Subserous node on the right rib of the uterus. What is subserous uterine fibroid and how to treat it? What is the difference between subserous fibroids and interstitial nodule?

A tumor in the uterus, called fibroids, is one of the TOP 5 most common pathologies of the reproductive organ. It can be single, but in some cases several formations develop at once. As a rule, in the plural, a subserous myomatous node may appear on the uterus. Education has almost no effect on the uterus, but significantly affects the functioning of neighboring organs.

What is subserous fibroid: symptoms and cause of appearance

Depending on the location of the node, uterine fibroids are divided into several types: intramural, submucous, interstitial, node in the cervix and subserous. We will consider the features of the latter in this article.

The subserous node arises on the outer membrane of the genital organ and grows towards the pelvic cavity. It is located on a wide base or on a pedicle, which is attached to the muscle layer. Characteristic of this type of formation – its multiplicity. This means that the uterus may be littered with nodules.

Install accurate diagnosis in the initial stages it is possible only with the help of ultrasound. However, even during a routine examination, an experienced gynecologist may suspect something is wrong during palpation. Heterogeneity of the uterus, uneven contours of the organ and an enlarged abdomen are reasons to send the patient to additional examination to determine the size and location of a possible formation.

The main reasons for the formation of a tumor are a failure in hormone levels and heredity. However, for a healthy woman who leads correct image life and has good immunity, these factors are almost harmless.

The impetus for the development of a tumor can be:

• surgical interventions in the genital area, abortions and curettage. All these manipulations can damage the muscle layer of the reproductive organ and provoke a new disease.
• the presence of tumors in the breast or ovaries;
• prolonged use of birth control pills;
• inflammatory processes in the genitourinary system.

It is characterized by mild symptoms, since it almost does not penetrate the wall of the uterus. If the base of the tumor has grown deeply into the muscle layer, the following problems may occur:

• Uterine fibroids located near fallopian tubes, blocks their patency, due to which fertilization and consolidation of the egg becomes impossible. As a result, a woman cannot conceive a child.
• If pregnancy does occur, fibroids can cause hemorrhages in the placenta, which leads to miscarriage.
• Failure of menstruation, which is accompanied by heavy discharge and bleeding in the middle of the cycle.

Yet, these violations are rare. Often, subserous uterine fibroids affect the functioning of other systems. Indeed, sometimes it can grow up to 10 cm in diameter. With such dimensions, the pressure on internal organs inevitably. In particular, the following consequences may occur:

• disruption of the functioning of neighboring organs - kidneys, intestines, which is fraught with constipation and frequent urination;
• abdominal pain due to pressure on nerve receptors. The sensations intensify during menstruation, sexual intercourse, and physical activity.

The most dangerous thing that can happen with this type of formation is the twisting of the node located on the stem. This can happen as a result of sudden movements or heavy stress on the abs. The vessels that feed the tumor rupture, causing necrosis of tumor tissue. This may be indicated by the following symptoms, which occur immediately:

• severe dizziness and fainting;
• temperature increase;
• sharp increasing pain;
• cardiopalmus;
• In case of infection, the body becomes intoxicated.

As a rule, in such a situation, surgical intervention is indicated.

Diagnosis and treatment

Modern medicine offers several ways to treat tumors. It could be surgical intervention or conservative treatment with hormonal drugs. Medicines are used if the formation has not reached the size of a 12-week pregnancy, develops sluggishly and is not accompanied by pronounced symptoms.

Doctors can prescribe different groups of drugs:

• Agonists interfere with the production of sex hormones by the ovaries. In this way, the growth of fibroids can be suppressed. Often, education even decreases.
• Antigonadotropic drugs stop the development of fibroids, but are not able to reduce the formation.

If necessary, anti-inflammatory drugs, as well as medications that alleviate the course of the disease, can be prescribed.

In addition, treatment may be accompanied by the use of dietary supplements and herbal medicine. The use of any drug must be agreed with a doctor. Treat yourself folk remedies dangerous because, by affecting the tumor, herbs can negatively affect the functioning of other organs. Therefore, before recommending treatment with herbal remedies, the doctor conducts a thorough examination and prescribes tests.

