Uterine Leiomyoma

　　The etiology of uterine fibroids is still not fully understood to date, and may involve complex interactions between normal muscle layer cell mutations, sex hormones, and local growth factors.
　　A large number of clinical observations and experimental results show that uterine fibroids are a hormone-dependent tumor. Estrogen is the main factor promoting the growth of fibroids, and some scholars believe that growth hormone (GH) is also related to the growth of fibroids. GH can synergize with estrogen to promote mitosis and thus promote the growth of fibroids. It is also speculated that human placental lactogen (HPL) can also synergize with estrogen to promote mitosis, suggesting that the acceleration of uterine fibroid growth during pregnancy is not only related to the high hormone environment during pregnancy, but may also involve the action of HPL. Influencing factors include:
　　Premature menopause in women who have not given birth:The number of primordial follicles in a woman's life is limited, and the years of ovulation are about 30. During pregnancy and lactation, due to the action of hormones, the ovaries suspend ovulation until the 4th to 6th month of lactation, and the ovaries delay a certain number of ovulations, resulting in women with a history of childbirth entering menopause later. Unmarried women do not receive timely and effective protection from gestational hormones, and are prone to hormone-dependent diseases, uterine fibroids being one of them.
　　Sexual dysfunction affects uterine health:Normal sexual life between couples can promote the normal functioning of the nervous and endocrine system, leading to the normal and good secretion of human hormones. However, long-term sexual dysfunction can easily lead to紊乱 of hormone level secretion, causing chronic congestion in the pelvis and triggering the formation of myoma.
　　High incidence of myoma in depressive women:Middle-aged women face dual spiritual pressures from work and family, which are easy to lead to depressive mood. With the advent of menopause, women begin to enter the 'estrogen control period'. During this period, the depressive mood of women themselves can easily promote an increase in estrogen secretion and its enhanced effect, which can sometimes last for several months or even years, which is also an important cause of the formation of myoma.

　　When it comes to the symptoms of myoma, many people only pay attention to symptoms such as abdominal mass and increased menstrual volume, however, there are many complications of myoma that patients are most likely to ignore.

　　1. Infection and suppuration: Myoma infection is mostly a consequence of pedicle torsion or acute endometritis, and blood-borne infection is extremely rare. Infection can sometimes be purulent, and a few cases form abscesses in the tumor tissue.

　　After the pedicle of a subserosal myoma twists, it can cause intestinal adhesions, which may be infected by intestinal bacteria, leading to suppurative inflammation. The inflamed myoma adheres to the uterine appendages, causing purulent inflammation.

　　2. Submucosal myomas are most prone to infection, often coexisting with acute endometritis after abortion or puerperium. Some are caused by injury from curettage or obstetric surgery. Due to the prominence of the tumor or surgical trauma, the tumor capsule is often broken, which makes it easier to become infected and cause necrosis. Necrosis often leads to severe irregular bleeding and fever. The decayed fragments excreted lose the coloring response of necrotic tissue, and microscopic examination often fails to yield results.

　　3. Twisting: Subserosal myomas can twist at the pedicle, causing acute abdominal pain. In severe cases of pedicle twisting, if surgery is not performed immediately or if it cannot be spontaneously rotated back, it may lead to the formation of a floating myoma due to the pedicle being twisted off. The twisted myoma can also pull the entire uterus, causing uterine axis twisting. The site of uterine twisting is often near the internal os of the cervix, but this situation rarely occurs, usually due to large subserosal myomas attached to the uterine base and a relatively thin and long cervix. Symptoms and signs are similar to those of ovarian cyst pedicle torsion, but the mass is usually harder.

　　4. Myoma combined with corpus uteri cancer: Patients with myoma combined with corpus uteri cancer account for 2%, which is much higher than those with myoma combined with cervical cancer. Therefore, for patients with myoma during menopause with persistent uterine bleeding, one should be vigilant about the possibility of concomitant endometrial cancer. Before determining treatment, a diagnostic curettage should be performed.

