The size of the myomatous node varies depending on the phase of the cycle. A benign tumor of the myometrium slightly increases in size after ovulation, closer to the next menstruation. After menstruation, its size decreases again.

Fibroid growth rate as an indication for surgery

Myomatous nodes tend to grow slowly but steadily throughout the reproductive period. Once it has arisen, the tumor will increase in size, and no medicinal herbs and other dubious techniques are able to slow down its development. The following factors affect the growth of fibroids:

Pregnancy. It has been noticed that some nodes increase in size during this period, while others decrease or stabilize. The maximum tumor growth is observed in the first half of gestation;
Lactation period. When feeding a baby with breast milk, the tumor usually does not grow, treatment during this period is not required;
Termination of pregnancy (spontaneous miscarriage or artificial abortion) provokes active tumor growth and brings the woman to the operating table;
The entry into menopause inhibits the development of fibroids. Normally, during menopause, the node should regress. If this does not happen, surgical treatment cannot be avoided;
Taking hormonal drugs affects the course of the disease in different ways. Some drugs inhibit the growth of the node, others provoke tissue proliferation. It is noted that estrogen and progesterone stimulate the development of fibroids, while gonadotropic hormone agonists lead to tumor regression.

The growth of fibroids depends on the hormonal background of the woman, and therefore, taking hormonal drugs in the presence of a tumor is possible only under the supervision of a doctor.

It is important to know

The rapid growth of the node (4 weeks per year or more) is considered one of the probable signs of a malignant tumor of the uterus - sarcoma. If there is a suspicion of malignancy, fibroids are always removed, followed by a histological examination of the material.

It is far from always possible to find out the exact reasons for the growth of the node. Evaluation of the size of the tumor in dynamics is carried out using ultrasound. The doctor makes measurements, comparing them with the results of the previous study. A fast-growing tumor is always an alarming symptom, and in this situation, there is no need to postpone surgical treatment.

Is surgery always necessary?

Gynecologists warn: fibroids will not disappear by themselves at reproductive age. The inevitable growth of the tumor leads to the fact that a large formation arises from a small node, threatening the development of serious complications:

Acyclic uterine bleeding. The larger the fibroids, the more often the endometrium bleeds, which over time leads to the development of anemia and can threaten a woman's life;
Compression of the pelvic organs: fallopian tubes, bladder, ureters, rectum. The outward growing tumor interferes with the functioning of adjacent structures and leads to the appearance of concomitant symptoms: impaired urination and constipation;
Infertility. With a large tumor, conception and bearing of a child is most often impossible.

Subserous nodes affect the functioning of neighboring organs.

If the doctor prescribes an operation to remove fibroids, there is no need to refuse treatment. The tumor will not resolve on its own. Auto-training, hirudotherapy, applying lotions on the stomach, taking herbs, gymnastics or massage will not help. All these methods are good for maintaining the general tone of the body, but they are useless in relation to the myomatous node of the uterus. The only guaranteed solution to the problem is surgical treatment.

There is no maximum size of uterine fibroids. The tumor can grow indefinitely. Reaching the size of a 12-week pregnancy, fibroids extend beyond the pelvic floor. The woman notes an increase in abdomen in size, the appearance of asymmetry on one side. Without treatment, the tumor grows up to 20 weeks or more, fills the abdominal cavity, pushing back the organs of the digestive tract. With such a size of the node, an urgent operation is indicated, and often with giant tumors, removal is possible only together with the uterus.

The uterus and appendages are normal; multiple formation with one dominant submucous node; dominant subserous node; multiple fibroids removed together with the uterus.

Important aspects of the surgical treatment of fibroids

Surgery for uterine tumors is indicated in the following situations:

The size of the neoplasm is more than 3 cm;
Rapid node growth (from 4 weeks per year);
Severe clinical symptoms: uterine bleeding, pelvic pain, not amenable to conservative therapy;
The development of complications such as tumor necrosis or compression of the pelvic organs;
Recurrence of uterine fibroids;
Infertility and miscarriage against the background of myomatous nodes;
Suspected sarcoma or confirmed malignant tumor.

On a note

Formations up to 30 mm in size are treated conservatively. In the treatment of uterine fibroids, hormonal agents are used that reduce the diameter of the tumor and eliminate the unpleasant symptoms of the disease. The effect of the use of hormones is temporary. After discontinuation of the drug, the tumor begins to grow again and gradually returns to its previous size.

The choice of the method of surgical treatment depends not so much on the size of the fibroid as on its location. The size of the knot is taken into account in the second place. With inoperable tumors, removal of the uterus is indicated.