If drugs are powerless, then surgery is indicated. The most gentle method is myomectomy. It involves minimal intervention and is indicated primarily for girls who want to conceive and give birth to a child.

In some cases, uterine artery embolization is effective - a microsurgical operation during which the uterine artery is blocked with special drugs. This manipulation blocks the blood flow to the node, stopping its nutrition.

In advanced cases, radical surgical intervention is indicated - removal of the node and uterus, and in some cases also the ovaries.

Special diet for subserous fibroids

Compliance proper nutrition promotes a speedy recovery. Recommended:

• Eliminate fried and fatty foods from your diet.
• Eat vegetables and fruits daily. Large amount of food plant origin accelerates metabolism and normalizes intestinal microflora.
• Dairy products and nuts help restore hormone levels.

Doctors insist that the patient give up high-calorie foods. Overweight dangerous with this type of education. Special diet with uterine fibroids, it will not only help prevent other chronic formations, but will also contribute to speedy recovery body when treatment ends.

As a rule, doctors advise:

• Eat whole grain cereals. The same goes for bread. This way the body will receive a lot of useful fiber.
• Saturate the body with vitamins in the form of berries - fresh or frozen. Drinking grape juice once a week is a guarantee of restoring hormonal balance.
• Introduce into the diet sea ​​fish, about three times a week. It is useful for various ailments.

• Consume flax seeds to normalize intestinal function.
• Eat nuts and beans in any form. The body needs them every day.
• Drink milk or low-fat kefir every other day.
• Avoid coffee and black tea. You can replace hot drinks green tea or rosehip decoction.
• Among different types choose the healthiest oil – olive oil. It prevents the development of the node.
• Avoid alcohol. Only on holidays can you afford a glass of red wine.

It is worth paying attention to individual products that should be consumed strictly limit or completely eliminate from the diet:

• Everything floury and sweet in the form of buns, cakes and pastries is taboo.
• Smoked meats, fatty meats and lard are also prohibited.
• Butter can be consumed in quantities of no more than 25 grams per day, margarine - not at all.
• Processed, smoked, sausage and even hard cheeses with high fat content should also be excluded.

Steam or stew food. Dishes prepared in this way are the healthiest for the body.

Collapse

Neoplasms in the reproductive system in women are quite common. Subserous uterine fibroids are a benign tumor that requires timely treatment. This tumor is not cancerous, but can cause quite severe complications without treatment.

Definition

There are fibroids in the uterus different types. They differ in tissue composition, location, structure, size, and quantity. Serous uterine fibroids are so named because they are located close to the serous lining of the uterus. May protrude into the organ cavity. Histology may vary. But most often it consists of blood vessels, muscle tissue and, to a lesser extent, fibrous tissue.

The picture shows where subserous fibroids are located

May vary significantly in appearance. Sometimes tumors are pedunculated, more often – on a broad base. Usually they have a round shape and vary greatly in size. They can be multiple or single. May have partitions made of connective tissue.

In some cases they can actively grow. They have a blood supply and are therefore more prone to rapid growth than those that do not have a blood supply.

Prevalence

Myoma is a very common disease. It is especially common in women aged 35 to 50 years. However, recently doctors have noted a trend towards a decrease in the age of patients. Now many patients are around 25 years old.

But older women are most susceptible to the disease. 50% of patients aged 35 years have fibroids. By age 50, this figure increases to 70%. But subserous uterine leiomyoma is not as common as, for example, submucosal leiomyoma. It accounts for about 30% of cases of all diseases.

Number of nodes

Subserous uterine leiomyoma is characterized by significant diversity. In this layer, not only leiomyoma can form, but also fibromyoma, fibroma, etc. That is, such a formation can have a different histological (tissue) composition.

The tumor also varies in the number of nodes. He may be alone. But this happens quite rarely. More often there are two or more nodes. In this case, myoma is called multiple. In this case, there is always a main unit of the largest size.

Reasons for development

Like any fibroid, subserous myomatous node is hormone dependent. That is, it appears and grows only when the hormonal balance is disturbed. When the body produces a large amount of estrogen, active division of endometrial tissue begins. It grows into other layers and a tumor forms. For this reason this phenomenon often occurs simultaneously with endometriosis.

