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The hysteromyoma (a disease also call a fibromyoma, a leiomyoma) is a tumor of high-quality character which is shown in the muscular layer of a uterus called a myometrium. Myoma is a peculiar ball in which smooth muscle fibers chaotically intertwine among themselves, and the roundish node as a result is formed. Such nodes sometimes reach especially big sizes and even several kilograms can weigh. Diameter of such nodes makes from several millimeters to the size in several centimeters.
The tumor is hormonedependent and arises at women who stay at reproductive age. Most often women from thirty to forty five years learn about what is a hysteromyoma on own experience. However recently very often it is about rejuvenation of this phenomenon. Today the hysteromyoma makes about thirty percent of all diseases of gynecologic character.
Today specialists speak about the hormonal theory if it is about education and further development of a hysteromyoma. Morphological changes in myometriums happen as a result of failures in excretion, and also metabolic transformation of estrogen. Besides, the ratio of fractions of estrogen matters. Also disturbance of immune responsiveness of an organism which often arises in the presence of the chronic centers of an infection becomes a push to formation of a hysteromyoma. Also genetic predisposition to this disease matters. Besides, abortions, bad ecological conditions, an adenomyosis, inflammations of the sexual sphere, difficult childbirth can be the reasons which provoke the beginning of a disease.
It is proved that myomatous nodes can be formed already at a stage of embryonic development. Cells which are predecessors of a hysteromyoma grow for many years. Their growth is stimulated by the activity of ovaries arising owing to influence of estrogen and progesterone. The structure of hysteromyomas is not identical. If to consider a ratio of connecting and muscular tissue, nodes can be subdivided into myomas, fibromas and fibromyomas.
Classification according to growth of nodes and their localization happens as follows: submucous myomatous nodes which develop are allocated and grow in a cavity of the uterus, afterwards deforming it, and also subserous nodes which grow towards an abdominal cavity. Sometimes in the course of growth of a myomatous node the rassloyka of a uterine sheaf is formed. In this case a node call intraligamentarny myomatous. Intersticial myomatous nodes burgeon from the center of a myometrium and are in more thickly myometrium. If to estimate localization and width of the basis of nodes, and also the size of an intramural component, several types of submucous myomas are also allocated.
If at the patient the submucous hysteromyoma develops, symptoms of this state are expressed in long periods of which existence of clots, and also metrorrhagias is characteristic that provokes display of anemia at the patient. Also during uterine bleedings at women with a hysteromyoma the skhvatkoobrazny, pulling pain in the bottom of a stomach is observed. In certain cases owing to reductions of a uterus the ekspulsiya of a myomatous node occurs randomly. In the course of an exit of a myomatous node the woman feels pains, very intensive, similar to pains. The submucous hysteromyoma and pregnancy very often cannot be combined: its existence threatens with not incubation of pregnancy and, as a result, infertility.
Sometimes small subserous myomatous nodes very long time do not prove certain symptoms at all. However in the course of their development and increase food of a tumor sometimes is broken, becomes probable twisting of a leg of a node. In this case at the patient begins it is expressed to be shown a hysteromyoma. Symptoms are similar with described above: discomfortable feelings in the bottom of a stomach, acute or nagging pains which are periodically shown. Such pain can give to a leg, a crotch, area of a waist. If torsion of a leg of a myomatous node already occurred or there was a necrosis zone, pain is shown much more intensively. The woman in this case can complain of symptoms "strictly a stomach"
If at a hysteromyoma there are iterstitsialno-subserous myomatous nodes, then less expressed tendency to destructive changes is characteristic of such educations. Respectively, such educations can not prove a long time. However gradually nodes grow to very impressive sizes: they can have a diameter up to 25 cm in this case women complain of feeling of strong weight and the expressed discomfort in the bottom of a stomach, and in process of growth of a node the stomach at the patient can increase.
Pain is shown as a result of uterus peritoneum stretching. Besides the increasing nodes press on neuroplexes in a small pelvis. The acute pain arises if there is a disturbance of blood circulation in myomatous nodes. Taking into account an arrangement of nodes there can be a disturbance of functions of bodies, close to them.
If the myomatous node grows kpered, at the patient the dysuric phenomena can develop. The woman complains of too frequent urination, at the same time the bladder is emptied not up to the end. The acute ischuria is also possible. Pressure of a myomatous node can sometimes break defecation. In the presence of subserous myomatous nodes menstrual function is broken rather seldom. But if at the patient multiple subserous myomatous nodes take place, sokratitelny ability of a myometrium is broken, and there are meno-also metrorrhagias.