Depending on the location of the node, different methods of surgical treatment are used.

Uterine artery embolization

One of the modern methods of treatment, involving the introduction of emboli through the femoral artery. Small balls clog the lumen of the vessels feeding the fibroids and lead to tumor regression. The size of myoma for UAE is not essential. The procedure is performed for almost any tumor size and is especially effective for multiple lesions. This method is considered one of the safest and is recommended for women planning pregnancy.

UAE is usually not performed for giant tumors when the uterus reaches 20 weeks or more. The procedure is not too effective for subserous formations on a thin stem.

According to reviews, the UAE procedure is tolerated quite well. In the postoperative period, the appearance of cramping pains in the lower abdomen against the background of tumor regression is noted, but unpleasant symptoms are stopped with medication. After UAE, there is no scar on the uterus, there are no obstacles to conception and bearing of a child. The procedure is considered very effective: the probability of a relapse of the disease is no more than 2%.

UAE allows to achieve reduction of myomatous nodes in the least traumatic way.

Hysteroresectoscopy

Removal of a tumor of the uterus through the vagina using an endoscopic instrument is carried out in the following situations:

Submucous myoma on the leg, protruding entirely into the uterine cavity;
Submucous-interstitial tumor, most of which is located in the uterine cavity.

With deeply localized formations, hysteroresectoscopy is carried out with great caution, since there is a high risk of bleeding and subsequent adhesions in the uterine cavity.

The size of the myomatous node plays a role in the choice of the method of hysteroresectoscopy:

Submucous-interstitial formations up to 50 mm in diameter are excised using an electrosurgical instrument;
Deeply located nodes with sizes of 50 mm or more cannot be removed through the vagina;
Submucous nodes on a pedicle measuring 50-100 mm are excised only mechanically (conchotome);
For tumors larger than 100 mm, transcervical myomectomy is not performed.

The critical size of fibroids for hysteroresectoscopy is 10 cm. A larger tumor is difficult to remove through the vagina, so abdominal surgery is indicated.

Removal of submucous myoma on the pedicle by hysteroresectoscopy.

Conservative myomectomy

Organ-preserving surgeries, in which only the tumor is removed, and the uterus remains, are performed by open and laparoscopic access. The possibility of performing myomectomy depends not only on the size of the nodes, but also on their number and location.

Surgical options:

Laparoscopic surgery - removal of fibroids through small punctures in the abdominal wall;
Abdominal surgery (laparotomy) - excision of the node is possible only after incision of the skin and underlying tissues.

Indications for laparoscopy:

The size of the uterus is not more than 12 weeks;
Number of nodes - no more than four;
Location of fibroids in the body or fundus of the uterus;
Subserous or interstitial localization of the node;
Myomectomy during pregnancy.

When choosing a method of surgical treatment, gynecologists are guided not by the size of the node itself in millimeters, but by the size of the altered uterus. It is difficult to draw a parallel between the diameter of the tumor and the genital organ. The uterus can be enlarged both at the expense of one node and with multiple formations. As a rule, laparoscopy is performed when the size of the dominant node is up to 10 cm.

On a note

Modern endoscopic technologies make it possible to carry out the operation with the size of the uterus up to 15 weeks.

Indications for laparotomy:

The size of the uterus is from 12-15 weeks;
The number of nodes is more than four;
High risk of bleeding during surgery;
Low location of fibroids: in the cervix or isthmus.

When large or multiple nodes are located on the posterior wall of the uterus, priority is also given to abdominal surgery.

It is important to understand

The choice of a treatment method is always determined individually, taking into account all the characteristics of the course of the disease.

Removal of uterine fibroids with open access.

Hysterectomy

Removal of the uterus together with myoia is carried out when other methods of treatment are ineffective and is an extreme measure. The size of the tumor is not decisive here. The need for a hysterectomy may arise in the following conditions:

Profuse bleeding that does not respond to conservative therapy;
Multiple myomatous nodes, when there are contraindications to UAE;
Identification of uterine sarcoma;
The presence of concomitant pathology of the genital organ;
Development of severe complications of the disease.

Indications for hysterectomy may arise directly during the operation. Each patient must be warned that if complications develop, the doctor can remove the fibroids along with the uterus.

The photo shows the removed uterus along with interstitial and interstitial subserous nodes. In one of the nodes, signs of malnutrition are noted, which became the reason for surgical treatment.

The removed uterus with multiple myomatous nodes.

