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Fibromatosis of the uterus

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Fibroids of the uterus Uterine fibromatosis is the process of replacing the areas of the muscular tissue of the uterus with a connective tissue that precedes the formation of the uterine fibroids. Fibromatosis of the uterus, contrary to the widespread mistaken opinion of patients, is not a diagnosis, but merely states the presence of atypical changes in the muscular wall of the uterus, that is, it is considered a conditional diagnosis. Its outcome is not always predictable: with progression, the process will end with the formation of a benign hormone-dependent tumor( fibromyoma), and in the absence of such a fibromatosis may for years be asymptomatic or completely disappear in the uterus symmetrically at the onset of menopause.

Prevalence of uterine fibromatosis is difficult to determine. Often, it can be asymptomatically present in women 25 to 40 years old for many years and comes to light accidentally. Much more often( 30%) is diagnosed the final stage of development of fibromatosis - fibromyoma, which manifests itself clinically and causes patients to undergo examination.

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The ubiquity and availability of ultrasound scanning in gynecology led to an increase in the number of cases of uterine fibromatosis detection, which means it was able to prevent its potential negative consequences.

The uterine wall is formed by three layers:

1. Perimetry. Dense outer serous membrane.

2. Myometrium. The most voluminous and powerful muscle layer, possessing a unique ability to keep the developing fetus in the uterus and "push" it out at birth. The increased strength and good elasticity( extensibility) of the myometrium is associated with a layered cross arrangement of muscle fibers: between the outer, under-serous, and internal, submucosal layers of longitudinal muscle fibers there is an average, circular layer in which the muscle structures spiral into a spiral. For elasticity and strength of the myometrium, elastic fibers and connective tissue elements are present in it.

3. Endometrium. Lining the uterine cavity, the outer mucous layer.

Uterine fibromatosis is formed exclusively in myometrium due to the available connective tissue structures. For reasons that are not well understood, an excess of connective tissue is formed in the muscle layer, which differs from the normal myometrium by a greater density and is not capable of contraction.

Diffuse fibromatosis of the uterus is characterized by a widespread compaction of the myometrium without a clear localization of the sites of proliferation of connective tissue. Sometimes the areas of fibromatosis have clear boundaries and with further growth form nodes.

Nodular fibromatosis of the uterus is considered to be a nascent fibromioma.

Clinical signs of uterine fibromatosis are minimal and exist only in conditions of a large number of pathological foci. The diagnosis of fibroids of the uterus states an ultrasound examination. More often echo signs of fibromatosis of the uterus are the only evidence of his presence.

Diagnosis of uterine fibroids should not frighten the patient, since it is conditional. That is, in the presence of certain conditions on the background of fibromatosis may( but not necessarily grow) to grow fibroids. The therapy of uterine fibromatosis is designed to eliminate these negative predisposing conditions.

Causes of uterine fibromatosis

There are no reliable reasons for the appearance of fibromatosis in the uterus. However, since in a significant proportion of patients uterine fibromatosis is combined with hormonal dysfunction, one of the most probable causes is the change in the normal ratio of sex steroids( FSH, LH and progesterone).According to the most popular hormonal theory of the origin of uterine fibromatosis, an increase in the content of estrogen and a decrease in the concentration of progesterone provoke structural changes in the tissues of the myometrium.

There are three most popular variants of the formation of fibromatosis:

1. Uterine variant. It is not associated with ovarian dysfunction. With a normal ratio of hormones, the receptors of the uterus incorrectly perceive progesterone, so the estrogenic effect on the myometrium increases. This can occur after mechanical damage to the structure of the uterine wall during abortion, diagnostic curettage, instrumental medical and diagnostic manipulations( hysteroscopy, biopsy and the like).Inflammatory processes( endometritis, endomyometritis) in the uterus also play a negative role in the origin of fibromatosis.

2. Ovarian version. Any pathological processes in the appendages, leading to a violation of the proper ratio of estrogens and progesterone.

3. The central variant. The entire hormonal function of the ovaries depends on the proper operation of the regulatory centers located in the pituitary and hypothalamus, therefore a change in the controlling effect of the brain can lead to hormonal dysfunction and provoke fibromatosis. Such situations include strong psychoemotional conditions, vegetative - vascular disorders, tumors and the like.

The level of estrogen is affected by chronic liver disease. The liver is responsible for the utilization of estrogens, if it does not cope with this function, they accumulate in the body.

Some extragenital diseases, especially endocrine diseases, are accompanied by a violation of lipid metabolism. Fatty tissue is able to synthesize a small amount of estrogens, but with obesity, when there are many, estrogen becomes larger.

A close association of the risk of developing fibromatosis with the presence of a genetic predisposition has been established. As a rule, the family of patients has relatives with signs of fibromatosis, uterine myoma, endometriosis.

None of the above reasons is not absolute, as their presence does not always imply the appearance of structural abnormalities in the uterus. For the development of uterine fibromatosis, a combination of causes and conditions for their implementation is required. There is a close etiological relationship between uterine fibromatosis and uterine fibroids. However, fibromatosis is not always transformed into myoma, it often exists for many years on its own.

