Uterine fibroids: what does the diagnosis of intramural myoma node mean?

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

A group of pathologies in which tumors of various qualities are formed in the main reproductive organ of the female body - the uterus, localized in different layers of the organ - muscle and mucous - are called myoma.

Pathology can involve all layers of the uterus, or the node is located in the muscle tissues of the organ - which happens most often. Such a neoplasm is called an intramural myomatous node.

The therapeutic regimen is selected based on the results of the examination and the stage of the disease.

The reason for the appearance of fibroids

The following factors influence the appearance of nodes:

1. Hormonal disbalance. The body produces estrogen much less than progesterone, which stimulates pathological changes in the muscle layer of the uterus. The situation is aggravated by artificial termination of pregnancy, spontaneous miscarriage. With age, such neoplasms resolve on their own, as estrogen production decreases.
2. Traumatic effects - abortion, gynecological curettage - increase the risk of endometritis and endometriosis, and, accordingly, tissue degeneration.
3. Nodes can appear against the background of inflammatory processes caused by genital infections.
4. The likelihood of the disease increases against the background of the occurrence of other neoplasms, polyps and cysts.
5. Genetic factor. The predisposition to the appearance of pathological processes in the uterus is transmitted through the female line from generation to generation.
6. Since fibroids are found in adolescent girls, the theory is currently being considered that the onset of this disease is laid during the embryonic period - during the formation of the fetus, some processes are disturbed, as a result of which pathologically altered cells of the muscle and submucosal layers are laid.

Social factors influence the appearance of tumors - vital activity, emotional background, nutrition; and a history of chronic diseases - diabetes mellitus, arterial hypertension, obesity, thyrotoxicosis.

Types of nodes in the uterus

There are several types of neoplasms, each of which has its own characteristics of development.

With intramural-subserous myomatous nodes in the muscular layer of the uterus, one or more nodes of different localization are found. The classic subserous node grows towards the peritoneum and, upon ultrasound examination, is found in the subperitoneal space of the uterus. If such a neoplasm grows inside the gynecological organ, then its contours change, and the functionality is impaired.

It is very dangerous if the myomatous node has a stem like a mushroom. There is a high risk that the fibroids will twist and tissue necrosis will occur if malnutrition occurs. In this case, the patient will experience severe pain, and the condition will require immediate hospitalization and surgery.

Submucous myoma is located in the submucosal layer and is formed from the fibrous - connective - tissue of the muscle layer. This tumor practically does not degenerate, grows towards the abdominal cavity, and is easily diagnosed.

Interstitial myoma is a neoplasm localized in the muscular layer of the uterus and does not go beyond its limits. If such a node has large dimensions, then the uterus increases and squeezes the surrounding organs. But in most cases, the neoplasm grows in the uterine cavity and in the area of its bottom.

Most often, the intramural node does not extend beyond the uterus.

Regardless of the localization of neoplasms and their types, the appearance of pathology causes the following symptoms:

• premenstrual and menstrual pain;
• severe uterine bleeding during the next cycle and between cycles;
• with an increase in the size of the intramural node in the uterus, the heaviness in the lower abdomen can be felt constantly;
• disorders of urination and constipation appear.

Due to heavy bleeding in women, anemia begins, the general condition worsens, severe weakness and drowsiness appear.

Very often, a woman is unaware of the appearance of an intramural neoplasm - pathological changes in the body can proceed without pronounced symptoms and be detected during the next gynecological examination.

Does the appearance of an intramural node in the uterus affect pregnancy?

1. If intramural subserous nodes appear in multiple numbers, pregnancy may not occur. In the case when the neoplasms are located in the corners of the uterus, the permeability of the egg is disrupted, on the back wall - the embryo cannot penetrate tightly enough and gain a foothold in the endometrium - it simply does not have enough space.
2. The risk of self-abortion increases if, due to multiple fibroids, the embryo is implanted near the cervix itself.
3. Large fibroids can cause birth bleeding, placental abruption, and miscarriage. But if their size is small, or fibroids are isolated, the disease is not reflected in pregnancy. Moreover, hormonal fibroids dissolve during pregnancy - the level of progesterone rises during this period, its production is constantly stimulated. However, after childbirth, the hormonal background will even out, and fibroids may appear again.

Diagnosis of the disease

• It is not difficult to identify an intramural neoplasm. The doctor can make a diagnosis after a two-handed examination, detecting a deformation of the body of the uterus, but to confirm the diagnosis, the patient is recommended to undergo an ultrasound examination. The most complete information is provided by examination using a transvaginal probe.
• Additional examination may be required using hysteroscopy - during this diagnostic intervention, the condition is assessed even more accurately, for histological examination, a sample of the endometrium is taken, and the likelihood of node necrosis is determined.
• The localization of the neoplasm and the degree of spread of the pathology - the involvement of neighboring organs in the process - allow MRI and CT.
• It is especially important to conduct such an examination if you suspect an ovarian tumor, which can disguise itself as a fibroid and has similar symptoms at an early stage.
• Laparoscopic diagnostic methods not only confirm the diagnosis and clearly describe the clinical picture, they are also curative.
• During the laparoscopy procedure, the removal of the pathological neoplasm can be performed.

Treatment of myomatous nodes

1. Conservative therapy of intarmural nodes of the uterus is the selection of hormonal drugs. The choice of medicines is carried out on an individual basis, based on the results of the examination and analysis data. In addition, the age of the woman is taken into account, whether pregnancy is planned. The effectiveness of treatment is assessed no earlier than after six months of taking hormonal drugs.
2. During treatment, it is required to completely exclude factors affecting the growth of neoplasms - inflammatory processes, relapses of chronic diseases. A special diet may be recommended.
3. In the presence of severe symptoms - profuse bleeding - or enlargement of the uterus for more than 12 weeks, removal of intramural nodes is recommended. The types and methods of surgical intervention are selected depending on the clinical picture of the disease, the woman's age and the presence of chronic diseases.
4. For women of reproductive age, they try to preserve fertility and remove nodes by excising them from the body of the uterus. Such surgical intervention does not guarantee against recurrence of the disease.
5. The embolization method can be used, when the blood circulation of the node is stopped - the vessels supplying it are pinched.
6. Myomatous nodes are removed from the vagina or during a laparoscopic examination, vaporization can be performed - a low-temperature effect is exerted on the node, which stops its growth and causes necrosis of pathologically deformed tissue.
7. If the nodes are more than 5-6 cm in diameter, myomatosis is combined with endometriosis, the woman is out of reproductive age, a hysterectomy is performed. This is the name of the operation to remove the uterus. The methods of performing surgical intervention also largely depend on the clinic of the disease.

Only the uterus with nodes, ovaries and cervix can be removed. The operation can be performed by the abdominal method or laparoscopic, the doctor determines the possibility of carrying out one or another type of surgical intervention, as well as the choice of the type of operation.