How Big is Too Big?

Uterine fibroid size can vary from less than an inch to larger than a grapefruit. So, do all fibroids need to be removed?

For the vast majority of patients, the answer is no. “Watchful waiting” is the usual course of treatment for most fibroids, particularly if they aren’t causing any symptoms. (i)

Types of Fibroids

Uterine fibroids are non-cancerous growths of the muscle tissue of the uterus. There are four types of fibroids:

1. Intramural fibroids, the most common, grow in the wall of the uterus.
2. Subserosal fibroids grow on the outside of the uterine wall. As they grow larger they can cause pressure on nearby organs or pain due to their size.
3. Submucosal fibroids grow just underneath the uterine lining and can crowd into the uterine cavity, leading to heavy bleeding and other more serious complications. These are the rarest type of fibroid.
4. Pedunculated fibroids grow on small stalks or stems and can grow either outside the uterus or inside the uterine cavity.

Between 70 percent and 80 percent of women develop a fibroid tumor by the time they reach age 50. (ii) You may also develop more than one type of fibroid.

Estrogen tends to stimulate the growth of fibroids in many cases. In fact, during the first trimester of pregnancy, about one-third of fibroids will grow larger, but will then shrink after the birth. (ii) Generally, uterine fibroids shrink after menopause, but postmenopausal hormone therapy may cause symptoms of uterine fibroids to continue.

Fibroids and Weight Gain

Most women with uterine fibroids have an enlarged uterus. In fact, doctors describe the size of fibroids and their effect on a woman’s uterus as they would a pregnancy, such as a 14-week-sized fibroid uterus. It’s not uncommon for a fibroid-affected uterus to grow to the size of a four- to five-month pregnancy. (iii)

A fibroid is considered “giant” if it weighs 25 pounds or more. (iv) The largest fibroid in the world weighed a record 140 pounds. (iv) That’s like carrying around the weight of another person!

The good news is that once any fibroids are removed, your uterus should return to its previous size and you’ll no longer suffer from the bloating that often accompanies fibroids.

Evaluating Uterine Fibroid Size for Removal

Women with large or symptom-producing fibroids may need to have an imaging study done to evaluate uterine fibroid size to determine whether it needs to be removed. The risk of not getting treatment is that fibroids sometimes grow to a size that often leads to significant symptoms, eventually requiring removal.

Larger fibroids or those that continue to grow may lead to complications.

• If submucosal fibroids are found on the inside of the uterus and are large enough to misshape the uterine lining, they should be removed to prevent reproductive problems. (iii)
• If fibroids are larger than a 12- to 14-week pregnancy (about the size of a large grapefruit), the risk of complications during surgery, such as injury to the ureter or bladder, increases. (i)
• Left untreated, very large fibroids can begin to degenerate or burst, even if they aren’t causing any symptoms. (i) Degeneration occurs when the growing fibroid outgrows its blood supply, causing the cells of the fibroid to die. This typically causes abrupt, severe pain and tenderness.
• When fibroids reach the size of a grapefruit (4 – 6 inches), there is a rare association with blood clots in the lungs, which can be deadly. (i)
• Rapidly growing large fibroids may be a sign of a rare cancerous form of fibroid, called a leiomyosarcoma. This type of tumor can’t be differentiated from a non-cancerous (benign) fibroid using ultrasound, MRI, or other imaging studies. However, this type of fibroid only occurs in less than 1percent of uterine fibroids, and these cancerous tumors are not believed to grow from a benign fibroid. (ii)

Treatment Options for Uterine Fibroids

There are several uterine fibroid treatment options:

• Uterine fibroid embolization (UFE) uses tiny particles about the size of sugar crystals that are injected into the blood vessels that lead to the uterus. The particles block the flow of blood to the fibroid, causing it to shrink and die. This minimally invasive procedure can be performed by an interventional radiologist on an outpatient basis. It doesn’t require open surgery and offers relief of symptoms with fewer risks, less pain, and a faster recovery compared to surgical procedures.
• Magnetic resonance imaging-guided (MRI) ultrasound surgery uses ultrasound waves to destroy fibroids. Waves are directed at the fibroids through the skin with the help of magnetic resonance imaging.
• Endometrial ablation destroys the lining of the uterus. This procedure is best for small fibroids that are less than 3 centimeters in diameter. (v)
• Hysterectomy is the surgical removal of the uterus. Because this surgery removes the fibroids along with the uterus, there is no chance of becoming pregnant after undergoing a hysterectomy.
• Myomectomy is another surgical option to remove all types of fibroids. There are three approaches to performing a myomectomy: hysteroscopy, laparotomy, and laparoscopy.

Talk to your healthcare provider about the various uterine fibroid treatment options so that you fully understand the risks associated with surgery, as well as the benefits of a minimally invasive alternative treatment such as uterine fibroid embolization.

Do you think you’re a candidate for UFE? Download our free information sheet Understanding Uterine Fibroid Embolization to learn more or call 844-UFE-CARE (833-2273) to schedule an appointment with a vascular specialist.

Sources:
(i) Bradley, J. G., MD. (2011, June 22). _Uterine Fibroids. Retrieved June 15, 2018, from http://www.obgyn.net/laparoscopy/uterine-fibroids
(ii) Stöppler, M. C., MD. (2018, February 28). Uterine Fibroids Symptoms, Treatment, Pictures, Causes, Surgery. Retrieved July 3, 2018, from https://www.medicinenet.com/uterine_fibroids/article.htm#uterine_fibroids_definition_and_facts
(iii) Brigham and Women’s Hospital. (n.d.). About Uterine Fibroids. Retrieved June 15, 2018, from http://www. fibroids.net/fibroids.html
(iv) Bora, A., Prasad, M., & Gupta, A. (2017). Large Degenerated Broad Ligament Fibroid. _Journal of Postgraduate Gynecology & Obstetrics, 4(1). Retrieved July 5, 2018, from http://webcache.googleusercontent.com/search?q=cache:8Joo72tk2HAJ:www.jpgo.org/2017/01/large-degenerated-broad-ligament-fibroid.html+&cd=1&hl=en&ct=clnk&gl=us
(v) American College of Obstetricians and Gynecologists. (2011, May). Women’s Health Care Physicians. Retrieved June 17, 2018 from https://www.acog.org/Patients/FAQs/Uterine-Fibroids

Fibroid Sizes – What To Know About Uterine Fibroids Size

How Large Can Fibroids Get?

Uterine fibroid sizes can range from as large as a melon to as small as a coin. According to my.cleavelandclinic.org: Fibroids may grow as a single nodule or in clusters and may range in size from 1 mm to 20 cm in diameter. A very large fibroid can even cause the uterus to expand to the size equivalent to a pregnancy heading into the 3rd trimester. Fibroids can further develop as a cluster of many small fibroids or form as one large, dominant fibroid.

Fibroid Size Comparisons

Use the following guide as a reference point to generalize the size of fibroids from small, medium, and large.

• Small (>1cm – 5cm)
• Medium (5cm – 10 cm)
  • Size of a peach to a large lemon.
• Large (10cm+)
  • Size of a mango to a watermelon.

Effects of Larger Fibroids

As fibroids increase in size, their impact on the body becomes more significant. They can take up space meant for other organs and can cause discomfort or pain. Below are a few effects that can arise when fibroids grow past smaller sizes.

• Swelling of the abdomen
• Unusual weight gain
• Discomfort, then pain in the pelvis and lower back
• Increased urination

These are just a few possible signs of a larger fibroid. Here is a more in-depth look at the symptoms.

Fibroid Treatment

If you think you have fibroids, schedule an appointment for a professional diagnosis. One of our gynecologists will talk to you about your symptoms and perform a pelvic exam. We may order further testing including an imaging procedure such as an ultrasound. If diagnosed, uterine fibroid embolization may be your best treatment option; it has a 95% success rate with patients. Here at the Fibroid Treatment Collective, we offer  free consultations in-office or over the phone. For more information on fibroids and their symptoms, feel free to contact us at 1 (866) 479-1523 or request a free consultation online.

Uterine Fibroids and Weight Gain: What to Know

It’s a fairly common question: Can fibroids make you gain weight? Since uterine fibroids affect between 20 to 80 percent of women by the time they reach their 50s, one would think this topic would be more often talked about. But we’re going to talk about the odd relationship between fibroids and weight gain, when these growths can be so large that they affect weight and, lastly, whether weight and diet can help prevent or manage them.

Facts About Fibroids

First off, let’s start with a quick refresher on what uterine fibroids are and how they affect the daily lives of many women. They are muscular tumors growing in the wall of the uterus that are usually benign.

They are typically more common in women in their 30s or older. They are also more common among African American women. Fibroids can happen alongside or be confused for endometriosis. Also, fibroids frequently cause anemia for women who experience heavy bleeding as a side effect, as well as general lethargy. Lastly, there is less-than 1 out of 1,000 chance of a fibroid being leiomyosarcoma, or cancerous. (Having fibroids does not increase your chances of having leiomyosarcoma.)

Common Symptoms of Uterine Fibroids:

• Heavy periods
• Menstrual periods that last more than a week
• Painful or excessive cramping
• Miscarriages
• Lower back pain
• Leg pain
• Constipation
• Difficulty emptying the bladder
• Frequent urination

As one can see from our list of fibroids symptoms, weight gain is not typically listed among them; however, this symptom can happen as a result of fibroids.

Do fibroids cause weight gain?

Often, they can. Fibroids cause weight gain in the abdomen when the fibroids themselves grow large in size. Very large uterine fibroids can weigh several pounds or even push on other organs. Often, women experience more than one fibroid. In severe cases, a woman may even appear pregnant because of the excess weight in the area. Many women may experience more than one type of fibroid. Sudden changes in hormones like estrogen can lead to this sudden growth.

A large fibroid cluster can measure to more than eight inches in diameter or larger, which is about the size of a small watermelon. Fibroids of this size can directly impact a woman’s weight. Beyond about four inches in diameter, or the size of a grapefruit, a doctor needs to be consulted, as this can impact other organs such as the bladder and the lungs. There is also an increased risk of blood clots or ruptures. Of course, in extreme circumstances they have been known to grow even larger. In one very extreme case in Singapore, one woman had a 61-pound fibroid removed.

Women should definitely contact their doctor if they are experiencing a bulge that resembles but isn’t pregnancy. Generally feeling or appearing bloated can be accompanied by extra weight.

Many women experience fibroids that are less than a pound altogether. A fibroid may not be the only explanation of weight gain. It depends on where it’s located, how many of them are and how they are progressing.

Types of Uterine Fibroid

• Subserosal: The fibroid grows outside of the uterus and can, when large, push on nearby organs.
• Submucsal: The fibroid grows just underneath the uterine lining.
• Intramural: The fibroid grows inside of the wall of the uterus. This type is the most common.
• Pedunculated: This type of fibroid grows on stalks that are connected to the inside or outside of the uterus.

Can you lose weight while you have fibroids?

Yes, uterine fibroid patients are encouraged to lose weight, but it can be somewhat difficult for a few reasons. For some women, simply having fibroids may lead to more weight just as a symptom of a growth getting larger. But more commonly it also can impact weight in secondary ways, like as a result of overeating.

Overeating happens when a patient feels anemic as a result of the heavy bleeding; they’re trying to make up for what feels like a loss of calories. Women also may feel like reducing their normal exercise, as the iron deficiency can make women feel frighteningly lightheaded, which can make exercise a far more worrisome experience. All of this complicates the question of, “Do fibroids make you gain weight?” Women can gain weight because they’re trying to manage their other symptoms. But it is definitely possible, if not encouraged, to lose weight while having fibroids!

Does losing weight help prevent fibroids?

It’s commonly recommended to fibroid patients to try to lose weight because it can help to prevent further fibroid growth. Fat cells make more estrogen, and sudden changes in hormones can lead to fibroid growth. Having a healthy weight, good diet and regular exercise routine can help prevent them. In addition, avoiding chemicals that can affect hormones, such as pesticides and paints, can help.

While fibroids and weight loss might not seem to go hand in hand, it is possible and helpful to reduce one’s weight.

These are some basic tips for dealing with this combo:

• Be aware of the iron deficiency and use vitamins or diet to correct it.
• Eat brightly colored fruits and vegetables.
• Eat foods high in fiber, such as cruciferous vegetables or oats.
• Get enough vitamin D, which can lower your risk of uterine fibroids by 32 percent.
• Avoid foods that affect estrogen, like soy, tofu and red meat.
• Avoid sugary foods and refined carbs.