The prices for uterine fibroids removal differ depending on the chosen method and the location of the clinic. In Moscow, the procedure for embolization of the uterine arteries will cost 50-150 thousand rubles, myomectomy - 40-90 thousand rubles, hysterectomy - about 50 thousand rubles. According to the compulsory medical insurance policy in the state gynecological departments, the operation is carried out free of charge for the patient.

Removal of a tumor when planning a pregnancy

When it comes to planning a child, patient management tactics change somewhat. In the presence of submucous fibroids, its removal is indicated regardless of the size of the node. Such a knot will interfere with the bearing of the fetus and with a high degree of probability will provoke a miscarriage.

The most favorable prognosis is given by subserous myoma. Even reaching a considerable size, it does not interfere with conception and bearing a fetus. Numerous reviews show that pregnancy against the background of a subperitoneal tumor usually passes without complications and ends with the birth of a child on time.

Pregnancy with subserous myomatous node.

Interstitial uterine fibroids behave differently. Small nodes (no more than 2.5 cm) are not dangerous for a woman, but observation will not hurt. Large formations can lead to spontaneous miscarriage, cause bleeding during childbirth and abnormalities in labor.

If a woman is planning IVF, the doctor may insist on excision of small fibroids, although usually such nodes are treated with hormonal drugs. With in vitro fertilization, they try to eliminate any risks to the woman and the fetus and remove all factors that can cause failure.

Planned surgery for fibroids is done 6-18 months before pregnancy. The timing depends on the chosen treatment method:

After hysteroresectoscopy (removal of the tumor through the vagina without incision of the uterus), the conception of a child is possible after 6 months;
Laparoscopic myomectomy requires recovery within 6-12 months. A full-fledged scar is formed no earlier than six months later;
Long-term recovery is required after abdominal surgery. Planning a pregnancy is recommended after 1-2 years;
Embolization of the uterine arteries leads to a gradual regression of fibroids. Conception of a child is possible in 6-12 months.

Treatment of uterine fibroids with UAE

Interesting video: laparoscopic surgery to remove the myomatous node

2012-12-12 08:11:54

Irina asks:

Hello! Your answer to this question is very much needed. I am 51 years old. I have uterine fibroids. Every year I do an ultrasound scan, I follow the growth of fibroids, recently, in October, I did an ultrasound scan, as my period went 9 days earlier, and here are the results: Dimensions of the body of the uterus: length 56 mm, anterior-posterior 52mm, width 70mm. Increased unevenly. The shape is wrong. Myomatous nodes 1) on the left rib there is a conglomerate of nodes 42x38mm of heterogeneous structure with a change (could not read accurately) blood flow. 2) in the posterior wall, the interstitial node is 16 mm. M-Echo 3 mm "three-layer". The left ovary is 27x19mm, the follicular apparatus is clearly differentiated, the follicle is 10mm. The right 15x10mm follicular apparatus is indistinctly differentiated. Ultrasound signs of uterine fibroids. Please comment on the ultrasound results. Is an operation necessary in my case, if so, what kind. I heard that doctors until recently are trying not to remove the uterus. Myoma does not bother me, but sometimes before menstruation it hurts a little in the lower abdomen. Last year, I was not given a conglomerate of nodes by ultrasound, they talked about nodes on the front wall 36x33 mm and two nodes 17 and 14 mm in diameter along the back. It turns out this year the node has grown, whether the increase in the previous ultrasound is considered much. What should I do? Will the fibroid continue to grow or is an operation required? I am looking forward to your reply.

Answers Silina Natalia Konstantinovna:

Irina, the indication for surgical treatment of fibroids is its rapid growth (in your case, it is not rapid growth), uterine bleeding, disruption of the work of adjacent organs. To exclude the hyperplastic process of the endometrium, it is necessary to undergo a medical diagnostic hysteroscopy. And if the histological conclusion is good, take herbal medicine.

2012-12-10 15:38:33

Rita asks:

Good afternoon! Hysteroscopy revealed a fibro-glandular polyp of the CK. The endometrium is of a proliferative type. The doctor prescribed Duphaston for the 2nd half of the MC, 1 t. 2 times a day for 2 months. Moreover, I also have uterine fibroids. In many publications, a categorical prohibition of Dufaston's acceptance with fibroids is written, because it affects the growth of fibroids. Tell me if my treatment was prescribed correctly. And what drugs are there that will simultaneously have a positive effect on both of my problems?

Answers Wild Nadezhda Ivanovna:

Dufaston is prescribed for the treatment of hyperplasias, according to different schemes, according to the reproductive plans of a woman, Dufaston is a synthetic progesterone, its reception is possible in the presence of fibroids.

