Uterine fibroids are the most common benign tumors in the female reproductive organs, and also one of the most common tumors in the human body. They are also called fibroids and uterine fibroids. Because uterine fibroids are mainly formed by the proliferation of uterine smooth muscle cells, a small amount of fibrous connective tissue exists as a supporting tissue, so it is more accurate to call uterine leiomyomas. Referred to as uterine fibroids.
The etiology of uterine fibroids is still not very clear. It may involve more complex interactions among normal muscle cell mutations, sex hormones and local growth factors.
According to a large number of clinical observations and experimental results, uterine fibroids are hormone-dependent tumors. Estrogen is the main factor that promotes the growth of fibroids. Some scholars believe that growth hormone (GH) is also related to the growth of fibroids. GH can cooperate with estrogen to promote mitosis and promote the growth of fibroids. It is speculated that human placental prolactin (HPL) is also It can synergize the mitogenic effect of estrogen. It is believed that the accelerated growth of uterine fibroids during pregnancy is related to the high hormone environment during pregnancy, and HPL may also participate in the role.
In addition, ovarian function and hormone metabolism are controlled and regulated by higher-level nerve centers, so nerve center activities may also play an important role in the pathogenesis of fibroids. Factor uterine fibroids are more common in women of childbearing age, widowhood and uncoordinated sexual life. Chronic pelvic congestion caused by long-term sexual imbalance may also be one of the causes of uterine fibroids.
In short, the occurrence and development of uterine fibroids may be the result of multiple factors.
Most patients are asymptomatic and are only found occasionally during pelvic examination or ultrasound examination. If there are symptoms, it is closely related to the growth location, speed, presence or absence of degeneration and complications of the fibroids, while the relationship with the size and number of fibroids is relatively small. People with multiple subserosal fibroids may not have symptoms, and smaller submucosal fibroids can often cause irregular vaginal bleeding or menorrhagia. Common clinical symptoms are:
(1) Uterine bleeding is the main symptom of uterine fibroids, which occurs in more than half of patients. Among them, cyclic bleeding is more common, which can be manifested as increased menstrual flow, prolonged menstrual period, or shortened cycle. It can also manifest as irregular vaginal bleeding without menstrual cycles. Uterine bleeding is more common in submucosal fibroids and intramural fibroids, while subserosal fibroids rarely cause uterine bleeding.
(2) Abdominal mass and compression symptoms. Myoma gradually grows. When it enlarges the uterus for more than 3 months of pregnancy or the size of the uterus or is a large subserosal fibroid located at the bottom of the uterus, the mass can often be palpated in the abdomen, It is more obvious when the bladder is full in the morning. The mass is solid, movable, and non-tender. When fibroids grow to a certain size, they can cause compression of peripheral organs. Those with anterior uterine fibroids close to the bladder can cause frequent urination and urgency; large cervical fibroids can cause poor urination or even urinary retention when they are compressed on the bladder; posterior uterine fibroids are particularly It is the isthmus or posterior lip myoma of the cervix that can compress the rectum, causing unsmooth stools and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis.
(3) Pain Under normal circumstances, uterine fibroids do not cause pain, but many patients may complain of lower abdomen swelling and back pain. Acute abdominal pain can occur when subserosal fibroids occur with pedicle torsion or red degeneration of uterine fibroids. Fibroids with endometriosis or adenomyosis are not uncommon, and they may have dysmenorrhea.
(4) Increased leucorrhea Increased uterine cavity and increased endometrial glands, combined with pelvic congestion, can increase leucorrhea. When ulcers, infections, or necrosis occur in submucosal fibroids of the uterus or cervix, bloody or purulent leucorrhea occurs.
(5) Infertility and miscarriage Some patients with uterine fibroids are infertile or prone to miscarriage. The impact on conception and pregnancy outcome may be related to the growth position, size and number of fibroids. Huge uterine fibroids can cause deformation of the uterine cavity and hinder the implantation of the gestational sac and the growth and development of the embryo; the fibroids compress the fallopian tube and cause the lumen to be blocked; the submucosal fibroids can hinder the implantation of the gestational sac or affect the sperm to enter the uterine cavity. The spontaneous abortion rate of fibroids is higher than that of the normal population, and the ratio is about 4:1.
(6) Anemia Due to long-term menorrhagia or irregular vaginal bleeding, hemorrhagic anemia can be caused. More severe anemia is more common in patients with submucosal fibroids.
(7) Others A very small number of patients with uterine fibroids can produce polycythemia and hypoglycemia, which are generally believed to be related to the production of ectopic hormones by the tumor.
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