When you have fibroids, weight gain is not an inevitability!

If your symptoms are affecting your daily life or if you’re observing a bulge in your lower abdomen, it’s best to check in with a doctor to check on the growth. Fibroids have symptoms in common with more serious diseases, so it’s best to keep a close and careful eye while attempting to lose weight.

Uterine Fibroids Info | Family Fertility Center

With few exceptions, surgical treatment is more effective in relieving symptomatic uterine fibroids.

Myomectomy

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman preserves her uterus, she retains her ability to become pregnant. It is an effective treatment to reduce both bleeding, pain and pressure from uterine fibroids.

Fibroids do not re-grow after myomectomy, but new fibroids may develop. The 5-year recurrence rate after abdominal myomectomy for a single uterine fibroid is about 10% and 25% with multiple fibroids. The 10-year recurrence rate after single myomectomy is 27%. For this reason, myomectomy is not the best choice for women who no longer wish to have future pregnancies.

There are several ways to perform myomectomy. The “best” way depends on the location, size and number of fibroid in the uterus.

• abdominal myomectomy: an incision (cut) is made is the lower abdomen to remove the fibroids.
• laparoscopic or robotic myomectomy: several small incisions are made in the stomach to allow small instruments and a camera (laparoscope) to remove the fibroids. Robotic myomectomy is a variation of laparoscopic myomectomy where the surgery is assisted with a surgical robot.
• hysteroscopic myomectomy: this procedure is specific and effective for fibroids located inside the cavity of the uterus (submucosal fibroids). Small instruments and a camera (hysteroscope) are inserted into the uterine cavity through the cervix to remove the fibroids. Recovery is rapid because there is no incision on the stomach.

Endometrial ablation

Endometrial ablation destroys the lining of the uterus. The treatment does not shrink the fibroids(s) but can help reduce heavy menstrual bleeding caused by fibroids (smaller than 3 centimeters). There are several ways to perform endometrial ablation.

Endometrial ablation is not a birth control. You need to use some form of birth control to prevent pregnancy after ablation. Women who do get pregnant after ablation are more likely to have an abnormal pregnancy.

Hysterectomy

Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is a permanent treatment that cures heavy menstrual bleeding, and the pressure and pain symptoms of fibroids. It is done when medical treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to become pregnant after having a hysterectomy.

Uterine artery embolization

In uterine artery embolization (also called UAE or uterine fibroid embolization, UFE), tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. However, the procedure is not recommended for large fibroids, submucosal fibroids or pedunculated fibroids.

Embolization is not recommended for women who desire to retain their fertility. When compared with myomectomy, embolization is associated with a higher rate of infertility and miscarriage.

Magnetic resonance guided focused ultrasound

This is the newest fibroid treatment option. A magnetic resonance mapping for heat is used to locate the uterine fibroids and high energy ultrasound is delivered to the fibroids to destroy them with instant necrosis. Injury to the skin and normal tissues in the pathway of the high-energy ultrasound are potential side effects. The technique is so new that safety and efficacy of this procedure remains to be established.

Estimated Effects on Assessing Fibroid Growth

J Ultrasound Med. Author manuscript; available in PMC 2017 Jun 1.

Published in final edited form as:

PMCID: PMC5452979

NIHMSID: NIHMS857280

Malana Moshesh

^*National Institute of Environmental Health, Research Triangle Park, NC 27709, Epidemiology Branch

Shyamal D.

Peddada

^†National Institute of Environmental Health, Research Triangle Park, NC 27709, Biostatistics Branch

Tracy Cooper

^‡Henry Ford Health Systems, Detroit, MI 48202 Department of Radiology Division of Ultrasound

Donna Baird

^*National Institute of Environmental Health, Research Triangle Park, NC 27709, Epidemiology Branch

^*National Institute of Environmental Health, Research Triangle Park, NC 27709, Epidemiology Branch

^†National Institute of Environmental Health, Research Triangle Park, NC 27709, Biostatistics Branch

^‡Henry Ford Health Systems, Detroit, MI 48202 Department of Radiology Division of Ultrasound

Corresponding author: Malana Moshesh, National Institute of Environmental Health, Epidemiology Branch, Research Triangle Park, NC 27709, Tel: (919) 541-5004, [email protected] publisher’s final edited version of this article is available at J Ultrasound MedSee other articles in PMC that cite the published article.

Abstract

Objectives

To evaluate intra-observer variability of fibroid sonography measurements, and apply this to assessing fibroid growth.

Methods

Study participants were young African American women, aged 23–34, who had never been diagnosed with uterine fibroids. All participants underwent transvaginal ultrasound to screen for the presence of previously undiagnosed fibroids (≥0.5 cm diameter). The diameters of up to six fibroids were measured in three perpendicular planes at three separate times during the examination by experienced sonographers. Intra-observer variability as measured by the coefficient of variation (CV) for fibroid diameter and volume was calculated for each fibroid, and factors associated with CV were assessed using regression models. Impact of variability on growth assessment was determined.

Results

Ninety-six women out of three hundred women screened were found to have at least one fibroid, yielding a total of 174 fibroids for this analysis. The mean CV for the three measurements of fibroid maximum diameter was 5.9. The mean CV for fibroid volume was 12.7. Fibroid size contributed significantly to intra-observer variability, with more variability for smaller fibroids. Fibroid type (submucosal, intramural, subserosal) was not important. Fibroids from the same woman tended to have similar measurement variability when assessed for fibroid volume, but not for fibroid maximum diameter. Calculations showed that when following up fibroids, as much as a 20% increase in diameter could be due to measurement error, not “true growth”.

Conclusion

A small fibroid must have a larger change in size than a large fibroid to conclude that it is growing, but even for small fibroids an increase in diameter of >20% is likely to indicate “true growth,” not measurement variability.

Keywords: ultrasound, fibroid, variability, growth, coefficient of variation

Introduction

Estimating size change of an organ is a research and clinical assessment that is used to relate symptom development to organ growth, to identify treatment needs, and to evaluate treatment effectiveness. The assessment and evaluation of uterine fibroid growth is usually done with 2-D ultrasound. Assessing true growth has problems including variation in measurement, operator limitations, and patient characteristics that might impact image quality. While many of these factors cannot be accounted for accurately, measurement error due to operator variability (intra-observer variation) of fibroids can be assessed accurately, but data on intra-observer variation of the assessment of fibroids has rarely has been evaluated.

As research on the treatment and management of fibroids advances, the ability to treat fibroids with medical and less invasive surgical treatments is likely to expand[1] [2] Thus precise measurements of fibroid size and estimation of growth using ultrasound will become more and more important. The primary objective of this study is to report our findings regarding intra-observer variation. We then provide a method to determine the effect of this measurement error on the estimates of fibroid growth. We suggest that only increases in tumor size that is larger than measurement “noise” can be attributable to real growth.

METHODS

STUDY POPULATION

The data were collected in the Study of Environment, Lifestyle, & Fibroids (SELF), a study of fibroid development conducted in the Detroit, Michigan area and supported by the National Institute of Environmental Health Sciences, NIH. Study participants were premenopausal African American women ages 23–34 who had not been previously diagnosed with fibroids. Women were recruited from the community through local healthcare clinics, fliers, radio announcements, community events, and by word of mouth. Upon enrollment women completed detailed questionnaires about their current dietary habits, life-style habits, medical & family history, and symptoms such as bleeding and pain which may be caused by the presence of fibroids. A standardized research ultrasound examination was used to screen for the presence of fibroids. Of the first three hundred participants who enrolled, 96 were found to have one or more fibroids, despite having no prior clinical diagnosis of fibroids. These 96 women constitute the sample for this analysis. This study was approved by the institutional review boards of the National Institute of Environmental Health Sciences, and Henry Ford Health Systems, and all participants gave written informed consent.

FIBRIOD ASSESMENT

All fibroid measurements were taken during a single examination. Examinations were not scheduled according to a specific time during the menstrual cycle. Ultra-sonographers conducting exams had at least three years of gynecologic ultrasound experience, and were trained registered diagnostic medical sonographers (RDMS). Ultra sonographers used Phillips IU-22s to conduct study exams, with the exception of one GE Logic 9 machine of a similar age. Magnification was performed as needed, but ultrasonographers did not magnify to the point that the location position or type of fibroid could not be determined when reviewing images. Additional training in the detection and assessment of uterine fibroids was provided by the lead sonographer. Fibroid identification was based on ultra-sonographic criteria previously described in the literature, but extended to identify small fibroids (at least 0.5 cm in maximum diameter) [3, 4]. Care to distinguish fibroids from other pathologic changes in the uterus was addressed by including training on detecting the differences between adenomyosis and fibroids and polyps and fibroids [3, 5, 6].

Ultrasounds were conducted transvaginally. Transabdominal ultrasound examination was added if the transvaginal examination did not provide a complete assessment. Only 6.25 % (n=6) of our sample reported any “difficulty “ assessing the uterus during the scan due to participant factors such as body habitus, patient discomfort, and bowel activity. However, only two ultrasound exams out of 96 required a transabdominal approach due to patient discomfort with the vaginal probe. When we dropped these two participants, our results essentially stayed the same, and we present the results based on the entire sample. Fibroids were recorded as fibroids only if they were at least 0.5 cm in maximum diameter, and could be visualized in all three planes. The largest fibroid measured was 5.7 cm. If a fibroid-like echo pattern could not be visualized in all three planes, it was recorded as a “questionable fibroid” and the visualized diameters were recorded.

Each individual fibroid was measured with their 3 perpendicular diameters (sagittal, longitudinal, and transverse see ). Each fibroid was relocated and re-measured two additional times during the examination. Caliper placement for each diameter was from outer border to outer border. Therefore, a total of 9 diameters were recorded for each fibroid. Sonographers used a standardized data collection form that included a diagram of the uterus where each fibroid was mapped and numbered. Therefore, in women with multiple fibroids each fibroid was carefully mapped, numbered, and measured separately three times.

Fibroid measurements in the 3 perpendicular planes (sagittal, longitudinal, and transverse)

Fibroid type (intramural, submucosal, subserosal, and pedunculated) and location (fundus, uterine corpus, cervix/lower uterine segment) were assessed by each ultra-sonographer during the exam. Fibroid type was defined as intramural if it was mainly within the myometrium and did not impinge into the endometrial cavity. If a fibroid impinged upon the endometrial cavity, it was considered submucosal. A fibroid was considered subserosal if it projected from the serosal (uterine) surface, distorting the uterine contour with 1/3 or more of its volume. Fibroid location was determined with respect to the uterine axis, and divided into three categories (fundus, corpus, cervix/lower uterine segment) based on a reference picture kept at all sonography stations (see ). Women were asked to void prior to examination.

Reference illustration of the uterus

STATISTICAL ANALYSIS

We investigated which diameter (longitudinal, transverse, and anterior-posterior) had the greatest variability, by calculating coefficients of variation (CVs) for each diameter type. Analysis of variance was used to compare mean CVs for each diameter.

We calculated CVs for fibroid volume and fibroid maximum diameter for each fibroid. Fibroid volume was calculated using the ellipsoid formula (length × width × height) × 0.52 for each of the three measurements taken for a given fibroid. Thus, each fibroid had a total of 3 separate volumes calculated. The CV was then calculated for each fibroid using the 3 volume measurements. Similarly, the maximum diameter was determined for each of the 3 measurements of a given fibroid and the CV for maximum diameter was calculated based on the three maximum diameters recorded.

We evaluated fibroid size as a continuous and as a categorical variable. We created four categories of baseline fibroid size very small (0.5 cm to 0.9 cm), small fibroids (1.0 cm to 1.9 cm), medium sized fibroids (2.0 cm to 2.9 cm) and large fibroids (3.0 cm and over). The maximum mean diameter was used for categorizing fibroid size as follows. We calculated a mean diameter for each of the three planes (sagittal, longitudinal, and transverse), and chose the maximum mean diameter. We also investigated the influence of fibroid type and location (defined above).

Statistical analyses were done using SAS (version 9.2). We examined the relationship between fibroid characteristics (size, type, location) and measurement variation (CVs for each fibroid) with mixed model regression. This accounts for the possibility that fibroids from the same woman may have similar measurement variation using participant ID as a random effect. The mixed model provides a measure of this effect by including participant as a random effect to estimate within-woman and between-woman components of fibroid variability. All fibroid characteristics were included in the initial model, i.e., fibroid type, fibroid location, and fibroid size, and those characteristics that were not significant were dropped. The assumption of homoscedasticity of CV by baseline fibroid size was assessed using residual plots.