Symptoms of uterine fibromatosis

Clinical signs of uterine fibromatosis depend on the nature and prevalence of structural disorders in the uterine wall.

Uterine fibroids can be of two types:

- Diffuse fibroids of the uterus. It is distinguished by widespread growth and lack of clear boundaries.

- Nodal, or focal, fibromatosis of the uterus. In the muscular wall of the uterus, there are delimited areas of fibrosis resembling nodes at an early stage of formation. Sometimes they begin to increase, and are transformed into uterine myoma. If the nodes grow outward, they are found under the serous layer( subserous nodes), with the nodes growing inward( towards the endometrium), they are localized in the submucosal layer( submucous nodes).

More often the presence of fibromatosis of the uterus has no clinical expression, therefore they are a complete surprise for patients. The first signs of fibromatosis can not attract attention. As a rule, the character of menstruation changes. The presence of foci of fibrosis in muscle tissue disrupts the processes of normal contraction, so menstruation becomes more prolonged, slightly painful, and blood loss increases. Such changes in the initial stage of fibromatosis development are not pronounced, and become evident only in the case of the formation of true myomatous nodes.

During gynecological examination with a small spread of fibromatosis it can not be detected. Sometimes it is possible to determine the increase in density of the uterus and / or a slight increase in its size.

Reliable information about the structure of the uterine wall is provided by ultrasound scanning. The presence of fibromatosis is indicated by an increase( diffuse or focal) of the volume of myometrium at the sites of growth of connective tissue, a change in its normal density, and the presence of nodes. Since the myomatous nodes grow unevenly, simultaneously in the uterine wall, one can see the presence of small foci of fibromatosis and the "adult" myomatous nodes.

Echopriznaki fibromatosis of the uterus and uterine fibroids do not have clear distinctions. The most reliable ultrasound criteria for uterine fibromatosis are:

- a change in the normal size of the uterus( increased in 85%);

- deformation of the contours of the uterus( 66.7%);

- presence in the walls or cavity of the uterus pathological formations( 100%): seals, nodes.

When the diagnosis of uterine fibromatosis is not obvious, additional diagnostic measures are required: hysteroscopy or laparoscopy.

To understand the cause of this disease in a particular patient, the hormonal status is studied, the presence of endocrine and metabolic diseases is established.

Patients who learned about the presence of this pathology, always ask the question of how to combine uterine fibromatosis and pregnancy. Problems with childbearing in most cases arise not because of fibromatosis, but because of hormonal disorders leading to both the appearance of fibromatosis and infertility. And only when in the myometrium there are significant impairments of the ability to contract, uterine fibromatosis and pregnancy result in miscarriage or premature birth.

Uterine fibromatosis refers to reversible conditions and does not always transform into fibroids. If the diagnosis of uterine fibromatosis is made on time, it becomes possible not only to stop the progression of the process, but also to eliminate it completely, eliminating provoking factors.

Treatment of fibromatosis of the uterus

To determine the need for treatment of fibromatosis, consideration is given to the extent of the process and its severity, as well as the presence of clinical manifestations. If possible, it is necessary to establish the cause of the appearance of fibromatous foci in myometrium.

If a woman does not experience negative manifestations of fibromatosis, and the process itself does not progress, no specific treatment is performed, but a regular( once every six months) dynamic control is established. In the intervals between control visits, the correct diet is recommended, sufficient physical activity, vitamin therapy and immunity-strengthening drugs.

With the progression of fibromatosis and the appearance of clinical manifestations, it is necessary to begin therapy. As a rule, there is a correction of the existing hormonal disorders.

To select the right therapeutic tactics, you need to study the data of hormonal research. If fibromatosis is formed in the uterus against the background of an incorrect function of the ovaries, hormone therapy is prescribed. It is designed to restore the normal ratio of hormones and eliminate the cause of fibromatosis.

Oral hormonal contraceptives with a low estrogen content( Janine, Yarina and the like) are more often used, they simulate the correct menstrual cycle and restrain the further growth of fibromatosis.

At small sizes of fibromatous nodes in combination with hyperplasia of the endometrium, administration of gestagens( Utrozhestan, Duphaston and the like) is possible.

A good result showed the use of an intrauterine hormone spiral "Mirena" containing gestagen( levonorgestrel).It is introduced into the uterus for five years, where daily "throws out" a portion of the hormone.

Symptomatic treatment means pain medications, vitamin therapy, sedatives and anti-anemia drugs.

If treatment is effective, but the cause of fibromatosis is not eliminated, it can recur.

If uterine fibromatosis is diagnosed at a late stage, when its rapid transformation into myoma is obvious, a therapy similar to that of uterine fibroids is performed. Myoma of the uterus also does not belong to irreversible ailments. Modern therapeutic techniques allow, if not to get rid of it, then stop its growth and eliminate the negative consequences.

Fibromatosis and uterine fibroids stop their progression by the time of menopause, and after its completion, regress.

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