　　5. Myoma combined with pregnancy:

　　(1) During pregnancy, close observation is required to prevent the occurrence of miscarriage or preterm labor. If the myoma is too large and it is estimated that pregnancy may not continue, surgery should be performed early.

　　(2) Pay attention to avoiding malpresentation, dystocia, and placental retention during delivery. If a fibroid blocks the birth canal, cesarean section must be performed.

　　(3) Pay attention to preventing hemorrhage and infection after childbirth.

　　Most patients are asymptomatic and are occasionally discovered during pelvic examination or ultrasound examination. If symptoms occur, they are closely related to the growth site, speed, whether there is degeneration, and whether there are complications, while the relationship with the size and number of fibroids is relatively small. Patients with multiple subserosal fibroids may not have symptoms, while a small submucosal fibroid often causes irregular vaginal bleeding or menorrhagia. Common clinical symptoms include:

　　(1) Uterine bleeding This is the most common symptom of uterine fibroids, occurring in more than half of the patients. Among them, cyclic bleeding is more common, which can manifest as increased menstrual volume, prolonged menstrual period, or shortened menstrual cycle. It can also manifest as irregular vaginal bleeding without menstrual cycle. Uterine bleeding is more common in submucosal fibroids and inter muscular fibroids, while subserosal fibroids rarely cause uterine bleeding.
　　(2) Abdominal mass and compression symptoms As fibroids gradually grow, when they cause the uterus to increase in size beyond that of a 3-month pregnant uterus or when there is a larger subserosal fibroid at the fundus, they can often be felt as a mass in the abdomen, which is more obvious when the bladder is full in the morning. The mass is solid, movable, and painless. When fibroids reach a certain size, they can cause compression symptoms of surrounding organs. Uterine fibroids on the anterior wall close to the bladder can cause frequent urination and urgency; large cervical fibroids pressing on the bladder can cause incomplete urination or even urinary retention; fibroids on the posterior wall of the uterus, especially those in the isthmus or posterior cervix, can compress the rectum, causing constipation and an uncomfortable feeling after defecation; large broad ligament fibroids can compress the ureter, even causing renal pelvis hydrops.
　　(3) Pain In general, uterine fibroids do not cause pain, but many patients can complain of a feeling of lower abdominal distension, lumbar and back pain. When subserosal fibroids twist their pedicles or uterine fibroids undergo red degeneration, acute abdominal pain can occur. It is also not uncommon for fibroids combined with endometriosis or adenomyosis to have dysmenorrhea.
　　(4) Increased leukorrhea Uterine cavity enlargement, increased endometrial glands, plus pelvic congestion, can cause an increase in leukorrhea. When submucosal fibroids in the uterus or cervix ulcerate, become infected, or necrotize, bloody or purulent leukorrhea may occur.
　　(5) Infertility and miscarriage Some patients with uterine fibroids may be infertile or prone to miscarriage, and the impact on pregnancy and pregnancy outcomes may be related to the growth site, size, and number of fibroids. Large uterine fibroids can cause uterine cavity deformation, hinder the implantation of the gestational sac and the growth and development of the embryo; fibroids pressing on the fallopian tubes can lead to incomplete tube patency; submucosal fibroids can hinder the implantation of the gestational sac or affect sperm entering the uterine cavity. The natural abortion rate in fibroid patients is higher than that in the normal population, with a ratio of about 4:1.
　　(6) Anemia Due to prolonged menstrual bleeding or irregular vaginal bleeding, anemia can occur, and severe anemia is more common in patients with submucosal fibroids.
　　(7) Other A very small number of uterine fibroid patients can produce polycythemia, hypoglycemia, which is generally believed to be related to the production of ectopic hormones by the tumor.

　　Women should pay attention to health care in their daily lives, which can prevent the occurrence of uterine fibroids to a certain extent. The main points to be done are as follows:

　　1, Women should pay special attention to their health during their menstrual period and postpartum. It is strictly forbidden to have sexual relations, pay attention to contraception, keep the vulva and vagina clean, maintain a pleasant mood, stable emotions, try to reduce various competitive pressures from work, study, and life, and avoid melancholy and anger. Learn to adjust oneself, pay attention to keeping warm, avoid catching a cold, maintain a moderate balance between work and rest, and have a diet rich in nutrition and reasonable搭配, prefer light and avoid spicy, cold, and stimulating foods.