2012-12-06 15:42:45

Ekaterina asks:

Hello! Please help me figure it out: according to ultrasound data in a paid clinic at 5 DMC M-echo: 1.36, heterogeneous structure, clear contours, jagged along the basal edge, the uterine cavity is not expanded. In the uterine cavity, a heterogeneous formation measuring 0.92 * 0 , 51, not protruding beyond the endometrium. On the posterior wall there is an intramural myoma. A node with a reduced echogen. 2.02 * 1.74. Diagnosis: uterine myoma, diffuse adenomyosis, LGE? Endomeric polyp?
On the same day, I changed the ultrasound in consultation, because. two cycles ago I did an ultrasound scan in Semashko and there were no signs of femoral hypertension and polyp, and there was no fibroids, I had adenomyosis for a long time. discharge, at that time they were no longer there, a little smeared and that's it), the myometrium of a heterogeneous structure, the cervix without features. Conclusion: adenomyosis cannot be ruled out. She said in words that there is still blood in the uterus, but there is still no more discharge was ... The endometrium is thin and normal.
Further, since the opinions of the doctors were completely divided, I went to another place on the same day and did another ultrasound: M-echo: 0.5, the endometrium of a homogeneous structure, the uterine cavity is not expanded, not deformed, the structure of the myometrium is homogeneous (it said that she would not diagnose adenomyosis, because the changes in the myometrium are quite insignificant and on the basis of one ultrasound she does not make such a diagnosis. Conclusion: the m-echo picture corresponds to the first phase of MC. Initial signs of adenomyosis.
Both of the last ultrasounds correspond to what I did two cycles ago in Semashko. The reason for such a meticulous study is the planned pregnancy. Two years ago there was a simple glandular hyperplasia of the endometrium (according to the results of hysteroscopy, it showed itself as a slight failure in the cycle: 28-32 days), now the cycle is clear, I do an ultrasound every 6 months. everything was good, I take dyufaston from 16 to 25 dmts to the present. In this cycle, in two days, it smeared a little, a drop is straight, menstruation came on time. My question is: what should I do with a planned pregnancy , because in the first case, ultrasound is clearly not the norm, could there have been an error in making such a diagnosis, because it does not coincide with the other two opinions? At the moment, this is very important for me, because. This pregnancy is very long awaited and I am undergoing a course of plasmapheresis, there are a lot of problems and unsuccessful attempts too. Please help me with advice !!! Thank you in advance, Ekaterina.

Answers Wild Nadezhda Ivanovna:

Prepare for pregnancy, repeat the ultrasound after 2 weeks, and then after menstruation. Preferably in the same place with the same doctor. Then you can expect results. Ultrasound is an additional research method, there may be errors. Therefore, control is needed, especially if you are planning a pregnancy.

2012-12-04 16:42:55

Lead asks:

I have a uterine fibroid node 22 * \u200b\u200b17mm on the front wall, I am pregnant - 7 weeks. Will I be able to give birth? I have my first pregnancy, I’m only 22, I have never done a revolution, where did myoma come from? Could this be

Answers Palyga Igor Evgenievich:

Do not worry, this is not even a fibroid, but a node that can increase during pregnancy, you need to observe it on ultrasound, but I think you can carry it out and give birth to a baby normally.

2012-12-03 21:06:00

Alena asks:

Hello! Tell me please, can I get pregnant with a diagnosis of uterine fibroids with an intramural node size 10 * 18mm?

2012-11-30 08:19:59

Lyudmila asks:

Hello I am 45 years old With monthly regular but heavy bleeding with clots! I have uterine fibroids 10 weeks polyp endometrium size of the uterus 82-83-88mm VOL314cm3 intramural subserous fibromatous node along the front walls D37mm at the bottom 62mm posterior stenosis 10mm endometrium 9mm round hyperexia with signs of a vascular pedicle Cervix 42-34mm pr ovary 36_20_21VOL7,7cm3 Leo ovary32 18 17VOL5cm3 The doctor said to do the operation laparotomy

Answers Kondratyuk Vadim Anatolievich:

Obviously, you are offered the removal of the uterus. This intervention is indicated when there is a reasonable suspicion of a malignant tumor. If there are no such suspicions, it is possible to do with more gentle methods - embolization of the uterine arteries.

