Uterine leiomyoma is a benign tumor formed by hyperplasia of uterine smooth muscle tissue. The common manifestations are uterine bleeding, pain, abdominal mass, compression symptoms of adjacent organs, increased leucorrhea, anemia and cardiac insufficiency. Some patients have no symptoms, and uterine fibroids are often found in gynecological general surveys. Uterine leiomyoma is the most common benign gynecological tumor, which usually occurs in 30-50 years old. According to the position of uterine muscle wall, uterine fibroids can be divided into intramural, subserous, submucosal and broad ligament fibroids.
Treatment:
If fibroids are small, asymptomatic, without complications and degeneration, they generally do not need treatment. Especially for women close to menopause, due to the low estrogen level after menopause, fibroids naturally shrink or disappear, and only need regular review (3 ~ 6 months). If the reexamination finds that the myoma is enlarged or the symptoms are obvious, then consider further treatment.
Second, the surgical treatment:
(a) hysterectomy, suitable for the size of the uterus, the size of the uterus for more than 3 months, obvious symptoms of fibroids, or rapid growth of fibroids can not rule out malignancy;
(2) Myomectomy: suitable for patients under 35 years old, unmarried or childless;
Third, drug treatment: used for patients with small fibroids, asymptomatic, close to menopause or systemic conditions that cannot tolerate surgery.
(a) Testosterone methyl and testosterone propionate;
(2) progesterone. (1) norethindrone, which is used for patients who require fertility; (2) Megestrol acetate, Megestrol acetate and norethindrone, choose one of them; ③ Luteinizing hormone releasing hormone analogues.
Prevention:
Those who suffer from hysteromyoma should have regular check-ups, such as B-ultrasound or gynecological check-ups every 3 to 6 months. If elderly women have rapidly enlarged fibroids or vaginal bleeding after menopause in a short time, they should be alert to whether sarcomatoid degeneration occurs. People with menorrhagia should actively correct anemia to prevent the occurrence of anemia heart disease and myocardial degenerative diseases.
Chief physician He, drug treatment of hysteromyoma
Uterine myoma is a common pelvic benign tumor in gynecology. According to statistics, among women over 35 years old, about 1 person in every 5 people suffers from uterine fibroids. In terms of treatment, doctors decide whether to adopt surgical treatment or non-surgical treatment (traditional Chinese medicine, western medicine, combination of traditional Chinese and western medicine or observation) according to the age of patients, the size of fibroids, menstrual flow and fertility. Patients generally hope to find an effective treatment without surgery. Is it possible? The answer is yes.
Ms. Huang, 49, discovered uterine fibroids three years ago. By the end of last year, she was diagnosed by B-ultrasound. 1×53×59mm size. Accompanied by menorrhagia, menstrual cycle disorder and anemia in the past 3 years; Usually dizzy, weak, unable to play. Testosterone propionate and tamoxifen have no obvious effect. A doctor suggested an operation, but Ms. Huang didn't want to have an operation, so she came to see a doctor. After 3 months of mifepristone treatment, B-ultrasound showed that the volume of hysteromyoma was reduced by half. The patient's complexion was rosy, anemia symptoms improved, and red blood cells and hemoglobin returned to normal. Ms. Huang was overjoyed, but she couldn't help asking, why does mifepristone work so well?
This has to be discussed from the pathogenesis of uterine fibroids. In the past, it was thought that the occurrence of hysteromyoma was related to estrogen, so it was treated with testosterone propionate. Or use tamoxifen, an estrogen receptor blocker, to reduce the effect of estrogen on uterine fibroids, but the effects of these drugs are not ideal. 1983 Felicori used GnRH-a (gonadotropin releasing hormone agonist) to treat uterine fibroids. Its mechanism is that through a series of pharmacological chain effects, it leads to hypogonadism (its low estrogen environment is similar to drug-induced ovariectomy), the blood flow of uterus and myoma decreases, and finally the myoma shrinks. This medicine has obvious effect on reducing uterine fibroids, which is incomparable to previous drugs. However, due to its high price and daily intramuscular injection, the course of treatment is as long as 3-6 months, which limits its wide use. In recent years, with the rapid development of medicine, it is considered that the occurrence of uterine fibroids is also related to progesterone. According to this mechanism, in 1993, Murphy first used progesterone receptor blocker Ru486 (domestic drug name mifepristone) to treat uterine fibroids, in order to block the effect of progesterone on uterine fibroids, and achieved satisfactory results. According to recent literature reports, compared with GnRH-A, mifepristone has similar curative effect in reducing uterine fibroids, but it has light side effects and low incidence rate, and the recurrence rate of uterine fibroids is lower than that of GnRH-A. This medicine is a tablet, which is taken orally/kloc-0 times a day, and the price is also lower. These advantages make this medicine easy to be accepted by patients and easy to popularize.