To estimate how much increase in fibroid diameter would be needed to identify what would likely represent true growth rather than measurement error, we used the 95% confidence interval of the CV to estimate the amount of increase that would be needed to exceed measurement “noise” (see appendix for sample calculations).

RESULTS

There were ninety-six women who had fibroids detected by ultrasound. There were a total of 178 fibroids; 174 were distinct, 4 fibroids were “questionable” and not used in the analysis. Age distribution and number of fibroids per woman are shown in . Most women had only one fibroid detected (61.5% n= 59). Type, location, and size of the fibroids can be seen in . Most fibroids were small (under 2cm in diameter n= 136, 78%). Most fibroids were intramural (n= 137, 79%). Only 4.0% (n=7) were submucosal. Approximately half of all fibroids were in the fundus (51%) and about another half in the uterine corpus (47%). Only 4 fibroids were detected in the cervix/lower uterine segment.

Table 1

Characteristics of women with fibroids enrolled in the Study of Environment Lifestyle & Fibroids (SELF). A total of 300 women enrolled and 96 women had at least one fibroid at baseline examination (all are African American)

Characteristics of Women	N=96 women	%
Age
23–25	7	7
26–30	52	54
31–35	37	38
Number (#) of fibroids
1	59	62
2	12	12
3	7	7
4	5	5
5	4	4
6 or more*	5	5
Fibroid Characteristics	N=174 fibroids †	%
Type
Submucosal	7	4
Intramural	137	79
Subserosal	28	16
Pedunculated	2	1
Location
Fundal	89	51
Corpus	81	47
Cervix/lower segment	4	2
Fibroid size‡
Very Small (0. 5cm–0.9cm)	45	26
Small (1.0cm–1.9cm)	91	52
Medium (2.0cm–2.9cm)	25	14
Large (3 cm and over)	13	8

We found that the anterior-posterior diameter had significantly greater intra-observer variation (CV=14%) as compared to the longitudinal and transverse diameters (7% and 6% respectively, P-Value_difference < 0. 001).

Considering all 174 fibroids, the mean coefficient of variation (CV) for the three measurements of maximum fibroid diameter was 5.9% (95% CI 1.2, 13.5). Fibroid size contributed significantly to the variation in maximum diameter measurement, with smaller fibroids showing higher variability (P= 0.04) (). Fibroid location (with respect to the uterine axis) was also a significant predictor of measurement variation for maximum diameter (P = 0.03). Controlling for fibroid size, fibroids located in the fundus showed the lowest variability in measurement of maximum diameter (CV_fundus= 4.9% 95% CI 1.2–10.0, CV_corpus= 6.9% 95% CI 1.2–17.2, CV_{cvx/lowersegment}= 5.7% 95% CI 1.5–13.5).

Table 2

Intra-observer measurement variability for fibroid maximum diameter and fibroid volume.

Parameter
Fibroid maximum diameter (cm)	N	Mean CV(95% CI)	Threshold for True Growth, cm/cm3a	Threshold for True Growth, %a
Very small (0. 5–0.9)	45	6.3 (3.9–8.6)	0.14	20
Small (1–1.9)	91	4.7 (2.6–6.8)	0.24	16
Medium (2–2. 9)	25	4.2 (1.9–6.5)	0.37	15
Large (3 and over)	13	3.2 (0.5–5.8)	0.67	14
Fibroid volume (cm3)a
Very Small (0. 065–0.51)	45	14.9 (10.6–19.2)	0.08	44
Small (0.52–4.1)	91	12.1 (8.2–16.1)	0.66	38
Medium (4.2–14.0)	25	8.9 (4.4–13.5)	2.56	31
Large(over 14. 0)	13	7.2 (1.8–12.5)	18.90	29

Measurement variability for fibroid volume, given that it was based on a formula using 3 diameters, was higher than for maximum diameter. The mean CV was 12.7% (95% CI 2.8, 28.7). The CV for volume varied significantly by fibroid size (P = 0.005), but not by fibroid type or location. Within woman effects were significant when considering the CV for fibroid volume but not for fibroid diameter. The significant within woman effects indicates that there was correlated measurement variation for multiple fibroids in a given woman. (P = 0.01). Volume measurements for small fibroids were much more variable than those for larger fibroids (). The significance of fibroid size was seen both when size was treated categorically and when it was treated as a continuous variable.

Given our results, small increases in fibroid size from one examination to the next could just be due to measurement error, not “true growth”. Our calculations showed that when following up fibroids, as much as a 20% increase in diameter could be due to measurement error, not true growth. We have calculated the threshold for true growth for fibroids for each size category to illustrate this (). See appendix for step-by-step calculation of such thresholds.

DISCUSSION

The intra-observer variability in 2-D ultrasound measurements of fibroid diameter and volume are within the general range of within-assay variability for biomarkers measured in blood or urine. Maximum diameter measurements had CVs <10, and the CVs for the fibroid volume estimates were also <10 for the fibroids ≥2 cm in size. Small fibroids were measured less accurately. Location appeared to also be a factor in measurement accuracy of the maximum diameter, with fibroids in the fundus being slightly more accurately measured than those in the corpus. The CVs for fibroid volume measurements are higher than those for fibroid diameter measurements. This is expected because volume is calculated using the longitudinal, AP, and transverse diameters, all of which have some measurement error. Within woman effects contributed to intra-observer variation for fibroid volume. One potential explanation of this finding is that sonogram quality differed somewhat between women. This would most likely be due to individual participant characteristics unique to that woman. These might be factors such as body habitus, shadowing from fibroids, and possible effects of time during the menstrual cycle, or retroversion of the uterus, which may interfere with image quality or image reproducibility.

We used the 95% CI of the model derived CV for maximum diameter to estimate the lower threshold for “true growth”, i.e., the smallest increase that can be distinguished from measurement error. For example, a fibroid measured initially at 1.5 cm maximum diameter would need to have a follow-up measurement of about 1. 75 cm (a 16% increase) to attribute the increase to true growth rather than to measurement error. The appendix provides the step-by-step calculations required to estimate the increase in either diameter or volume to attribute the increase to “true growth”. As a useful rule of thumb, fibroids that increase in diameter by more than 20% can be assumed to have grown, while a <20% increase might be attributable to measurement variability.

Our study focused on intra-observer variation. Our estimate, based on 3 measures during the same examination could be an underestimate if the sonographer made a special effort to get near identical measures each time. That is unlikely given the protocol which requires a separate approach for each evaluation. We did not focus on inter-observer variation which would require multiple sonographers to measure the same fibroids (multiple examinations for the same woman). Ultrasonographers in our study had at least 3 years of experience in gynecologic ultrasound. They also underwent additional training to identify and measure fibroids according to research protocol. We know of no data for inter-observer variation in ultrasound measurements of fibroids, but increased variability between operators in other measurements have been linked to operator experience (more experienced operators have less inter-observer variation) [7] [8], and decreased variability has been linked with training prior to measuring the organ of interest, which was done in our study [9] [10]. Considering our lack of data on inter-observer variation, a fibroid size change needed to show true growth may be somewhat greater than the measure we calculated here especially in the context of less experienced operators.

We limited our calculation to the assessment of fibroid growth and not fibroid shrinkage, as fibroid growth tends to be more clinically relevant. However, as noted in the appendix of this paper, the method used to asses” true growth” can also be applied to the evaluation of “true shrinkage. ”

Other limitations of our study included, small numbers of fibroids for certain subgroups of fibroids (submucosal, cervix and very large fibroids),, the fact that ultrasound examinations were not performed at a designated time during the menstrual cycle, and it is possible that our measured variability could also be increased because our protocol include a pre-examination void which has been shown to increase myometrial contractions [11]. There is no data available that has evaluated the impact of the stage of the menstrual cycle on the variability of fibroid measurements. However, it is possible that a thickened echogenic endometrium often found in the secretory phase of the menstrual cycle may be more likely to interfere with image quality of fibroids as compared to images taken during the menses or follicular stage of the cycle where the endometrium is likely to be thinner with a uniform multi-layered appearance [12]. This may be especially true for small submucosal fibroids that are close to or within the endometrial cavity. However, this effect would most likely have little impact on most other types of fibroids. Our study, like others, found few submucousal fibroids (4%, n=7).

2-D ultrasound is the most common radiologic modality to diagnose and evaluate fibroids. Magnetic resonance imaging (MRI) is more accurate when a woman has more than four fibroids [13], but is far more expensive. The addition of saline infusion to 2-D ultrasound improves evaluation of the endometrial cavity, but is more invasive than ultrasound alone [14]. 3-D ultrasound may also improve measurement accuracy especially for irregular structures, including the uterus [15–17], but measurement error for fibroids based on 3-D ultrasound has not been evaluated.

We are not aware of other data like ours on fibroid measurement error with 2-D ultrasound. Similar assessments for measurement of other structures are also limited, but appear to be similar to our findings. Intra-observer CVs for muscle diameter and cross sectional area was 8. 5 and 8.9, respectively, and CVs for echocardiograph measures in foals was 5–15[18]. Our estimates of size change needed to identify true growth based on volume change is generally similar to that calculated for the prostate using 2-D ultrasound. A relative increase in prostate volume of 43% was needed [16], while we estimate a 29% volume increase would be needed for a 5-cm fibroid.

The ability to accurately measure fibroids will become more important as pharmacologic treatments become available [19]. Currently we know very little about fibroid and symptom progression, even though fibroids are the leading cause of hysterectomy in the United States [20]. While fibroid growth has often been linked to increased symptomatology in women, there are very few studies evaluating the relationship [21] [22]. This is in part due the difficulty of assessing fibroid growth accurately using 2-D ultrasound the most commonly used modality to assess fibroids. Our work will aid clinicians and researchers who want to evaluate tumor growth by allowing them to take intra-observer variation into account. We suggest using the upper bound of the 95% CI of model based CVs to estimate the lower threshold for “true growth” (see and appendix for details).

CONCLUSION

Using 2-D Ultrasound, measurement error for fibroid diameter and volume varies with fibroid size. However, our estimates suggest that for most fibroids a 20% increase in diameter from one examination to another is likely to be indicative of “true growth”, while less change may just be “measurement noise”.

Acknowledgments

This research was supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.

Funding also came from the American Recovery and Reinvestment Act funds designated for National Institutes of Health research.

Drs Grace Kissling and Zongli Xu provided helpful comments on an earlier draft of the manuscript. Melissa Williams, Deborah Cousins, and Sue Edelstein provided additional support with images for the figures.

Appendix

To obtain an estimate of what would constitute “true grow”th that exceeds measurement error (“noise”), we used the right hand tail of normal distribution for computing the probabilities (hence a one-sided tail). This assumes that growth, not shrinkage is the outcome of interest. The probability that the increase in the fibroid size at follow-up is larger than
1.645×2×standarddeviationofthemeasurement, given that there is no change in size, is 0.05. Thus there is only a 5% chance of observing a growth exceeding
1.645×2×standarddeviationofthemeasurement, when in reality there is just noise. To obtain a suitable estimate of standard deviation, a clinician may refer to and obtain an upper bound of the CV for the measurement of interest. The SD of the fibroid measurement is back-calculated as fibroid measurement of interest x CV/100.

Then the upper bound for measurement error is derived as follows. Suppose X₁ and X₂ are the measurements of a tumor at two different time points, and we make the assumptions that; (a) Variance (X₁) = Variance (X₂), and (b) X₁ and X₂ are independent. Then the estimated variance for the change in size will be the sum of the variances at each point in time, times the estimated standard deviation (SD) = √2 x (SD). That is, we can be 95% confident that the growth exceeding (1.645) x √2 x SD (i.e., 2.33 x SD) is real. Similarly if an investigator is specifically looking for shrinking tumors then a decrease in excess of (1.645) x √2 x SD (i.e., 2.33 x SD) is considered to be “true shrinkage”.

For example, a fibroid with maximum diameter measured as 1.5 cm would be in the “small” (1.0 – 1.9cm) category. From , the upper bound of the 95% confidence interval for the intra-observer CV is 6.8%. The SD would be 1.5 × (6.8/100) = 0.102. An increase in diameter that would likely constitute real growth would be 2.33 x 0.102 = 0.238 or approximately 0.25 cm. Thus a fibroid diameter of 1.5 cm would have to increase to 1.74 cm or more (at least a 16% increase in diameter) to be considered to have undergone real growth.