　　2, Do a good job of contraception. Sometimes multiple abortions can trigger many complications in women, including uterine fibroids. Therefore, it is very necessary for women to take good preventive measures in daily life. This can prevent the occurrence of uterine fibroids and also prevent the occurrence of many other gynecological diseases, which is beneficial to health.

　　3, For patients with uterine fibroids, attention should be paid to regular follow-up, observation of the condition changes, and timely medical treatment if there are symptoms such as abdominal pain, increased vaginal discharge, and irregular vaginal bleeding to prevent malignancy. Secondly, it is not advisable to place an intrauterine device or to take oral contraceptives.

　　4, Pay attention to personal hygiene, pay attention to diet, and pay attention to rest.

　　The routine examination of uterine fibroids includes:

　　1, Ultrasound examination:It can measure the size and shape of the uterus, and fibroids can show hyperechoic areas, and can exclude the uterus that has increased in size due to pregnancy and determine whether the fibroids are associated with pregnancy.

　　2, Hysteroscopy:Through hysteroscopy, one can observe the condition inside the uterine cavity under direct vision, and can also remove submucosal fibroids under hysteroscopy. It is also possible to understand the condition of the endometrium under hysteroscopy. And it can also be used to exclude endometrial lesions through curettage.

　　3, Laparoscopic examination:It can be correctly diagnosed under direct vision. It can clearly identify uterine fibroids. Even small serous submucosal fibroids are easy to find, and they can be correctly distinguished from ovarian tumors. Hysteroscopy can also be used to understand the condition of the fallopian tubes at the same time.

　　4, X-ray examination:For example, hysterosalpingography with iodine contrast has certain value in diagnosing submucosal fibroids, as it can show a filling defect in the uterine cavity, especially for young infertile patients, it can also understand whether the fallopian tubes are patent at the same time.

　　Dietary precautions for patients with uterine fibroids:
　　1, For patients with uterine fibroids, the first thing to note is that they should avoid spicy foods, alcohol, and frozen foods. Spicy foods can stimulate the endocrine system and may cause endocrine imbalance, so as a patient with uterine fibroids, it is better not to eat hot pot and spicy foods.

　　2, Lamb, shrimp, crab, eel, salted fish, black fish, and others. In winter, everyone likes to eat a little lamb to warm their bodies. However, for patients with uterine fibroids, it is not suitable. These meats contain a lot of fat, and overweight women have a high possibility of developing uterine fibroids. In addition, patients with uterine fibroids should also avoid eating seafood, as these seafood products contain a lot of hormones, which may lead to the progression of uterine fibroids. If you need to supplement meat, you can eat lean pork and chicken instead.

　　3. Abstain from alcohol, as alcohol can also stimulate the uterus significantly. Moreover, drinking can cause blood to rise, which is not good for the emotional control of uterine fibroid patients. Even in summer, uterine fibroid patients should not drink cold drinks at will, as these can cause menstrual irregularities and may lead to more serious menstrual disorders. Some plum juice or mung bean soup can be eaten to relieve summer heat.

　　4. Do not eat longan, jujube, ejiao, and royal jelly. Generally, these things are health products that tonify the blood and Qi for women, but they are not suitable for uterine fibroid patients. Since fibroids rely on estrogens for development, if the level of estrogens in the body is too high, it may promote the growth of fibroids. Therefore, these foods should be avoided. If nutritional supplements are needed, these ingredients should be removed from the ingredients.

　　5. Oral contraceptives should not be used. If uterine fibroid patients have a need for contraception, they should not take oral contraceptives either, and it is better to use methods such as condoms. Since most oral contraceptives contain estrogens and progestogens, which are very harmful to fibroids.