2012-11-28 15:45:18

Galina asks:

Hello! My name is Galina, I am 59 years old. For the last 10 years, I have been seen by a gynecologist for uterine fibroids. The last ultrasound showed: the body of the uterus vanteflexio, irregularly shaped, enlarged, the contour is even, the boundaries are clear, the surface is even. The myometrium of a heterogeneous structure due to numerous, small EXO positive containing and EXO negative areas up to 10 mm, along the posterior wall of the uterus there is an intramural-subserous fibromatous node 35x40 mm, slightly deforms the uterine cavity, on the left subserous fibroids. node up to 25 mm, numerous intramural fibromatous nodes up to 12-13 mm. the uterine cavity is slit-like. Endometrium 2 mm, thin EXO positive, smooth outline. The cervix is \u200b\u200bof normal size, homogeneous. (etc.)
When I asked if I needed treatment, the doctor replied that menopausal patients with such a diagnosis as mine were not interesting and did not require any treatment. Only periodic ultrasound control.
My question is: is the doctor right or is it still necessary to take some measures?

2012-11-27 14:12:45

Natalya asks:

Hello!
Ultrasound results: the size of the uterus DL: 85mm, P \\ W: 70mm, WID: 72mm, corresponds to: 9-10 weeks of pregnancy. Contours: uneven, V \u003d 223ml. Structure: on the back wall of the intestines. knot d48mm.
M-echo: 3mm, endometrium: narrow hyperechogenic strip
Cavity: deflected towards the front. In the bottom, the anechogen content is expanded to 5 mm.
Cervix: 33-25-27mm, single stromal cyst d5mm along the anterior lip.
Right ovary dimensions: 21-18-18mm, position: along the edge of the uterus
Echostructure: V \u003d 3.6 ml, follicular apparatus is not expressed.
Left ovary dimensions: 20-20-17mm, position: above the uterus.
Echostructure: V \u003d 3.7 ml, it is difficult to achieve with TV-examination.
Features: in the posterior vault, free liquid in a strip up to 4mm. Iliac l / nodes are not visualized.
Conclusion: Echocardiography of interstitial uterine myoma with cavity deformation. Signs of the transferred oophoritis.
Question: please explain to me what I have in non-scientific language and what is the possible treatment?
Thanks!

Answers Gritsko Marta Igorevna:

You have suffered an inflammatory process of the appendages and a benign tumor (myoma), which deforms the uterine cavity. It is quite large and most likely requires surgical intervention. It depends on your age, at a more mature age, in the premenopausal period, such a tumor can be simply observed. If you are a young woman under 40 years old, an operation is required. Make an appointment with a gynecologist who will prescribe treatment and, if necessary, send you to a hospital.

2012-11-23 09:42:34

Ekaterina asks:

Hello! Please help me figure it out. In November 2011, I was referred for hysteroscopy. They did the RFE for me. Removed 2 polyps in the c / c. The result of histology: c / c blood, mucus, stratified squamous epithelium. p / m glandular cystic polyp of the endometrium. After 9 months I went to the control appointment without complaints and the doctor prescribed me 3 months, 1 tablet 2 times a day to take norkolut continuously. After 3 months, my period came, although before that I had not had them for 5 years. I did an ultrasound on November 23, 2012. The body of the uterus is 80 mm, antero-posterior 55mm, width 64mm. The contours are uneven, the structure of the myometrium is heterogeneous. wall in n / z interst. / not particularly clear / node d 25mm, on s / st / not clear / subserous on a broad base d 13mm node.M-echo 9.8mm The structure of the endometrium contains a structure of increased echogenicity-9 * 28mm.Conclusion : Uterine myoma and endometrial polyp. "D" scraping is recommended. I am 55 years old. Myoma for 6 weeks since 2002 was without an increase until that time. Could all this be caused by taking norkalut / ie an increase in fibroids and polyp growth / What should I do in the future and how serious is everything, since the doctor suggests removing the uterus to avoid serious consequences in the future. Thank you !!!

Answers Kondratyuk Vadim Anatolievich:

Diagnostic curettage is necessary to exclude malignant tumors and precancerous conditions. If none are found, removal of the uterus is not indicated, it is a mutilating operation that can significantly impair the quality of life at any age. The most reasonable alternative is uterine artery embolization.

What

A fibroid is a benign neoplasm in the uterus, which is formed primarily as a result of the malfunctioning of a woman's hormonal system. Myoma of the uterus may appear one or several at once. Most often, it has the correct rounded or oval shape, and sometimes a node on the leg develops.

The size of the fibroid can be either very small (only a few millimeters) or very impressive (up to 20 cm in diameter). It is customary to use the circumference of the uterus in determining its parameters, which, with an increase in fibroids, grows as during pregnancy. Thus, in the card, the doctor will write down the "age of the mime" in the number of weeks corresponding to the increase in the uterus during pregnancy.