Likewise, if volume is being used to assess growth, one would use the values associated with volume. For example, a 65 cm³ fibroid (the size of a 5 cm diameter sphere) is within the “large” category. The upper bound of the 95% confidence interval for CV is 12.5. Thus, an estimated SD = 65 × .125 =8.12. The increase in volume that would likely constitute real growth would be 8.12 × 2.33 = 18.9 cm³. Thus a fibroid initially of volume 65 cm³ would need to increase to approximately 84 cm³ (an increase of about 29% in volume) to be considered true growth.

References

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The painful truth about fibroids: why FKA twigs is not alone | Health & wellbeing

It was, said the singer FKA twigs, “a fruit bowl of pain every day”. She likened the size of the fibroids – benign tumours that had been removed from her uterus in December – to fruit: two cooking apples, three kiwis and a couple of strawberries. The nurse, she added, “said that the weight and size was like being six months pregnant”. Her experience, the singer said, was “excruciating at times and, to be honest, I started to doubt if my body would ever feel the same again … I know that a lot of women suffer from fibroid tumours and I just wanted to say after my experience that you are amazing warriors and that you are not alone.”

She shared the post on Instagram last week, which was picked up by news organisations around the world – indicating how rare it was for anyone to talk openly about fibroids, even though it is a condition that affects about a third of women at some point in their life.

Fibroids are non-cancerous growths of the uterine muscle that develop in or around the uterus. “It’s unusual for them to be painful,” says Dr Virginia Beckett, a consultant gynaecologist and spokesperson for the Royal College of Obstetricians and Gynaecologists. “Usually, they’re very small and harmless. They can occur either on the outside of the womb, within the muscle wall of the womb or pushing on to the inside of the womb. ” Many women will never even know that they have them but, for some, they can cause debilitating pain, bleeding, heavy periods, discomfort during sex and, in some cases, fertility problems.

Their cause is unknown, but thought to be linked to oestrogen levels – women of childbearing age are more likely to develop them and they can shrink in women who have been through the menopause. African-Caribbean women are more likely to suffer from larger fibroids that cause symptoms. There is no known way of cutting your risk, says Beckett. “There are no dietary methods or medications and having your baby early or late makes no difference.”

A recent all-party parliamentary group on women’s health – which also covered the condition endometriosis – found “unacceptable treatment” for women with fibroids. It reported that 42% of women said they were not treated with “dignity and respect” and nearly half were not told about the short- or long-term side effects of treatment. It found that 12% of women took up to two years even to be treated for their fibroids. One woman told the survey she had been told by her gynaecologist that there was only one treatment option. “I was only offered a hysterectomy and only through my own online research did I discover the other options out there. I had to ask for these other treatments,” she said. Another respondent said her symptoms were ignored.

“Far too often, women put up with symptoms and incredible pain because they are not aware of what is ‘normal’ and they feel stigmatised by talking about ‘women’s problems’,” said the report.

Bridgette York, a solicitor who founded the Fibroid Network patient and campaign group, was diagnosed with fibroids when she was in her mid-20s. She says that, at the time, some 20 years ago, women – even young women who hadn’t had children – were being pushed towards unnecessary hysterectomies. “It was very distressing emotionally and people weren’t talking about it,” says York. After doing lots of research, she was treated nine years after the diagnosis with a myomectomy, which removed the fibroids but kept her womb intact. She had four fibroids removed, with one measuring 33cm (13in) across and the largest weighing 5kg (11lb). York recovered well and went on to have twins.

One of her concerns now is the number of women who are offered medication to treat symptoms rather than a cure. Some drugs also act as contraceptives and are often prescribed to women in their 20s and 30s who may not be aware that it may delay their ability to conceive once they come off it. Medication can be useful for some women, but York says there are safety and efficacy concerns. She points to the drug Esmya (ulipristal acetate) – in February, the Medicines & Healthcare Products Regulatory Agency informed medical professionals that it was the subject of a new EU safety review after several women suffered serious liver damage while taking it. The agency ruled that it should not be prescribed to new patients and that liver function should be tested once a month for women already on it.

“We’re concerned that women are not being given all of the options, and not being given informed choice, and that drugs [might not] have as much effect as they think it might do, especially if they have large fibroids,” says York.

The all-party parliamentary report found that 70% of women were told about hysterectomy, with 38% undergoing one. However, in many cases, fibroids can be treated with less extreme surgery, but also non-surgical interventions such as uterine fibroid embolisation, which is carried out by a radiologist who essentially blocks the blood vessels “feeding” the fibroid. Woodruff Walker, a pioneer of uterine fibroid embolisation, says not enough women are being told about the treatment by gynaecologists, either because they are not familiar with it or because it is not something they offer. “For about 25% of patients who come to me, who have fought their way through the system, embolisation is not mentioned by their gynaecologist as an option.” There are also newer treatments involving laser or ultrasound to destroy the fibroid, but the NHS points out that “the long-term benefits and risks are unknown”. “We do have some medical therapies, but they’re not useful for very large fibroids,” says Beckett.

For large fibroids, she explains, “you would probably offer a hysterectomy. You can do open surgery to remove the fibroids and leave the womb, but that can be quite complicated. You can remove smaller ones laparascopically [through a small incision]. You can do minimally invasive techniques to interfere with the blood supply of the fibroid [such as embolisation] and, if they are impinging on the lining of the womb, you can remove them through a camera that goes into the womb through the cervix.” Embolisation “is not extremely widely available and there are some disadvantages to it. You can get quite significant pain afterwards and the data on fertility is not very well established. The data  is much more established with traditional surgical methods,” she says.

Can Uterine Fibroids Cause Weight Gain and Bloating?: Goke Akinwande, MD: Vascular and Interventional Radiologist

If your clothes are fitting a little tighter, you’re struggling to tone your tummy and you’ve put on a few pounds recently, you might not think that it’s due to uterine fibroids. Well unfortunately – although it’s not a well-known symptom – fibroids can indeed cause weight gain, especially around the stomach area. So if you haven’t changed your diet and you know for sure that you’re not pregnant, fibroids might just be the cause of your bloating.

Understanding exactly what fibroids are, determining whether they’re behind your weight gain and how to treat them is an important step to getting relief from your symptoms – so let’s take a closer look…

Firstly, what exactly are fibroids?

Fibroids typically affect women in their thirties and forties and are benign tumors that grow in the uterus. While that may sound serious, fibroids aren’t cancerous or life-threatening, they’re just uncomfortable and inconvenient. What’s more, these tissue growths can come in many sizes and numbers – you may have just one small uterine fibroid, a small cluster of fibroids or one large fibroid.

Who’s more likely to develop them?

UCLA Health states that as many as 30-77% of women may develop fibroids at some point during their childbearing years. Yet despite widespread research, no specific cause has been found on why these growths develop. But what we do know is that they’re closely linked to estrogen and women who have higher levels of this hormone have a tendency to develop fibroids. It’s also thought that they could be hereditary too.

Fibroids, weight gain & bloating

So what’s the link between fibroids, bloating and weight gain? To put it simply, the bigger a fibroid grows, the heavier it becomes. As a result, some of these growths can weigh as much as 20-40 pounds, which can leave you feeling a little heavier too.

Although some fibroids can be very small, completely painless and symptomless, others grow large enough to cause swelling in the abdomen, to the point that it can sometimes be mistaken for pregnancy. Surges in estrogen – such as during pre-menopausal hormone swings or pregnancy – can cause a growth spurt for fibroids and lifestyle factors like stress and diet can also play a part.

Moreover, combined with other symptoms of fibroids such as discomfort, anxiety and fatigue, it can cause a cycle of craving for and overeating foods that have a higher calorie content. Symptoms can also lead to a reduction in the amount of exercise that’s usually enjoyed too, which is another factor that can lead to even more weight gain.

Other symptoms to look out for

Aside from bloating and weight gain, fibroids that keep growing can put pressure on other organs, particularly the bowels. Some women experience frequent urination, blocked intestines, constipation and a feeling of fullness. On top of that, heavy bleeding during your period can lead to reduced iron levels which can cause anemia. This can leave you feeling lethargic and fatigued – and leads many women to comfort eat, which is another indirect way that fibroids can cause weight problems.

Can you get rid of fibroids?

If it’s determined that your weight gain is due to fibroids, the good news is that there are a range of treatment options. Around 20-50% of women have symptoms, so if fibroids aren’t causing too much bother right now, it may be suggested to wait and see if they worsen before any treatment is carried out.

If treatment is necessary, possible options include medication to regulate the hormones, a hysterectomy or a non-surgical procedure called uterine fibroid embolization (UFE). Here at MINT, we carry out this minimally invasive, low-trauma treatment that shrinks the size of fibroids and eliminates any symptoms such as bloating and weight gain, while still keeping the uterus intact.

Aside from treatment, while you may not be able to control or prevent the growth of fibroids, eating a well-balanced diet and exercising regularly is really important for your overall health and could also help you to lose any extra weight gained because of fibroids.

If you’re experiencing unexpected weight gain and frequent bloating despite eating a healthy diet and following a good exercise routine, it could be time to point the finger at uterine fibroids. Contact MINT today on 314 255 2204  to learn more about how our UFE procedure can help.

90,000 Uterine fibroids – when is surgery needed?

Photo: Gediminas Mechejus
Material prepared jointly with candidate med. Gediminas Mechejus, obstetrician-gynecologist of the Medical Diagnostic and Treatment Center.

Uterine myoma is a benign tumor. According to statistics, women aged 30-50 are most susceptible to this disease. Recently, more and more often, fibroids of a fairly large size are also found in young women under 30 years of age. Their occurrence is associated with the action of sex hormones.

Myoma does not always require surgical treatment.

In 50% of cases, fibroids form and grow asymptomatically.

Myoma is, in fact, a muscle node, which is considered a benign tumor, rarely progressing to a malignant stage. The operation is required only when certain discomfort manifests itself or the woman’s health condition worsens.

Uterine fibroids may be accompanied by the following symptoms:

• heavy menstruation,
• signs of bleeding that are found in the intermenstrual period,
• no pregnancy despite regular sex life,
• enlargement of the abdomen in volume,
• violation of urinary function (frequent urination),
• pain in the lower abdomen and in the lumbar region (these symptoms are rare in fibroids).

As already mentioned, myoma only occasionally degenerates into a malignant tumor, during the menopause it decreases in size, at the same time a process can occur that causes calcification of the fibroid. If the fibroid is larger than 6 cm, it can compress the veins and organs of the small pelvis, which leads to stasis and thrombosis of the veins of the small pelvis and lower extremities. Fortunately, such cases are quite rare.

It is very important where the tumor began to form and grow. When it grows into the uterine cavity, even being small, fibroids can provoke profuse bleeding during menstruation, and cause infertility.

As a rule, fibroids do not cause pain. You need to be wary if you have heavy periods, because they can deplete the body and lead to anemia. If fibroids are the cause of the bleeding, the only effective method is surgery.

Until recently, one of the most popular and most common operations was to remove the tumor along with the uterus. Today the situation has changed dramatically. Obstetrician-gynecologist of the Medical Center for Diagnosis and Treatment Gediminas Mechejus says that if a fibroid threatens a woman’s health, then, of course, an operation is needed, but ONLY fibroids (!) Need to be removed, emphasizing that while removing a tumor, the uterus itself can and should be preserved! !!

While myoma does not bring trouble and does not worsen the quality of life, it is enough to observe it periodically, performing the necessary examinations when visiting an obstetrician-gynecologist once a year.Only when the symptoms begin to cause discomfort or the fibroid increases significantly in size, surgery is necessary.

Today, there are many achievements in obstetrics and gynecology, but special emphasis is placed on the most gentle methods that preserve women’s health and women’s attractiveness. The operation to remove the fibroids is performed through the vagina or a micro-incision. Women very quickly return to their usual rhythm of life. But it is invaluable that now you can save the main thing – the uterus, which makes a woman a woman.

90,000 carrying out the procedure, recovery after surgery and the consequences for the woman

Table of Contents

Removal of the uterus (hysterectomy) is one of the most frequently performed operations in gynecology. Intervention is a real test for a woman. It is not surprising that patients experience not only fear of the operation itself, but also depression and vulnerability, confusion and inferiority. We will try to answer all the questions that women have. We will understand how the removal of the uterus is carried out, and how life can change after such an intervention.