At intersticial myomatous nodes the uterus increases, and sokratitelny abilities of a myometrium suffer essential changes. As a rule, at women at whom such hysteromyoma has revenges symptoms of an illness are shown by plentiful and very long periods. Sometimes allocations from generative organs appear also between periods.
As a result of constant big losses of blood patients with a hysteromyoma have an anemia. This phenomenon can take place and without plentiful bleedings during periods. The matter is that in the uterus increased because of nodes there is a blood deposition. Women with a hysteromyoma of the big sizes complain of an asthma and the strong heartbeat arising in a prone position owing to a syndrome of the lower vena cava. Also there is pain, the stomach increases, urine can be late or to be shown a hydronephrosis.
It is important to consider that on the course of pregnancy the hysteromyoma makes negative impact. Women at whom the hysteromyoma and pregnancy is combined suffer from fetoplacental insufficiency. They often have a threat of an abortion. The most negative impact of a hysteromyoma affects if the placenta is located in a projection of a myomatous node. As a result, functionality and a structure of a placenta is broken, and to a fruit the insufficient amount of oxygen can arrive. If there is very high risk of manifestation of complications, both for the woman, and for a fruit, the issue of preservation of pregnancy is resolved individually. At preservation of pregnancy the issue of hospitalization of the woman, and use of Cesarean section is also individually resolved. If there are no contraindications, at a hysteromyoma also childbirth is possible in the natural way.
Diagnosis of a hysteromyoma
Now as the most effective diagnostic method of a hysteromyoma consider an ekhografiya. Also for establishment of the diagnosis ultrasonic research is conducted. The topographical arrangement of myomatous nodes is defined by use of ultrasonic tomographs by means of which it is possible to receive the informative three-dimensional image. The method of a gidrosonografiya gives the chance to carry out differentiation of a hysteromyoma with an endometria polyp. It is possible to define by this method where the submucosal node is localized and the cavity of the uterus is how deformed.
Besides, allows to differentiate a disease with other illnesses – tumors, increase in lymph nodes a computer tomography and a magnetic and resonant tomography.
The method of hysteroscopy is used for exact definition of small submucous nodes.
The scraping of a mucous membrane of a uterus and histologic research of scraping is conducted for the purpose of an exception of pathology of a mucous membrane of the cervical channel and an endometria. In certain cases the patient appoints also carrying out a laparoscopy.
Treatment of a hysteromyoma
If at the woman revealed a small hysteromyoma, the question of need of treatment is accepted by the gynecologist in an individual order. In general treatment of a hysteromyoma is carried out only to 10-20% of cases, in other cases the waiting attitude and regular supervision is applied.
However women need to visit surely regularly the doctor and to control a state by carrying out ultrasonic research at least once a year. Besides, the woman has to is accurate to realize what is a hysteromyoma and to understand what methods of prevention of further development of a hysteromyoma can help to slow down a course of a disease.
In this case it is necessary to limit the use in food of fats and carbohydrates, not to use too spicy and salty food. If at the woman the hysteromyoma develops, contraindications exist for stay on the sun and in a sunbed. At a hysteromyoma it is very carefully necessary to appoint massage sessions, to carry out physiotherapeutic treatment. Also to women reception of vitamins according to the special schedule which is defined by the attending physician is appointed. At a hysteromyoma of contraindication exist also for use of contraceptive hormonal means.
To suspend growth of a hysteromyoma, and also for the purpose of therapy of menometrorrhagias and anemia conservative treatment is applied. Generally for treatment of a hysteromyoma drugs — derivatives of 19-norsteroid which promote reduction of a hysteromyoma are used. As a result, bleedings become less plentiful, the level of hemoglobin returns to normal.
If the disease considerably worsens the general quality of life of the woman, then in this case removal of a hysteromyoma is reasonable. Depending on severity of an illness surgical removal of a hysteromyoma or a uterus in general is carried out. Very often operation with use of laproskopichesky access which is the least traumatic practices. In more exceptional cases as an operative measure the hysterectomy is applied, however this method is rather traumatic.
Prevention of a hysteromyoma
As the most important point in prevention of a hysteromyoma it is necessary to consider regular inspection at the gynecologist and carrying out BONDS researches which promote detection of a disease at an early stage. Therefore, there is an opportunity to begin treatment of an illness at once and to prevent in the subsequent developing of infertility, oncological diseases, and also some other complications of a hysteromyoma. It is proved that the hysteromyoma very often arises at women who transferred abortion in due time. Therefore for prevention of a hysteromyoma it is necessary to approach a question of contraception competently.