"Age" of fibroids and symptoms

Most often, a small fibroid is found on a routine examination by a gynecologist or on an ultrasound examination of the pelvic organs. In this case, she does not bring any discomfort to the woman, because her size will be no more than three cm (8 weeks). Small neoplasms do not manifest themselves in any way and, most often, do not require urgent surgery.

When uterine fibroids are found on the leg, the operation is performed without fail. Arbitrary twisting of the stem can cause tissue necrosis and the development of sepsis - life-threatening conditions.

A medium-sized myoma, equal to about five cm (11-12 weeks), a woman can even detect herself. Some symptoms of the disease will tell you:

enlargement of the abdomen with a negative pregnancy test;
pain in the lower abdomen and sacrum;
menstrual irregularities (disruptions, absence of menstruation, bleeding lasting more than six days);
acyclic bleeding or breakthrough bleeding;
infertility;
miscarriages;
soreness when urinating;
constipation.

If there are still no symptoms of the disease, you can try to treat the middle myomatous node in a conservative way. This is especially true in the period before menopause, when there are still chances of independent regression of the disease.

A large myoma, more than 8 cm in size (from 12-15 weeks of pregnancy), is simply impossible not to notice.Such a myoma always brings discomfort to the patient, and an increase in the abdomen due to its growth is noticeable even with the naked eye.

Large fibroids over 12 weeks in size require mandatory urgent minimally invasive or complete surgical intervention.

When an operation is needed for uterine fibroids 12 weeks (8 cm)

The main method for treating a large myomatous node or multiple neoplasms is a surgical operation - myomectomy. Myomectomy is performed in several ways.

Laparotomy is a complete abdominal surgery performed through a fairly long incision in the lower abdominal wall. Indications for laparotomy will be: large nodes, severe deformation of the walls of the uterus, multiple formations. During a laparotomy, doctors, most often, manage to avoid bleeding, completely remove all diseased tissue areas and make the correct suture on the uterus, which will not interfere with the normal development of pregnancy and natural childbirth.
Laparoscopy is a minimally invasive type of surgery, during which nodes are removed through several small incisions in the abdominal wall. Laparoscopy is performed if the formation is not more than 6 cm in diameter and only on the nodes accessible to the laparoscope. Carrying out this type of operation in hard-to-reach areas is dangerous, since the uterus is densely supplied with blood vessels, and any damage to them can lead to extensive bleeding.
Hysteroscopy is a method of removing myomatous nodes without incisions. A thin tube is inserted through the vagina and the cervical canal into its cavity and, under the control of a miniature video camera, neoplasms are removed.
Hysterectomy is a complete or partial removal of the uterus. This is an extreme measure, which doctors take in the most advanced cases of the disease, with severe tissue damage that cannot be restored, with severe concomitant diseases.

Myomectomy helps not only completely remove the formation of almost any size, but also preserve the reproductive function of the female body. For a quick recovery, drugs are used that normalize the state of the uterus after surgery, accelerate tissue healing and prevent the recurrence of the disease.

myomectomy

There are a number of absolutely clear indications when it is necessary to carry out surgical treatment:

when the fibroid size is more than 8 cm (12 weeks of pregnancy), surgery is the only way out;
too fast growth of fibroids (by 2-3 cm in 12 months);
the appearance of multiple nodes;
uterine bleeding (spotting or breakthrough);
anemia;
pain in the lower back and lower back;
pediatric uterine myoma;
The "birth" of fibroids (germination beyond the cervical canal).
death of neoplasm tissues;
infertility;
miscarriage;
dysfunction of organs associated with the growth of the myomatous node (constipation, frequent or painful urination, impaired blood supply to neighboring organs);
the danger of the degeneration of fibroids into a cancerous tumor (sarcoma).

The operation for these manifestations is performed regardless of the patient's age.

Treatment of fibroids measuring 5 centimeters

For fibroids 4.5.6 cm in size (age 8-12 weeks), there is alternative treatment.

Laser treatment (FUS-ablation) - elimination or reduction of fibroids without incisions and damage to healthy tissues. The procedure consists in "burning out" the tumor using a laser beam. The operation is carried out under the control of a magnetic resonance imaging apparatus, which makes it possible to perform manipulations as clearly as possible and completely eliminate trauma to the pelvic organs, and preserve reproductive function.
The method of uterine artery embolization is to block the blood flow to the fibroids. In the area of \u200b\u200bthe right femoral artery, a small incision is made through which a catheter is inserted into the artery up to the vessels of the uterus. With the help of a specially developed drug, the vessels are blocked, after which the blood supply to the neoplasm is stopped and its gradual dying off. Then the uterine fibroids are excreted from the body during menstrual bleeding.