Purpose of hysterectomy

The operation is performed in cases where other methods of treatment were ineffective or inappropriate. Emergency interventions are often life-saving.

Interestingly, in a number of European countries and the United States, the operation is common among women after 40–45 years. This is due to the fact that it makes it possible to reduce the risks of developing fibroids and tissue proliferation, if any, and also avoids the appearance of malignant tumors.

Indications for Operation

Hysterectomy is performed for the following pathological conditions and diseases:

• Uterine cancer. After surgery, chemotherapy and radiation therapy are also carried out
• Multiple fibroid nodes
• Internal bleeding with a risk of anemia and the development of other life-threatening conditions
• Acute pain syndrome
• Vaginal bleeding
• Growth of tissue of the lining of the uterus in the ovaries and fallopian tubes

Preparation

Before removing the uterus, a woman undergoes a comprehensive examination. It allows you to assess the patient’s health status and identify possible contraindications.

The following diagnostics are usually carried out:

• Pelvic ultrasound or MRI with contrast agent
• Vaginal swab
• Endometrial biopsy

The so-called hospital complex is mandatory.

It includes:

• general and biochemical blood test
• general urinalysis
• blood test for group and Rh factor, as well as infections, coagulation disorders, HIV and other diseases
• fluorography
• ECG

The patient consults with a gynecologist, therapist and anesthesiologist.

Important! If temporary (relative) contraindications to the intervention are identified, the necessary treatment is carried out. If, for example, infectious diseases are found, the doctor prescribes antibiotics and anti-inflammatory drugs. It is very important to achieve complete recovery or remission. Otherwise, there will be a high risk of operational and postoperative complications. In addition, the existing diseases negatively affect the rehabilitation process, lengthening it.

If the removal of the cervix or other operation is performed to remove a malignant tumor, hormonal and other drugs are prescribed.They help eliminate tumor growth. Therapy can reduce the size of the formation, which will have a positive effect on the course of the intervention, reducing tissue trauma.

Contraindications

Surgery to remove the uterus is not performed if the following contraindications are present:

• low blood clotting rates
• arterial hypertension
• acute infectious diseases (including small pelvis)
• angina pectoris
• anemia
• diabetes mellitus
• liver failure
• renal failure
• allergic reactions to anesthesia drugs

Important! There are both absolute and relative contraindications to the intervention. In this case, the doctor makes the final decision on the operation. If necessary, the patient is consulted by specialists of narrow profiles.

Procedure

Hysterectomy of the uterus (including those with appendages) is performed under general anesthesia. The intervention usually takes 1–1.5 hours.

There are 3 methods for accessing organs:

• Laparoscopic. The intervention is performed through punctures in the abdominal wall area. The technique allows to reduce tissue trauma and shorten the rehabilitation period.Usually only 4 small punctures and a specialized tool are required. It is inserted into the cervical canal. First, the ligaments of the uterus are excised, and then it is removed. After that, the walls of the vagina are coagulated and sutured
• Abdominal. Such an operation is traditional and the most traumatic. It requires a large incision in the abdominal wall. The fixation of the bowel loops is mandatory for standard intervention. This avoids damage to them. The cervix is ​​cut off in the inner area of ​​the pharynx.After that, her stump and vaginal vaults are sutured. Drainage tubes are then installed. They take them off after a few days
• Transvaginal. Access is provided through an incision in the vaginal area. The surgeon then exfoliates the bladder. Then the vessels and fallopian tubes, as well as ligaments, are isolated and intersected. After that, the uterus is cut off. The stumps of pipes are stitched at the same time

There are 3 types of hysterectomy.

Radical

It involves the removal of the uterus, fallopian tubes, ovaries, regional lymph nodes and adipose tissue.The operation is performed for endometriosis and cancer.

Total

This hysterectomy involves the removal of the uterus with the cervix and appendages. It is prescribed for cancer. The technique allows to reduce the risks of the spread of the tumor process. It is often combined with other methods of cancer therapy (chemotherapy, etc. ). Total hysterectomy can also be performed in emergency situations.

Subtotal

The cervix is ​​not removed during this operation.This intervention eliminates the risk of damage to the ureters and large vessels. It is prescribed for adhesions, pelvic endometriosis and some other pathologies.

Rehabilitation

Recovery from hysterectomy is a lengthy process. Conditionally rehabilitation is divided into 2 periods:

1. Early. 3-4 days after the intervention, the woman is under the supervision of medical personnel. Therapy is aimed at eliminating pain, preventing bleeding, restoring the body, reducing the risk of developing anemia and inflammation.The doctor also monitors the work of the intestines, the condition of the seam and the amount of discharge from the genitals. To remove fluid from the body, a urinary catheter is installed on the first day. At this time, the patient only drinks and does not eat anything. Then, gradually, low-fat broths and yoghurts are introduced into the diet. You should eat light food that is quickly absorbed. Chocolate, cabbage, legumes, corn are completely excluded, that is, foods that can cause increased gas formation and constipation. A woman should eat in small portions and at least 4-5 times a day
2. Late.With the classical technique of the operation, it lasts about 1.5 months, with the laparoscopic method – no more than 30 days. The late rehabilitation period begins after discharge from the hospital. At this time, a woman should be attentive to her health and direct all actions to its full recovery

There are certain recommendations that the patient should adhere to during rehabilitation:

• Mandatory intake of medications prescribed by a doctor.Usually, pain relievers, anti-inflammatory, hormonal, enzyme and general tonic agents are recommended
• Restriction of physical activity. It is especially important to avoid excessive pressure on the abdominal and pelvic floor muscles
• Performing simple exercises (if recommended by your doctor)
• Denial of sexual activity. Return to it with caution. If a woman experiences discomfort, you need to contact a gynecologist. Perhaps it will prolong the period of sexual rest
• Healthy eating.Even after discharge from the clinic, you need to adhere to the correct diet with limited alcohol, baked goods, fatty foods, smoked meats, marinades
• Correct drinking regime. A woman should drink about 1.5-2 liters of water per day. This will allow the body to naturally detoxify

Of course, the main consequence of removing the uterus is that the woman loses fertility. Otherwise, life can remain as full of value as it was before.

Over time, the menstrual cycle is restored, the level of hormones returns to normal. Even the libido may remain the same after the uterus is removed. At the same time, the ability to lead an active sex life also fully returns.

Advantages of contacting MEDSI

• Experienced doctors. Our specialists are not only professionally trained to solve the problems of women, but also provide patients with an attentive and delicate approach
• Comprehensive surveys. They are carried out using modern equipment and ensure the accuracy of diagnoses and the identification of all pathologies
• Possibilities of using sparing techniques for hysterectomy of the uterus and ovaries. Operations are performed using minimally invasive methods, which increases their safety and shortens the rehabilitation period
• New high-tech equipment. It minimizes the risk of bleeding and complications and relapses
• Comfortable hospital stay before and after surgery to remove the uterus
• Opportunities for rehabilitation and follow-up on an outpatient basis

To clarify information or make an appointment, just call +7 (812) 336-33-33.Our specialist will answer all your questions. Recording is also possible through the SmartMed application.

Uterine fibroids

Gynecology

Olesya Golubtsova:

The program “Gynecology with Dr. Bakhtiyarov” is on air. Today I, Olesya Golubtsova, lead it, and Dr. Bakhtiyarov will answer my questions.

Our topic today is “Uterine fibroids”.Fibroids are a very common disease. What does the statistics say?

Kamil Bakhtiyarov:

On the one hand, this is a well-worn topic. But, on the other hand, the number of questions that come to the mail, and the number of questions that our patients ask on the Internet, prompted to raise this topic today. According to statistics, myoma ranks 2nd among gynecological diseases after inflammation, but 1st among tumors. It is believed that approximately 30-35% of our respected women suffer from this disease.The first mention of myoma was in the literature in 1793 by the British pathologist Matthew Bailey, he first described this disease. Also, later in scientific works, the nodal structures in the uterus were described and, in fact, this disease is relevant to this day. Unfortunately, the incidence of this disease is increasing. In the United States of America, approximately 200,000 hysterectomies, that is, removal of the uterus, occur annually in connection with fibroids.

Olesya Golubtsova:

This begs the question: why is it growing?

Kamil Bakhtiyarov:

The most interesting thing is that the level of medicine is rising, and, unfortunately, the cause of fibroids has not been found.Myoma nodes develop from one muscle cell, but it is still unknown what is the main, main trigger that promotes the shift, promotes the development of fibroids from this cell. There are a number of contributing factors. I never tire of saying: first of all, it is a way of life. In most cases, fibroids develop in overweight women. Why? Because, nevertheless, it is believed that uterine fibroids are a hormone-dependent disease, that it mainly manifests itself in actively menstruating women.Rarely, when the disease occurs, for example, before the onset of menstruation.

Most fibroids develop in overweight women.

Olesya Golubtsova:

By the way, by age. Is myoma considered an age-related disease? From some age threshold should you already follow?

Kamil Bakhtiyarov:

Follow-up should be from the girl reaches 18 years of age and, in fact, annual examinations have not prevented anyone.We have met situations when our patients have not yet entered adulthood, have not yet begun to live sexually, and the size of myomatous nodes … In general, the size of uterine fibroids is measured in weeks, as in pregnancy – 9 weeks, 10 weeks, 20 weeks, 30 weeks …

Olesya Golubtsova:

In general, I must say that myoma is a tumor-like formation.

Kamil Bakhtiyarov:

Yes, this is a benign tumor from our own muscle tissue, from the muscle tissue of the uterus, if we are talking about uterine fibroids, because there may be fibroids of other organs, for example, the stomach. This is not only a gynecological disease.

Olesya Golubtsova:

Got it. But today we will focus on the gynecological. You said it is measured in weeks of pregnancy. I wonder if this somehow correlates with the size of the fetus?

Kamil Bakhtiyarov:

Yes, it correlates with the size of the fetus. Let’s say a fibroid of 20 weeks corresponds to a 20-week pregnancy. Large enough, in fact, about the size of a child’s head.

Olesya Golubtsova:

Probably at this stage it manifests itself?

Kamil Bakhtiyarov:

At this stage, she is already visible, although it all depends on the size of the woman herself.2 years ago I had a very interesting clinical case, when a woman from one of the CIS countries applied, her weight was initially 140 kilograms, a rather large woman. She decided to lose weight with her own means. She lost about 100 kilograms, that is, dropped 40. It was evident that her legs, trunk, arms were reduced, but her stomach remained. She came to the specialists, they told her: “You have some kind of tumor, it is not clear what kind.” Living with her was really great. Before the operation, of course, we had to do additional research, to do an ultrasound examination, but we did not fully understand what kind of tumor it was.It turned out – a huge myoma of a 30-week pregnancy, which has already begun to squeeze the internal organs, although the woman herself said: “I don’t really feel anything, except that my stomach is big.” She has an exceptional case. She did not feel, she had asymptomatic fibroids.

Clinical manifestations of myomatous nodes depend on their localization. Myomatous nodes can be located on the uterus; in medical language, they are called subserous, that is, they grow into the abdominal cavity. Myomatous nodes can be intramural, which are located in the muscle itself, there can be many of them.Myomatous nodes can grow into the uterine cavity; the main complaint in such patients is heavy menstrual bleeding, which leads to a decrease in hemoglobin and a sharp deterioration in well-being. Also, if, for example, a large node is located in the projection of the bladder, then there may be frequent urination, if on the back of the uterus, then there may be a problem with the act of defecation. That is, it all depends on the localization. If there are many, many nodes, then the uterus may not contract, which is why menstruation can be very heavy.When the nodes grow large enough and begin to squeeze each other, then pain syndrome already appears, the uterus swells, and here, of course, serious measures need to be taken.

Olesya Golubtsova:

Is it possible to detect fibroids at the initial stage during a routine examination, if you do not look for it purposefully, shall we say so?

Kamil Bakhtiyarov:

As I said, fibroids are measured in weeks of pregnancy. Somewhere in about 5-6 weeks, it can be found with your hands, an obstetrician-gynecologist can make such a diagnosis during a vaginal examination.But, of course, ultrasound is an indispensable diagnostic method. Ultrasound examination in gynecology is carried out in two ways. The first method is transabdominal, which is done through the anterior abdominal wall, it is mainly done in girls who are not sexually active, or during long periods of pregnancy. There are situations when the myomatous nodes are large enough, and they must look both from above and from below. Usually, ultrasound examination in women who are sexually active is carried out through the vagina, this is more informative.Moreover, modern ultrasound devices allow us to determine myomatous nodes, starting from 5 millimeters. The diagnostic value of ultrasound is about 90%, or even more. Depends on the experience of the ultrasonist, because sometimes there are nodes on a thin base. Let’s say they move away from the uterus a little, and sometimes ultrasound doctors can confuse this node with another ovarian formation, for example, with fibroma. But in most cases, in terms of diagnosis, problems with fibroids do not arise.