The clinical application of this medicine shows that the fibroids have shrunk in different degrees, the symptoms of anemia have disappeared, and the indexes such as red blood cells and hemoglobin have returned to normal. This medicine is especially suitable for the treatment of hysteromyoma in the following two situations: First, menopausal women with hysteromyoma can shrink hysteromyoma after taking the medicine, and some experts believe that it has the function of entering menopause in advance. For those who suffer from menopausal functional uterine bleeding at the same time, it can be said that one medicine has three effects. After taking the medicine, most patients stop menstruation in the same month to stop bleeding (after treatment, menstruation usually recovers within six weeks). Secondly, for patients with huge uterine fibroids and severe anemia, this medicine is used to shrink the fibroids before operation, which is convenient for hysterectomy and reduces intraoperative bleeding, so that there is no or less blood transfusion during operation. If it is infertility caused by hysteromyoma, taking medicine can shrink hysteromyoma, preserve uterus and create conditions for fertility.
Since mifepristone was used to treat uterine fibroids, a considerable number of patients have been spared the pain of surgery, but this drug must be used under the guidance of experienced experts. In clinical application, we must master its indications and contraindications strictly and carefully. Patients with asthma, angina pectoris, ulcerative colitis, arrhythmia, heart failure and adrenal insufficiency are prohibited.
Free Hospital Network www.cmn.com.cn Tian Tian Health News Editorial Department 2000/ 12/28
hysteromyoma
This disease is a kind of reproductive system disease that occurs in middle-aged women, and it is the most common benign tumor. The main symptoms of hysteromyoma are increased menstruation, prolonged menstruation and shortened menstrual cycle.
Uterine leiomyoma is the most common benign tumor in female reproductive system diseases, which occurs mostly in middle-aged women. Compared with malignant tumor, this kind of tumor grows slowly and does not spread and endanger life. Some uterine fibroids may grow to be as big as grapefruit in a few years, and some will be as big as mung beans after many years.
Uterine fibroids can be divided into three types according to the growth site:
① submucous myoma of uterus: the myoma protrudes into the official cavity, and the surface is only covered by a layer of endometrium, accounting for about10% of the total myoma;
② Intramural myoma of uterus: the growth of myoma is located in the wall of uterus muscle and surrounded by muscle, accounting for 60-70% of the total myoma;
③ Subserous myoma of uterus: The growth of myoma mostly protrudes from the serous surface of uterus, accounting for 20-30% of myoma.
The main symptoms of hysteromyoma are increased menstrual flow, prolonged menstrual period and shortened menstrual cycle. Submucosal and intramural myomas are the main causes of menorrhagia, while subserous myomas have little effect on menstruation. Therefore, subserous fibroids can grow very large, causing other symptoms, and patients often come to see a doctor because they touch abdominal masses.
Due to the different growth sites and sizes of fibroids, there may be different degrees of compression symptoms, such as compression of bladder muscles, frequent urination, urgency, etc. Squeezing the rectum can cause dysuria. Severe abdominal pain can be caused when the pedicle of subserous myoma is twisted. This situation often requires surgery to remove fibroids, which will increase the area of uterine cavity, increase the secretion of endometrial glands and increase leucorrhea. If accompanied by infection, purulent leucorrhea may occur. According to the survey, about 25%-35% of patients with fibroids may be infertile.
Family prevention and treatment of hysteromyoma
Family therapy for hysteromyoma;
(1) According to the doctor's advice, take hysteromyoma powder orally, three times a day, each time 15g. Take it for three months to observe the curative effect.