How to treat fibroids 9 weeks

Most fibroids before 12 weeks can be treated with medication.

Analogues of gonadotropin-releasing hormone provoke drug-induced menopause by reducing the production of estrogen. Treatment can greatly reduce education, however, it is more appropriate to use it in women after 45 years, when there is not very long before real menopause.
Combined oral contraceptives are used in young women when fibroids up to two centimeters in diameter are detected. It is good to carry out such treatment in preparation for pregnancy.
The intrauterine hormonal coil helps with small and medium formations in the subserous (outer) layer of the uterus.
Antiprogestin is a newer drug (synthetic steroid) for shrinking knots.

It is important to remember that with the help of pills, it will not be possible to completely get rid of fibroids. Such treatment is necessary in order to stop its growth or temporarily reduce it in size. Some time after the end of treatment, the fibroids will begin to grow again.

The doctor should decide on the method of treating fibroids. If you are in doubt about the competence of your doctor, consult with several specialists and listen carefully to why each of them recommends a particular treatment. Remember that the gynecologist always evaluates the situation as a whole: collects anamnesis, examines the medical history and test results. Therefore, if several doctors recommend surgery, do not postpone it. The treatment completed on time will protect you from complications.

Uterine fibroids are diagnosed in every fifth woman. It is a benign muscle mass that grows in size and can affect women's health and the ability to have children. Usually, fibroids only require regular visits to the gynecologist in order to monitor the development of the tumor and take prescribed medications. Sometimes surgery is required. One of the indications for removal of uterine fibroids is the size of the neoplasm.

Classification

The size of the tumor is determined by ultrasound in centimeters or weeks. The growth of education provokes an increase in the uterus as during pregnancy. If its size corresponds to a certain period of pregnancy, for example, 10 weeks, then they say that a woman has fibroids for 10 weeks. Fibroids in size are:

Small - up to 2cm (20mm). Corresponds to 4-5 weeks of pregnancy;

Average - from 2cm (20mm) to 6cm (60mm), which corresponds to the interval from 4-5 weeks to 10-11 weeks;

Big - more than 6cm (60mm) or 12 or more weeks.

Often, the tumor does not affect well-being and may not make itself felt even at large sizes. However, some patients report prolonged and heavy menstruation with severe pain that analgesics cannot stop. Large neoplasms are characterized by an increase in the abdomen while maintaining the total body weight. Small fibroids can manifest themselves if they grow on legs that can twist.

If the fibroid is so large that the size of the uterus corresponds to a period of 20 or more weeks, then the tumor may affect the work of neighboring organs. There is a feeling of pressure in the lower abdomen. This tumor presses on the organs, disrupts their work. From the pressure on the bladder, as well as during the carrying of a child, there is a frequent urge to urinate.

Indications for surgery

Uterine fibroids require removal in the following cases:

There is a risk of transforming it into a malignant tumor - sarcoma;
Pregnancy is planned;
Severe pain syndrome;
The syndrome of compression of adjacent organs has developed;
The presence of anemia with pathological bleeding;
The tumor has a leg;
The process of urination is disturbed.

A fibroid node in size exceeding 6 cm (which corresponds to a period of 12 weeks) requires surgical intervention.

Fibroid growth stops during menopause. In this case, an observational strategy is acceptable. Even if it is large, it is not necessary to remove it if it does not interfere. The alternative is a radical measure - removal of the uterus, since the reproductive period is already over.

Why are fibroids dangerous?

If you refuse to remove the fibroid, then the following consequences are possible:

When the inflammatory process begins, there is a high probability of kidney inflammation (pyelonephritis), parametritis, and peritonitis;
Conversion of a benign tumor into a malignant one;
Continued growth of fibroids and strong compression of organs;
Anemia;
Infertility.

If uterine fibroids are detected, it is necessary to be observed by a gynecologist, undergo regular examinations and take prescribed medications. All problems associated with myoma can be successfully and promptly eliminated by modern methods of treatment, including the use of organ-preserving technologies.

Video: 3-D modeling of operations for uterine myoma. Variants of organ-preserving operations, in which only the nodes are removed, are shown, as well as variants of operations to remove the uterus.

Myoma of the uterus is a benign formation that is detected in every fifth woman. Fibroids can grow in size, which can affect the ability to have children. Usually, regular visits to the gynecologist are sufficient to maintain the desired level of health. But sometimes the size of uterine fibroids exceeds the permissible ones, then a surgical operation is indicated.