　　6. Do not eat grilled, fried, or preserved foods. For uterine fibroid patients, it is best to eat fresh and plain foods, avoid eating fried or greasy foods, and also avoid canned foods, as these foods are not good for health.

　　7. Uterine fibroid patients should have enough rest time every day to improve their body's immunity and not overwork. Especially during the menstrual period, it is necessary to ensure adequate sleep. In daily life, attention should be paid to maintaining the cleanliness and hygiene of the external genitalia, washing the external genitalia with warm water every day, and wearing loose cotton underwear.

　　8. Fruits suitable for uterine fibroid patients to eat: For uterine fibroid patients, most fruits are very suitable, such as apple, loquat, lemon, mangosteen, prune (with a significant antibacterial and anticancer effect), banana, strawberry, papaya, pear, orange, grape, honeydew melon, peach, etc.

　　9. Fruits that uterine fibroid patients should not eat too much: hot and blood-activating fruits that are prone to causing heat, such as jujube, longan, lychee, durian, tangerine, almond (excessive consumption can lead to poisoning), persimmon, etc. Uterine fibroid patients can eat a little less of these, for example:

　　Drug treatment

　　The basis for drug treatment lies in the fact that uterine fibroids are hormone-dependent tumors, so drugs that antagonize sex hormones are used for treatment. The recently used drugs are those that temporarily inhibit the ovary. Danazol and gossypol are commonly used drugs in China, along with other androgen, progesterone, and vitamin drugs. Gonadotropin-releasing hormone analogs have successfully shrunk uterine leiomyomas, indirectly reducing the secretion of gonadotropins at the pituitary level, thereby effectively inhibiting ovarian function, which is known as the 'dysregulation' phenomenon.

　　In cases where drug treatment fails to alleviate symptoms or worsens the condition, or where malignant transformation is suspected, surgical treatment should be considered.

　　Surgical methods

　　The complete hysterectomy method for the treatment of uterine fibroids can be said to be quite thorough, but this treatment method has significant side effects. Because the uterus plays a very critical role in female reproductive secretion, such as the generation of menstruation, the breeding of offspring, and the close relationship with prostaglandins, prolactin, relaxin, growth factors, endothelin, insulin-like growth factor, and so on. And the blood supply and function maintenance of the ovaries in women are closely related to the blood supply of the uterus. Blindly removing the uterus will inevitably affect the normal physiological function of women.

　　Myomectomy is currently one of the most commonly used methods for treating uterine fibroids in China. This method can preserve the patient's uterus, maintain normal reproductive endocrine and physiological functions, but it has many residual problems. If the residual volume is small, it is difficult to be discovered, and ultrasonic examination is difficult to detect fibroid residuals with a diameter less than 0.5 centimeters. There are significant differences among patients with uterine fibroids, which leads to a very large difference in the size and volume of uterine fibroids, and the growth site and development speed are also different. This requires choosing a good hospital and doctor.

　　Situations requiring surgical treatment include:

　　1. Uterine fibroids (whether single or multiple) are less than 5 centimeters in size, and the entire uterus is smaller than the size of a 2-month pregnancy uterus, and the patient has no symptoms, can be observed, and followed up with B-ultrasound for 3 to 6 months; while if there are mild symptoms or the patient is close to the age of menopause, then drug treatment can be considered, such as using androgens, gonadotropin-releasing hormone analogs, mifepristone, etc. under the guidance of a doctor.

　　2. If the fibroids exceed 5 centimeters or the entire uterus is larger than the size of a 2-month pregnancy uterus, then it has the indication for surgery. The surgical methods include more invasive laparotomy and minimally invasive laparoscopy or hysteroscopy, and the most suitable one should be chosen according to the specific situation.

　　3. In any of the following situations, regardless of the size of the fibroids, surgical treatment can be considered: ① Excessive menstrual bleeding caused by uterine fibroids leading to anemia; ② Compression symptoms of the bladder and rectum caused by fibroids; ③ Rapid growth of fibroids; ④ Failure of conservative treatment.