There are also a number of provoking factors:

1. Bad ecology;
2. Unhealthy diet (the diet for uterine fibroids should be completely natural);
3. Physical inactivity, sedentary lifestyle;
4. Obesity;
5. Bad habits;
6. Absence intimate life, especially after 25 years;
7. Mechanical injuries of the endometrium;
8. Frequent pregnancies;
9. Frequent abortions;
10. Inflammatory processes;
11. Hard physical labor;
12. Frequent stress and depression.

The same reasons lead to the fact that subserous nodes begin to grow rapidly. Although in general, this fibroid does not grow as actively as some other types of tumors in the uterus.

Symptoms

Symptoms and signs of the disease are most often absent. This asymptomatic leads to the fact that subserous uterine fibroids large sizes often found in a very advanced state. Symptoms and any manifestations occur only when the fibroids have reached a large size. Small and medium-sized tumors are often diagnosed by chance. Usually, when undergoing an examination for another reason.

But if signs do appear, they look like this:

1. Pain in the lower abdomen during menstruation, and sometimes outside this time;
2. Nagging pain in the lower back;
3. Enlargement of the abdomen (with a significant size of the tumor);
4. Heavy periods, extended over time;
5. Uterine bleeding outside of menstruation, sometimes quite severe;
6. Irregular menstrual cycle;
7. With large tumors, compression of neighboring organs is possible characteristic symptoms(defecation disorders, frequent urination);
8. Persistent anemia, caused by significant blood loss.

The subserous node of the uterus is most dangerous precisely because it has mild or absent symptoms. As a result, treatment begins only when the condition is very severe.

Complications

Why is fibroid dangerous? One of the most serious complications This disease is the development of infertility. It comes by various reasons. If fibroids are present, the endometrium is damaged and the embryo cannot attach. Large tumors can block sperm access to the egg. And fertilization does not occur. In addition, it is even more disrupted hormonal balance, which also prevents fertilization.

In severe cases of the disease, the subserous node of the uterus cannot always be removed separately. And in some cases (rather rarely) the entire organ has to be removed.

The presence of fibroids causes severe blood loss. As a result, anemia develops. Strong uterine bleeding, cause persistent anemia. Because of this, rapid fatigue, weakness, etc. develop. Severe uterine bleeding can provoke hemorrhagic shock and even lead to death.

If the formation is located on a pedicle, then torsion of this pedicle may occur. As a result, it develops acute condition, requiring immediate surgical intervention. The same thing happens with node necrosis. The condition is recognized by a sharp increase in pain and an increase in body temperature.

With large tumors, the neoplasm may block the outflow menstrual blood. As a result, a hematoma cavity is formed in the uterus and filled with this blood. It can only be removed surgically. And often this needs to be done urgently, since the patient’s condition is serious.

When the size of the tumor is very large, compression of neighboring organs (intestines, Bladder) and disruption of their functioning. In addition, the likelihood of developing inflammatory and infectious diseases in the genitourinary system increases.

Effect on pregnancy

Subserous fibroids and pregnancy are rarely combined. The likelihood of pregnancy if you have fibroids is very low. It is more difficult for the embryo to attach, there is hormonal disbalance. Together, this significantly reduces the likelihood of pregnancy.

Pregnancy with fibroids is very complicated

But even if fertilization has occurred with fibroids on the uterus, it will be difficult to carry a child to term. Hypertonicity develops. Therefore, there is always the threat of miscarriage or premature birth. Fetal hypoxia develops. It is possible to give birth to a child with multiple pathologies.

The birth process itself is also complicated. Usually it takes longer. Severe uterine bleeding may develop.

Diagnostics

The following methods are used to diagnose the condition:

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Radical, that is, surgical, involves removing the fibroids along with the uterus (hysteroscopy) or separately. Prescribed for large, multiple formations, or for severe symptoms. This is described in more detail in the material "".

Treatment with folk remedies can also be used as an additional treatment. It can alleviate the condition a little, but it will not help you cope with the problem on your own. It is described in the article “Folk methods of treating uterine fibroids.”