(2) Take 65438 000 grams of Semen Vaccariae, 30 grams of Prunella vulgaris, 30 grams of oysters and 30 grams of Perilla frutescens, and decoct them in water, with 30 doses every day or every other day as a course of treatment.
(3) If the menstrual flow is large, under the guidance of a doctor, intramuscular injection of testosterone propionate 25 mg, twice a week, a total of 8 times.
After suffering from uterine fibroids should pay attention to:
(1) prevent excessive fatigue, and pay special attention to rest during menstruation.
(2) Eat more fruits and vegetables and less spicy food.
(3) keep the vulva clean and dry, and the underwear should be wide. If there is too much leucorrhea, pay attention to cleaning vulva at any time.
(4) After the diagnosis of hysteromyoma, you should go to the hospital for examination once a month. If the myoma grows slowly or does not grow, it can be reexamined once every six months 1 time; If the increase is obvious, surgical treatment should be considered to avoid severe bleeding or oppression of abdominal organs.
(5) avoid getting pregnant again. Women with hysteromyoma have poor uterine recovery after induced abortion, which often leads to long-term bleeding or chronic genital inflammation.
(6) If menstrual flow is excessive, eat more foods rich in iron to prevent iron deficiency anemia.
(7) Do not take extra estrogen, especially after menopause, to avoid the growth of uterine fibroids.
(8) If it is necessary to preserve fertility and have surgery, myomectomy can be used.
A new method to treat uterine fibroids-uterine artery embolization (article source: Sun Bingwen, columnist of Women's Health Friends)
Uterine myoma is a common benign tumor in women of childbearing age, with an incidence rate as high as 20%. The common symptoms are menorrhagia, frequent menstruation and prolonged menstruation, which leads to anemia and physical decline. Especially submucosal myoma is the most likely to cause bleeding, infection and so on. Too many fibroids can also cause pelvic compression symptoms.
Traditional methods to treat uterine fibroids include hysterectomy, myomectomy, myomectomy, cryotherapy and hormone therapy. Hysterectomy is traumatic and will make the patient lose fertility. Myomectomy has the same problem, and the postoperative recurrence rate is 20~25%. Hysteromyomectomy and cryotherapy can preserve the uterus, but laparotomy or laparoscopy is needed. Although hormone therapy can control bleeding, long-term application has great side effects and can cause endocrine disorders.
In recent years, there has been a new method to treat uterine fibroids-uterine artery embolization. Uterine artery embolization was first used to treat acute uterine bleeding, and 1995 was first used to treat uterine fibroids. Because UAE is simple to operate and minimally invasive, it does not affect other treatments and has a broad application prospect. The main principle is that arteriography shows that the uterine artery of patients with hysteromyoma is obviously thickened. The bigger the myoma, the thicker the artery and the richer the blood vessels. The local blood supply of hysteromyoma mainly comes from the left and right uterine arteries, and the blood supply of bilateral uterine arteries accounts for about 93%. Through radiation interventional therapy and percutaneous femoral artery puncture, the arterial catheter is directly inserted into the uterine artery, and permanent embolic particles are injected to block the blood supply of uterine fibroids, so that they gradually shrink or even disappear due to ischemic changes, thus achieving the therapeutic purpose.
The short-term effect of uterine artery embolization is remarkable. According to 1998 statistics, the global total effective rate is 90%, and the tumor volume is reduced by 50%. Due to the short development time and limited follow-up, the long-term effect remains to be seen. The indications of UAE are basically the same as those of surgery.
The main advantages of this therapy are:
(1) has excellent curative effect, especially for patients with bleeding symptoms. After embolization, the tumor shrank obviously and remained stable.
(2) Compared with surgery, UAE has less trauma, simple technical operation and lower postoperative complications, and is more acceptable than surgery.
(3)UAE can preserve uterine function and normal uterine fertility.
(4) Other treatments are not affected after (4)UAE. In other words, even if embolization fails, patients can receive other treatments. Therefore, uterine artery embolization is a new treatment with less trauma, simple operation, stable curative effect and broad prospects.
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