Olesya Golubtsova:

That is, they find it. If you find small ones, then what to do with them? These are benign formations.

Kamil Bakhtiyarov:

I will say this for our listeners that myoma becomes malignant very, very, very, very rarely. With fibroids, you need to take serious action when a clinic appears. What clinic can there be? Pain syndrome, disorders of the urinary system, disorders of the rectum, when the act of defecation is difficult, bleeding, and when the uterus itself begins to hurt.

Olesya Golubtsova:

And if there are no manifestations, then what?

Kamil Bakhtiyarov:

If there are no manifestations, then everything depends on the size of the formation. It is also necessary to take into account such a factor, how does this fibroid grow? In most cases, fibroids grow very slowly. If the fibroid grows for 4 weeks or more per year, then this is the so-called rapid tumor growth, it is an indication for surgical treatment. For example, a woman came to you on January 1, 2018, she has 8 weeks; she came to you on January 1, 2019, she has 13 weeks.5 weeks a year is considered a rapid growth, such a fibroid, of course, it is desirable to operate, but in the event that the woman is not planning a pregnancy. Here you need to weigh. If, of course, the woman has fulfilled her reproductive function, then such a fibroid can be safely removed. And if you are planning a pregnancy, then you need to perform additional methods, for example, MRI with contrast, that is, modern radiological techniques, to see if this formation looks like a malignant one or not.

I say again that uterine fibroids become malignant in a very small percentage of cases.What are they always afraid of? They are afraid of a disease, the so-called sarcoma. This is a very malignant, but very rare disease, which, according to statistics, accounts for approximately 1% of all malignant diseases of the female reproductive system. Unfortunately, the 5-year survival rate for this disease is less than 20%, it is very malignant, rapidly metastasized, and spreads rapidly. But in my 23 years of work in a surgical hospital, I saw only 3 cases of sarcoma, and these were histological findings, that is, the woman was operated on for uterine fibroids, and elements of sarcoma were found in her nodes.

It is necessary to work seriously with fibroids when the clinic appears: pain syndrome, disorders of the urinary system and rectum.

Olesya Golubtsova:

But in the nodes of the fibroid, that is, the fibroid has degenerated, or were there separate formations?

Kamil Bakhtiyarov:

I can’t say now. There could be separate formations, there could be a rebirth.

Olesya Golubtsova:

If you do an MRI with contrast, will there be a malignant one?

Kamil Bakhtiyarov:

I want everyone to understand: unfortunately, there are no one hundred percent diagnostic criteria for uterine sarcoma. Unfortunately. There are no markers so that we can say: this woman has sarcoma and needs to be done a lot, or this woman, most likely, has a fast-growing fibroid, you can just remove the nodes and leave the uterus. Unfortunately, science has not yet reached the level of 100% diagnosis.As they say, the most important diagnostician is the pathologist. We can only make a diagnosis if we have received a piece of tissue from this fibroid, and then we can say that it is: inflammation, or, indeed, a malignant tumor. I say again that sarcoma is a very rare disease. In most cases, we are dealing with a benign tumor.

Olesya Golubtsova:

Does myoma itself prevent getting pregnant? Does it happen, for example, that a girl got pregnant, came for an ultrasound scan, and found a fibroid?

Kamil Bakhtiyarov:

A very good question and a question that my patients ask very often.In most cases (in most cases!) Small fibroids do not interfere with pregnancy if it does not deform the uterine cavity. But, it is pleasant to note that a lot of our respected girls come before pregnancy for an examination, when a person is planning, or getting married: “We want to try to get pregnant in the next six months.” Here you need to decide where the knots are located, what sizes, will the 2-3-centimeter knot of this pregnancy be an obstacle? In most cases, small sizes (2-3 centimeters) will not affect the outcome of pregnancy.

Another moment. It so happens that the entire uterus is “stuffed” with nodes in a young girl. This is, of course, problematic. Why? Because the muscular membrane of the uterus, as a muscular organ, has the ability to stretch and contract. When fibroids develop, the membrane loses its ability to stretch. It turns out that a pregnancy has occurred, several nodes, the uterus cannot stretch. Accordingly, what’s going on? An interruption of the onset of pregnancy occurs. Or there may be necrosis of myomatous nodes or necrosis of these nodes.Operations that are carried out during pregnancy are always fraught with the risk of bleeding and termination of pregnancy, and even often, unfortunately, removal of the uterus. Therefore, I urge all our listeners to go to the doctor in advance, to decide whether there is a fibroid or not. So that the doctor can make a prognosis: an intervention is required or not, drug treatment is required or not?

Olesya Golubtsova:

That is, it is possible that the fibroids are left and they say that pregnancy will not interfere, give birth – will we figure it out?

Kamil Bakhtiyarov:

In many cases, myomatous nodes are left.They are being watched, observation tactics. Especially if the fibroid is asymptomatic.

Olesya Golubtsova:

What’s scary: won’t it start growing with the fetus?

Kamil Bakhtiyarov:

This is most often the case, it begins to grow with the fetus. But observation must be observation. If the node is small, then, most likely, it will not grow enough to harm both mother and fetus.

Olesya Golubtsova:

Are there times when you need to play it safe, do something with the nodes, perhaps delete them?

Kamil Bakhtiyarov:

There are situations when the nodes are large enough. Patients with uterine fibroids have a specific list of indications for surgical treatment. First of all, these are the large sizes of the uterus itself. Large sizes are considered over 13-14 weeks. If the uterus is 13-14 weeks in size and even myoma is asymptomatic, then in this situation we recommend surgical treatment. If a woman is planning a pregnancy, then, of course, she needs to try to preserve this uterus as much as possible, if possible.

Olesya Golubtsova:

Why can the uterus be enlarged?

Kamil Bakhtiyarov:

Because the fibroid is growing and the uterus, of course, is enlarging.Due to the volume of the nodes, it increases in size.

Olesya Golubtsova:

We talked a little about diagnostics. Let’s talk about treatment. I know that there are various options for both medical and surgical treatment, up to and including removal of an organ. Tell us, in what case is it possible to save it? In general, I think now the tendency is towards preserving the organ?

Kamil Bakhtiyarov:

Yes. The patients themselves, after reading the Internet, understand that it is possible in most cases to preserve the organ.Regarding hormonal treatment, unfortunately, to say that uterine fibroids can be cured with hormonal drugs does not exist. There are drugs that cause drug-induced menopause. We inject them once every 28 days for 3-4-5-6 months, and myomatous nodes begin to decrease. The function of the ovaries is turned off, estrogens (active hormones of the female body that affect the growth of fibroids) cease to be produced, and we drive the woman into drug menopause. This is a serious condition, not everyone can easily tolerate it.

Olesya Golubtsova:

Even for young girls?

Kamil Bakhtiyarov:

For young girls, yes.

Olesya Golubtsova:

And if they are planning kids anyway?

Kamil Bakhtiyarov:

In most cases, this is done in order to perform a specific combination, that is, a combination of hormonal therapy in combination with surgical treatment. Let’s say a young nulliparous patient has a large node in the uterine cavity. We prescribe drugs for 3 months, this node is reduced from 5 centimeters to 3.5 or 4 centimeters, and then we can remove this node completely without incisions through the cervix. There is such a technique called hysteroresectoscopy. This technique is carried out without entering the abdominal cavity, through the cervix. A very beautiful technique came to our country in the late 80s – early 90s. One of the first publications of this technique in general in the world was, in my opinion, in 1976, when the first transcervical myomectomy was performed (it is called transcervical, “trans” – through the cervix).It was produced successfully, I don’t remember, in my opinion, in England. The entire fibroid is removed. Currently, this operation has become quite common. These are the so-called hospital-replacing technologies, when a person comes fully examined in a hospital, the procedure is performed, the myomatous node is removed, and the patient, practically on the same day, can go home.

Olesya Golubtsova:

That is, one day’s operation?

Kamil Bakhtiyarov:

Yes.The operation lasts about 35-40 minutes, depending on the node, on the location, on the skill of the surgeon, but if the node is large. There are situations when the node is very large, 6-7 cm, but it is the only one and is located in the uterine cavity. Then we can prescribe hormone therapy, which induces an artificial menopause, or drive into menopause. But it happens that it is not always possible to completely remove this node. The sweetest story is when the entire node is in the uterine cavity, but there are situations when part of the node is in the muscle, and most of it is in the uterine cavity.There are situations when a smaller part is in the cavity, and most of it is in the muscle. In such a situation, transcervical myomectomy is not very good, I would even say it is not at all good. This situation needs to be solved, of course, in a different way: either with the help of laparoscopy, or with the help of gluttony, no one canceled it. Through an incision on the anterior abdominal wall, the myomatous node is exfoliated and the uterine wall is sutured – the same as with laparoscopy. Another point is that laparoscopic operations are naturally more complicated; they require serious technical equipment, require quite serious skills of the surgeon to apply a laparoscopic suture.Not everyone knows it, or maybe they don’t know it well enough. At the moment, these technologies are developing and, in principle, in many hospitals both in Moscow and in Russia, these operations are performed.

There is one but. In general, it is believed that if a woman is planning a pregnancy, then in most cases she undergoes a laparotomy, she is made an incision. Why? Because in most cases a full-fledged suture can be applied only by hand, that is, the surgeon feels the tissue, pulls the suture. Plus, there are still myoma nodes that are not visible from the outside, but upon palpation, with sensation, with pressure on the myoma, we see that, for example, there is a 2-centimeter myoma node. Of course, if you go for an operation, then all the nodules should be removed as much as possible. With laparoscopy, this does not always work, because we cannot feel the knot, it may not be visible. It is felt only on palpation. You need to enter the abdominal cavity with your hands and palpate the uterus. But, I say again that laparoscopy is now quite actively used. If the nodes are on a thin base, or the base occupies about 3-4 centimeters superficially (subserously), then laparoscopy is quite actively used even with large nodes, despite the fact that the laparoscopic holes are about 1 cm.

You may ask me: how is the formation of 7-8 cm removed?

Olesya Golubtsova:

Interesting! Is it undercut?

Kamil Bakhtiyarov:

Not just hooked. The node is peeled off, a laparoscopic suture is applied, and the myomatous node itself is crushed inside with a special tool called a morcellator and removed. A kind of meat grinder. That is, a large tumor is removed and small incisions remain.This is the great advantage of laparoscopy. The leading clinics in the world at the moment, of course, are trying to do everything laparoscopically. These are beautiful, but, I emphasize, complex operations that do not exclude the possibility of complications, in fact, like gluttony.

At first glance, laparoscopy is a beautiful operation, and people forget about the complications. When we do laparoscopy, in order to examine the pelvic organs, we inject a gas into the abdominal cavity, in most cases it is CO2 – carbon dioxide.We inject this gas so that the intestinal loops move upward so that we can see the female organs well enough. When inserting a needle that injects gas, there can be complications if a woman has an adhesive process. There are methods that allow you to inject gas without inserting a needle. Therefore, all our listeners should, nevertheless, listen to the opinion of doctors and not demand harshly from the surgeon and say: “Give me a laparoscopy. ” A lot of patients say: “We want only laparoscopy, surgery only through small holes!” Because the seam is small.We perfectly understand that our women want to be beautiful, they want no one to know about the operation, and so on. There is a modern suture material that dissolves well enough and if a woman does not have a tendency to form keloid scars, then the suture will be invisible. Of course, it also depends on the skill of the surgeon, on the ability to beautifully suture with a thin thread. There are situations when a keloid scar is formed after laparoscopy. This should not be forgotten either. I always ask patients: “Will you cut your finger, do you have a trace or not?” This is a strictly individual genetic trait.There are people who say: “We want to anoint such and such a cream. Will it help, won’t it? ” Will not help. In most cases, it does not help, because this is a genetic feature of each organism.

Olesya Golubtsova:

What is the FUS-ablation method? What it is?