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What determines the size of the neoplasm

Myoma appears for the following reasons:

Excessive physical activity;
Constant stress;
Ovarian pathologies, due to which the work of the genitals is disrupted;
Endocrine system problems;
The presence of chronic infectious diseases;
Genetic predisposition;
Overweight problems, obesity. In the photo you can see the degree of obesity, which can provoke pathology.

The size of uterine fibroids can be within the normal range, then a woman needs only constant observation by a gynecologist. But there are provoking factors that lead to an increase in neoplasm. These include:

Frequent abortions. Sometimes one abortion can provoke the development of a tumor, but this is extremely rare;
Absence of pregnancy and childbirth up to 30 years. The same applies to lactation;
The constant presence of inflammation in the reproductive system of the body;
Constant use of contraceptives that affect hormonal levels. What does it mean? Anti-pregnancy medications work with a woman's hormonal state. With the abuse of such drugs, the hormonal background can change forever;
Tanning bed abuse or prolonged exposure to the sun. This is especially true for women with sensitive skin.

Uterine fibroids 38 mm on ultrasound

To understand how high the risk of surgery is, you need to calculate at what stage the pathology is.

Classification of fibroids by size

The size of the fibroid is determined using ultrasound. It is described in weeks and in centimeters. As the neoplasm grows, the uterus grows in the same way as during pregnancy. That is, if the uterus is enlarged at 10 weeks of pregnancy, the woman is diagnosed with 10 weeks of fibroids. The sizes in weeks and cm are as follows:

Fibroids in the uterus

Small - up to 2 cm or 20 mm. This usually corresponds to 4 or 5 weeks of gestation;
Medium - up to 6 cm or 60 mm. This figure is considered normal for 6-11 weeks of pregnancy;
Large - from 60 mm or 6 cm or more. Usually relevant at 12 weeks of gestation and beyond.

When education corresponds to 20 weeks of gestation, it can significantly affect the work of neighboring organs. Myoma is also dangerous in that it can disrupt the work of neighboring organs without provoking severe symptoms. But more often than not, minor symptoms are still present.

You can see a photo of myomas in size below.

How to determine the size of a tumor in weeks

What to do when the appropriate diagnosis is made? How do you know if you are being treated correctly? There is a table that shows the size of fibroids by week and what method of treatment is used (table of correspondence between the height of the fundus and the period):

Size in weeks	Uterine fundus height	What type of treatment is used
1-4	1-2 cm or 10-12 mm	Hormonal and drug therapy
Up to 7	3-7 cm or 30-70 mm
Up to 9	8-9 cm or 80-90 mm
Up to 11	10-11 cm or 100-110 mm
Up to 13	10-11 cm or 100-110 mm	Surgical (operational) intervention
Up to 15	12-13 cm or 120-130 mm
Up to 17	14-19 cm or 140-190 mm
Up to 19	16-21 cm or 160-210 mm
Up to 21	18-24 cm or 180-240 mm
Up to 23	21-25 cm or 210-250 mm
Up to 25	23-27 cm or 230-270 mm
Up to 27	25-28 cm or 250-280 mm
Up to 29	26-31 cm or 260-310 mm
Up to 31	29-32 cm or 290-320 mm
Up to 33	31-33 cm or 310-330 mm
Up to 35	32-33 cm or 320-330 mm
Up to 37	32-37 cm or 320-370 mm
Up to 39	35-38 cm or 350-380 mm
Up to 41	38-39 cm or 380-390 mm

Depending on the stage of development of the pathology, the symptoms inherent in it make themselves felt.

Usually the critical days inhibit tumor growth. During this period, the doctor only monitors her condition. If the woman no longer plans to have children, then the alternative may be to completely remove the uterus.

What will happen without surgery

If the patient is indicated for an operation to remove the fibroid, it is necessary to adhere to this appointment, otherwise the outcome may be unpredictable. What does it mean? Possible consequences:

If the inflammation is severe, severe kidney disease will result;
A benign tumor will become cancerous in a short amount of time;
The growth of fibroids will continue, which will lead to even greater pressure on neighboring organs, the outcome of this process can be unpredictable, even lethal;
Anemia will develop rapidly;
There is a risk of infertility.

If you regularly visit a gynecologist, follow all his requirements, then the consequences of the problem will not affect you. Today there are many modern techniques that allow you to remove the tumor quickly and without consequences. Therefore, you should not be afraid of doctors, this pathology can be eliminated by living a full and rich life.