Kamil Bakhtiyarov:

This is a very interesting organ-preserving method, when the ultrasound signal is focused in one place under the guidance of MRI. The method is quite new. I cannot say that very positive results have been obtained in terms of reproduction, I do not have such data.But this method has the right to exist, although there are certain limitations to it. If the patient has scars on the anterior abdominal wall, if myomatous nodes are located on the posterior surface of the uterus, if nodes with elements of inflammation, then in most cases this technique will be ineffective.

Olesya Golubtsova:

What is the access for ultrasound? Through natural paths, or through an incision again?

Kamil Bakhtiyarov:

There are no incisions, this is a non-invasive technique.The nodes are focused with the help of a special apparatus, nothing is injected anywhere. The only question is the effectiveness of this method, because there are certain limitations. If, for example, there was a hernia on the anterior abdominal wall, and a mesh was placed on the patient, then this method cannot be used, it will be ineffective. If there were inflammatory changes in the nodes, then this method will also be ineffective. That is, it is rather limited. The small size of the formation – 4-5 cm, 2-3 nodes located on the front wall – perhaps this method will work.

Olesya Golubtsova:

How will it work? Will they clean up?

Kamil Bakhtiyarov:

They are not completely removed, but they are reduced in size. What is the point of the method? Ultrasound heats up these nodes to a temperature of 90 degrees, and, in medical terms, denaturation begins, destruction occurs. Accordingly, these nodes decrease, but they do not disappear.

Olesya Golubtsova:

How do the fabrics that are next to each other behave?

Kamil Bakhtiyarov:

As I say, this is a focused ultrasonic signal, due to this, heating occurs.How are the fabrics? Of course, some kind of violation is happening. Complications can be with any method.

Olesya Golubtsova:

But non-invasive techniques are always attractive because there are no incisions?

Kamil Bakhtiyarov:

Of course they are attractive!

The method of embolization of the uterine arteries is also attractive – a beautiful method, when a special catheter is inserted into the femoral artery, which embolizes and produces blockage of the uterine vessels.Sufficiently large myomatous nodes can be embolized, since, roughly speaking, nutrition is disturbed in them and they begin to decrease in size. But in most cases, blood flow is restored after 5-6 months. We can use the embolization method as an independent method, on the one hand. On the other hand, we can use this method as preparation for myomectomy. Reduced the knot, performed the operation. What are we trying to achieve? We are trying to achieve that there will be a smaller node, accordingly, its blood supply is less, respectively, there will be less blood loss during the operation.

Also, very interesting methods of using all kinds of powder structures have now appeared. Indeed, myomectomy itself is a rather bloody method, when we cut the uterus, excrete the node, which is located in the so-called pseudocapsule. But when we suture the uterus, the suture on the uterus begins to bleed, because the uterus is abundantly supplied with blood. If you sprinkle this seam with special powdered substances based on cellulose, a gel film forms, and the bleeding stops.Thanks to this, we reduce blood loss, improve tissue healing and prevent the occurrence of adhesions. Why? Because any finding of blood or blood residues in the abdominal cavity is a risk of adhesion formation. And if we are dealing with a patient who is planning a pregnancy in the future, then it is very important that she does not form adhesions. Of course, we cannot completely prevent this, although now all kinds of anti-adhesive gels have appeared. Technology is moving forward, it is gratifying to note, but, unfortunately, we cannot completely avoid it. I say again: unfortunately!

Olesya Golubtsova:

I wonder if there are relapses after the nodes are removed?

Kamil Bakhtiyarov:

Of course there are!

Olesya Golubtsova:

High relapse rate?

Kamil Bakhtiyarov:

Now I cannot tell you the percentage, it all depends on the specific situation.

Olesya Golubtsova:

I am interested from this point of view.Still, you said that the causes of the occurrence are now unknown to the end, have not been studied. How to prevent the reappearance of fibroids if it is removed?

Kamil Bakhtiyarov:

Unfortunately, this cannot be prevented. If I say it is possible, I’m lying. But, if the patient was operated on, then a lot depends on how correctly the surgeon performed the operation, how radically he removed the nodes, how much he saw these nodes, how well the diagnosis was carried out. Because, for example, they do an ultrasound examination, there is a node of the same size; cut the stomach, and there are still nodes. Do you understand? Accordingly, you need to remove and sew up these nodes as much as possible.

Olesya Golubtsova:

But even if they were removed and stitched up, was there any reason that made them reappear? Accordingly, you probably give some recommendations?

Kamil Bakhtiyarov:

Of course, we make recommendations.A very important point exists, especially for women in terms of childbirth, because an incision in the uterus is a certain risk of rupture of the uterus during pregnancy, during childbirth, so it is very important that a full-fledged scar is formed. All kinds of powdered substances contribute to the fact that the tissues of the uterus heal better. There are powder substances that contain antibacterial drugs. The suture technique and the suture material are also very important. It depends on the surgeon.

As for the patients, again, this is the correct way of life.In women with increased body weight, obesity, or, as they say now, with metabolic syndrome, the risk of fibroids is higher than in women with a normosthenic physique.

Olesya Golubtsova:

So, first of all, is it weight?

Kamil Bakhtiyarov:

Weight. By what means? There is a concept of “extragonadal estrogen synthesis”, that is, estrogens are produced in adipose tissue. These estrogens are an additional pool of hormones that affect the entire reproductive system and the entire body in general.It stimulates bad processes in the mammary glands, in the ovaries, in the uterus. If a woman leads a sporty lifestyle, is mobile, eats right, then the risk that a relapse will occur is naturally lower for her. Although, I say again that there are many factors that we, unfortunately, do not know about. It seems to be a well-worn topic, but they cannot find that trigger. There are many theories of occurrence – both genetic theory and hormonal theory – but, unfortunately, none of them explains.

Estrogens, which are produced in adipose tissue, are an additional pool of hormones that adversely affect the reproductive system and the whole body in general.

Olesya Golubtsova:

Is it inherited?

Kamil Bakhtiyarov:

I can tell you that very often. If the grandmother, the mother has, then both the daughter and the granddaughter are likely to have fibroids.How it will develop is unknown. How it will grow is also unknown. But it is believed that all kinds of intrauterine interventions in the form of abortions affect this, because the mucous membrane of the uterus is damaged, the balance is disturbed and, accordingly, there is a reaction to damage. There is a theory that uterine fibroids are formed as a scar. There are fibroblast cells that are triggered against the background of inflammation, against the background of oxygen starvation. Therefore, abortion is always bad! I always say this, no matter what abortion is.Even if the patient went well, there was no temperature, no pathological discharge, this is a further aggravating factor – the factor of infertility, the appearance of uterine fibroids. Therefore, I urge our women to protect themselves very well, and pregnancy should be really planned. If you do not plan, then follow the precautions.

Olesya Golubtsova:

Does a successful pregnancy reduce the risks?

Kamil Bakhtiyarov:

Of course! Successful pregnancies, of course, decrease.

Olesya Golubtsova:

Now it is customary to say again that there is a certain age favorable for childbirth, and if this age is met, it reduces the risks of many diseases.

Kamil Bakhtiyarov:

Here it is necessary to consider from the point of view of reproduction. Our colleagues reproductologists (and I think that soon reproductologists will probably be singled out as a separate specialty) believe that the uterus is okay, but after 35 years of age a woman’s ovaries begin to age. That is, a woman can look good, she can be young, cheerful, but the quality of the genetic material, the quality of eggs after 35 years old decreases. Therefore, if the patient did not become pregnant before this age, then at the moment the tactics have changed. If earlier we didn’t understand why she didn’t get pregnant, then we said: “Probably, you need to do diagnostic laparoscopy, see what’s inside, check the tubes” and so on. Now, in most cases, we send to a reproductive specialist, and this is justified, because reproductive specialists receive a genetic apparatus, check cells and carry out in vitro fertilization.But, unfortunately, there are already a lot of infertile men, whose sperm quality is sharply reduced. A healthy, handsome, young man, and he has problems with this business.

Olesya Golubtsova:

Why?

Kamil Bakhtiyarov:

Also a way of life. Bad habits, of course, wrong diet.

Olesya Golubtsova:

Any research? Is there a connection between bad habits – alcoholism, smoking?

Kamil Bakhtiyarov:

Alcoholism – of course! Smoking is always vessels. Reproduction is always a vascular factor. Delivery of hemoglobin, delivery of nutrients to the endocrine organs. After all, the ovaries are an endocrine organ. If there is hypoxia, if there is oxygen starvation, then hormones will be produced in the wrong way. Do you understand? The brain is also the main regulator. Therefore, smoking is a terrible harm. Throughout my life, I will fight smoking in both men and women.

Olesya Golubtsova:

It’s still interesting for me to ask you a question, although I have asked it many times.What is the favorable age for the first pregnancy, for the first birth?

Kamil Bakhtiyarov:

From 20 to 30 years old.

Olesya Golubtsova:

And for the second one?

Kamil Bakhtiyarov:

Somewhere, from 30 to 35. As I told you, 35 years is not like a milestone, but it is on average, this is what reproductologists tell us. Reproductologists are building such a scheme for us. Now we have emancipation, women are making a career, buying Mercedes cars, apartments and so on, and want to be better than men.But nature takes its toll, and women pay a very high price for their achievements – they pay with their reproductive health. Therefore, the recommendations from reproductive health specialists are as follows: if you suddenly did not meet your man, or did not meet him, but he is not entirely decisive, then try to freeze the eggs until the age of 35 so that you have a reserve so that you can more boldly go through life. At 40, you can become pregnant, but if we look at the frequency of missed pregnancies at 40-42, it grows.At 44-45 years old, in my opinion, this is 80%, if I’m not mistaken.

Olesya Golubtsova:

Dear friends! We have to end our interesting broadcast. We learned a lot of interesting and really important information.

Let me remind you that it was the program “Gynecology with Dr. Bakhtiyarov”, which today, in fact, answered the questions. Thank you for being with us and see you soon!

Kamil Bakhtiyarov:

Thank you! Good luck!

“Overweight is deceptive” – ​​Kommersant St. Petersburg

Why aesthetic medicine is something more than cosmetology, how weight loss corrects health problems and how not to harm yourself in the pursuit of beauty, said Natalya Fedorova, chief physician of the ApexMed clinic.

Prepared by Svetlana Khamatova

BUSINESS GUIDE: How would you describe the aesthetic medicine market in St. Petersburg?

NATALYA FEDOROVA: How very intense. At the same time, the crisis has affected this area as well. Large clinics keep their positions due to the fact that they have occupied a certain niche – some specialize in plastic surgery, others in cosmetology. In our country, for example, this is a combination of three areas: body shaping (using injection and hardware methods), cosmetology and neurology.And small companies, unfortunately, are closing. In addition, some have problems with quality, because they cannot afford employees with higher medical education, and even more so they are not able to pay them for continuous professional development. After all, it is not enough to buy new expensive equipment, you also need to train personnel to work on it, each new technique requires both knowledge and practice. So, our clinic employs doctors who have certificates for the procedures performed, categories, academic degrees, they regularly undergo training, including abroad.Alas, if there are not enough funds in the clinic, then the appointment and implementation of a number of important procedures can be entrusted to nursing staff, which is unacceptable. The result is unpredictable, there is a risk of getting aesthetic problems, injury, death is not excluded.

BG: Have you had to deal with the consequences of unprofessional services?

N.F .: There are a lot of such cases. A lot of clinics on the market are engaged in manual therapy, but this is a very serious area: one wrong move – and a person can be disabled! We were asked to go home to patients who suffered from such inept manual therapy, therapeutic massage.Or take the problem of losing weight. It is physiological and safe to lose weight by 4.5-5 kg ​​per month. But they promise until 15! By what methods? How will this turn out for the body? The cause of obesity can be endocrine diseases, damage to any organs, psychosomatic diseases. It turns out that a sick person will be subjected to various procedures, which will only worsen his health? Any hardware technique implies drainage, electrical procedures, and if the patient has cholelithiasis, you can end up with peritonitis! And if a woman has uterine fibroids? Bleeding possible! Therefore, in our clinic not a single procedure is prescribed without consulting a therapist and examination, including ultrasound diagnostics, laboratory examination.All examinations can be completed within one day. So people who come to us, wanting to correct their figure, at the same time learn a lot about their health. After all, being overweight is deceiving, if a person is still young, then he may not feel sick. You start asking, “How does the pressure behave?” – “I don’t know, I have never measured it.” I clarify: “Do you have swelling?” – “And what is it?” I start the examination, I press on the skin – the water accumulates! And the examination shows that the patient already has diabetes mellitus… We save beauty according to the principle “Do no harm!”

BG: Do women mostly contact you? Or are men already ready to adjust their figure too?

N.F .: 30% of our clients are men. As a rule, these are businessmen, being overweight harms their business image and health. They often come to us on the recommendation of their doctor. A typical case: a big boss, right during a meeting, has a hypertensive crisis, a cardiologist warns him that the treatment will not be effective until he loses weight.A serious problem in obese men aged 45 is a decrease in potency. Many also complain about snoring, profuse sweating … Everything can be corrected against the background of weight loss! Someone comes just like that, because “it became difficult to bend over because of the beer belly”, someone has a specific goal: to put themselves in order for their son’s graduation, daughter’s wedding, vacation, and so on – we even have a special program “21 days to …”. By the way, the oldest patient is 82 years old. For me, it is like a crystal vase, because after 65 years you cannot prescribe many procedures.There is also a large cohort of clients – those who quit smoking. A healthy lifestyle has become fashionable, but it is not so easy to tune in to it. 80% of clients come on the recommendation of friends. Recently, aesthetic medical tourism has been very popular: people come to us from Germany, Israel, America – they admire the city and at the same time undergo certain procedures. Abroad, they are three times more expensive, but we work on the same machines, and all of them are not older than five years. An additional argument: we provide a comfortable place to stay just a minute’s walk from the clinic, in the very heart of the city.

More often than not, the matter is not limited to one course – after all, the result is obvious! I have been working in the clinic for the fifth year already, 50% of clients have been with us all this time. They are usually treated by families. If a man comes to us, I certainly ask to bring my wife, because she cooks this, together we discuss a balanced menu, sports. Now we have a family, I call them “Three Fat Men”, as in a fairy tale; they are not offended. These are dad, mom and son 19 years old. Dad is the boss, mom works with him, they, of course, have their own cook.After the first lesson on rational nutrition, the son said: “Dad, we are going to go buy dishes now!” They did not have half-portion plates in their luxurious sets. Everything was served at large, by nine o’clock in the evening, because the parents work a lot, everything is incredibly tasty … The result is clear.

BG: Are there any seasonal, summer problems?

N.F .: In the summer, due to the increased temperature, many suffer from edema. The LPG procedure, pressotherapy, saves from this.The problem of sweating is aggravated – often it’s not about stress, which we all justify, but about a disease called hyperhidrosis. Girls wear black, men do not take off their jackets even in the heat. However, we have been using effective techniques for three years now: locally, with the help of Botox, synaptic impulses on the sweat glands are blocked. It is safe, painless – and in two days you will forget about wet palms and armpits for six months or a year!

BG: Are there any new techniques that can radically get rid of fatty deposits?

N.F .: I would like to draw your attention to a sensational novelty that has conquered the best clinics in the world – the Ultrashape slimming machine. This is a unique device that gives amazing results both for serious overall weight loss, and in those cases when you need to quickly and effectively get in shape. The procedure is as effective as surgical liposuction, it makes it possible to remove up to 400 grams of fat and up to four centimeters in circumference in one session. The secret of the effective effect of the apparatus lies in the targeted destruction of fat cells by ultrasonic waves with an instant and irreversible result, by means of their splitting and removal from the body.

BG: What procedures help to improve the patient’s condition, to stay in good shape?

N.F .: For example, the lift effect is visible immediately from the Styx wrap procedure. For an hour and a half of exposure, three phases will change: detoxification, lymphatic drainage and lipolytic. In one procedure, the patient can lose up to 2-3 kg. We use acupuncture. On the auricle, at certain points, there are buttons: I wanted to smoke or eat, I clicked on the appropriate – and the desire decreases.

90,000 Uterine fibroids – free treatment in Moscow

The diagnosis of “cervical fibroids”, perhaps, can be attributed to the number of the worst female nightmares. Hearing such a verdict from a doctor, many fall into a stupor, since the word “myoma” evokes a persistent association with oncology. Let’s dot the i right away: fibroids are not cancer, but a benign tumor arising from muscle tissue. Let’s take a closer look at what a disease is and how it can be cured.

Causes of the disease

Unambiguously answer the question “What causes fibroids?” impossible. The reasons are different: ranging from infectious and inflammatory diseases of the female genital area and ending with a hereditary predisposition on the maternal side.

Among the provoking factors are endocrine and autoimmune diseases, obesity and various surgical interventions in the uterine cavity (instrumental abortions, diagnostic curettage, removal of polyps), which the woman underwent earlier.

At first, the uterine fibroids node can be tiny (about 3 – 5 mm) and stay “in one pore” for a long time, and then begin to increase in size. Depending on the location, there are fibroids of the walls, body and fundus of the uterus.

One interesting fact should be noted. Previously, it was believed that the risk of the disease increases with age, and often it can first manifest itself in a woman with menopause. Today, an unprecedented “rejuvenation” can be traced: such a diagnosis is no longer uncommon in young women under 35 years old.

Timely fibroids can be detected if two simple rules are observed: regular observation by an obstetrician-gynecologist at the place of residence and an ultrasound scan of the pelvic organs once every six months.

The only effective prevention of the development of fibroids is a regular visit to the gynecologist once every six months. Nothing else is required from a woman!

Yulia Vladimirovna Kovpiy

gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the G.K.S.I. Spasokukotsky

Symptoms and signs of uterine fibroids

Is it possible to identify the disease on your own? Gynecologists use a term such as “asymptomatic uterine myoma”, when the tumor does not manifest itself for years and is discovered by chance during an ultrasound examination.
But most often a woman herself may suspect the following signs of uterine fibroids:

• Pain with uterine fibroids. Pain sensations occur in the lower abdomen and lower back.
• Bleeding. Menstruation with uterine fibroids is always abundant and prolonged.
• Discharge with uterine fibroids. Generally bloody, brown or yellow in color, and can be viscous or liquid in consistency.

Even if you have noticed one of these symptoms (not to mention their combination) for a long time, this is a reason to immediately consult a doctor!

What are uterine fibroids: sizes, types, stages

Fibroids in medical terminology can be called differently.If we talk about nodular myoma, then there is only one node in the uterine cavity. Multiple (multinodular) fibroids suggest the presence of several nodes, sometimes they are located in different parts of the uterus.

According to the type of location of myomatous nodes, doctors distinguish three main types of fibroids:

• 1. Submucous. It is also called submucosal myoma. As a rule, such a tumor either penetrates into the vagina or grows into the uterine cavity. It is characterized by profuse menstruation.
• 2. Subserous. The second name is subperitoneal. It is subserous myamatous nodes that most often grow to gigantic sizes and a weight of the order of 10 – 12 kg.
• 3. Interstitial. Intramural, or intermuscular. It grows in the thickness of the myometrium and is considered the most common type of fibroids.

At the same time, mixed fibroids (for example, submucous-intramural, etc.) are not uncommon. But regardless of its type, uterine myoma goes through 3 stages: the formation of the myomatous node, its growth and maturation of a large tumor from it.And, unfortunately, most of the patients seek help only at the 3rd stage of the disease, when the myoma is “visible to the naked eye” and has the size of a full-term pregnancy.

When is deletion required?

“When is an operation to remove uterine fibroids necessary?” – probably the second most common question of interest to women who are faced with this disease.

According to modern medical protocols in force in gynecology, uterine myoma of small size (up to 4 cm), asymptomatic, requires only regular observation by a doctor without any therapy.

Myoma of small size (more than 4 cm), which at the same time increases by 3 – 4 weeks per year, by analogy with the size of the pregnant uterus, already requires surgical intervention.

Today, there are several effective methods of treating uterine fibroids, and the operative one is far from the first among them. Only if there are large myamatous nodes that are not amenable to any type of therapy, including medication and embolization of the uterine arteries, does the question of surgical treatment arise.But at the same time, obstetricians-gynecologists always face the task of preserving the uterus of a patient of any age.

Yulia Vladimirovna Kovpiy

gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the G.K. S.I. Spasokukotsky

Methods for removing uterine fibroids

Methods for the treatment of uterine fibroids are divided into radical (when there is a need to remove the uterus) and organ-preserving (when only myoma nodes are removed in one way or another).

Treatment of uterine fibroids without surgery, unfortunately, is not always effective.Drug therapy is aimed only at restraining the growth of nodes, making their size smaller, but it is impossible to completely get rid of the tumor in this way.

Today, the following types of operations are most effective for removing uterine fibroids.

Hysteroresectoscopy

Performed under intravenous anesthesia using a hysteroresectoscope with an electric loop at the end. It is introduced through the cervical canal and the node is gradually cut off. As a rule, it is used for submucous myoma of small sizes up to 4 centimeters.Has a short rehabilitation period.

Laparoscopy

Under the control of a video camera, special instruments are introduced into the abdominal cavity through small incisions. Refers to high-tech surgical interventions. Has a fairly short recovery period.

Laparotomy

For large tumors, an abdominal operation is performed. Its main advantage is the possibility of forming a full-fledged scar on the uterus, which will preserve it for future childbirth. It is carried out through an incision on the anterior abdominal wall up to 10 cm in size.Requires a long period of rehabilitation.

UAE (Embolization of the uterine arteries)

Refers to minimally invasive surgical interventions. The goal of the method is to cut off the blood supply to the myomatous nodes with the help of a special medication that is delivered to the arteries through a catheter on the thigh. Despite its obvious attractiveness from the point of view of a short rehabilitation period, UAE is not the # 1 method. A positive effect from the application of the technique is achieved only when many factors coincide: the size of the fibroid, the age of the patient, the location of the tumor, etc.n. Therefore, embolization of the uterine arteries is used exclusively according to indications.

FUS-ablation of uterine fibroids

Another example of minimally invasive surgery. FUS ablation is a rather rare technique performed according to strict indications, and not by ordinary gynecologists, but by endovascular surgeons. Myomatous nodes are removed using ultrasound waves under the guidance of MRI. In fact, they are “evaporated”. Unlike ultrasound used in ultrasound diagnostics, ultrasound therapeutic waves have a lower frequency, but they are superior in power.As a rule, this is a first-aid method in the case of extensive uterine bleeding. In inpatient treatment of fibroids, FUS-ablation is practically not used.

* Please note that the decision to choose one or another method of treatment is made by the doctor, depending on the individual indications and contraindications of the patient.

The uterus, together with the fibroids, is removed only in the most extreme cases. As a rule, we are talking about elderly patients who have already completed their reproductive function and, in addition to fibroids, suffer from age-related prolapse of the pelvic organs (prolapse).This is done through vaginal surgery and involves a fairly quick rehabilitation.

Yulia Vladimirovna Kovpiy

gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the G.K. S.I. Spasokukotsky

Compulsory medical insurance policy and treatment of uterine fibroids

Hysteroresectoscopy, laparoscopy and laparotomy are methods for removing fibroids that are available to patients under the compulsory health insurance program. If you have been diagnosed with uterine fibroids and an operation is required, then remember that all residents of Russia have the right to treatment in Moscow free of charge under the compulsory medical insurance policy.

Pregnancy and uterine fibroids

“Is it possible to get pregnant with fibroids?” – this is the question that worries everyone who wants to become a mother.Doctors’ forecasts on this score are quite optimistic. If the uterine fibroids are small, then the pregnancy proceeds without complications, and the delivery takes place naturally.

If the myomatous node is located so that it prevents the attachment of the ovum, it must be removed six months before planning pregnancy. The method of removal is chosen by the doctor, based on the individual characteristics of the patient: age, presence of pathologies, etc. After removal of fibroids, you can give birth, but the method of delivery is selected by the doctor individually in each case.

Fibroids can sometimes cause infertility or miscarriage, but not always. Everything is individual. First of all, this occurs with the submucous location of the myomatous nodes. And in this case, if the patient is a young nulliparous woman, who still has everything ahead, our task is to minimize all surgical interventions on the uterus as much as possible so that she can carry the baby. When it comes to surgical treatment, we often opt for laparotomic myomectomy, which allows us to form a full-fledged scar on the uterus.

Yulia Vladimirovna Kovpiy

gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the G.K. S.I. Spasokukotsky

What is the danger of fibroids?

If treatment is not completed in time, the consequences of uterine fibroids can be very serious.

Firstly, when myomatous nodes are actively growing, they begin to squeeze adjacent organs and disrupt their work. If it is the ureters or bladder, then urination is impaired, and if the rectum, then constipation begins.