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The diagnosis of subserous uterine fibroids means that under outer shell organ there is a neoplasm. A tumor consists of pathologically multiplying cells, but is not a type of cancer. All forms of fibroids respond well to treatment with hormonal drugs at an early stage of development. And even advanced disease does not lead to the death of the patient: all fibroids are considered benign tumors, but can have dangerous complications.

What does subserous fibroid look like?

The subserous node is a tumor localized directly under the membrane that surrounds muscle tissue uterine bodies from the side abdominal cavity. There are 2 main forms subserous nodes:

1. A knot with a wide base looks like a rounded convex area on smooth surface uterus.
2. A pedunculated myomatous node often extends beyond the common surface. It remains inside the serous membrane of the body of the organ, but is connected to the uterus by a thin isthmus. The length of the leg may vary.

The size of subserous tumors depends on the speed and time of growth. In medical practice, the size of fibroids is often indicated in weeks of pregnancy.

There are also histological types of subserous nodes:

Any type of fibroid is not malignant: it does not grow into neighboring organs, the node is enclosed in its own capsule. As the tumor develops and ages, dystrophic and necrotic changes occur in the tissue, and areas of calcification or hemorrhage appear.

Complications of fibroids

With the growth and development of benign subserous nodes, a sick woman faces dangerous conditions that can arise due to complications of fibroids. The pressure of a growing tumor on the surrounding abdominal organs provokes disruption of their functions. Most often the bladder and intestines are affected. But problems with urination and defecation are not as serious as the consequences of the processes occurring inside the fibroids:

With complications of fibroids, symptoms often occur “ acute abdomen": sharp or rapidly increasing pain, drop in blood pressure, loss of consciousness and states of shock. External sign- tension abdominal wall and temperature rise. The appearance of such symptoms and knowledge of the dangers of subserous fibroids should force close people of the sick woman to immediately call ambulance, because this condition requires immediate hospitalization and surgical intervention.

A serious complication that occurs quite rarely is fibroid malignancy. In this case, the benign neoplasm changes its nature to malignant and must be immediately removed. The reasons for the changes are unknown to doctors. In order not to take risks, a woman should listen to the advice of a gynecologist regarding the fight against fibroids before the risk of complications arises.

Symptoms and diagnosis of the disease

In order to consult a specialist in time and begin treatment at an early stage, a woman needs to pay attention to her health and pay attention to minor changes in well-being. These may be symptoms of fibroids:

A doctor can diagnose the disease by palpation during an examination. The tissues of the node have a greater density than the muscles of the uterine body. But the main examination method, which helps to monitor the progress of the process during therapeutic treatment, is ultrasound. The image shows signs of malignancy and swelling of the organ with the development of inflammation or necrotization of fibroid tissue.

Subserous uterine fibroids cause deformation of the organ cavity less often than other forms. When diagnosing it, methods such as metrography or hystersalpingography are used in the case of large or multiple nodes.

To differentiate between fibroids and malignant neoplasms CT or MRI studies may be prescribed. Laparoscopy allows you to remove tumor tissue for histological examination(biopsy).

How is subserous uterine fibroid treated?

The choice of treatment regimen is influenced by the size of the node and its growth rate. Fibroids detected at an early stage can often be cured with medications. For conservative therapy apply:

• gestagens and antiestrogens, which reduce the flow of female hormones into the blood and thereby inhibit the growth of the node;
• combined contraceptives with progesterone and estrogen;
• gonadotropins and antigonadotropins, which regulate the activity of the ovaries and reduce the release of estrogen.

Except hormonal drugs, other medications may be prescribed according to individual indications.

Drug therapy is supplemented with special therapy, which is designed to provide good nutrition women. Herbal medicine is also part of conservative treatment. Taking herbal infusions does not replace medications, but has an auxiliary effect, reducing the manifestation of symptoms of the disease. If treatment does not have an effect within 3–6 months, then the patient is recommended to remove the myomatous node.

Methods for removing fibroids

The main indications for surgery are large node sizes (more than 12 weeks). If complications occur, surgery becomes the only treatment option. The following methods are used for surgical interventions:

If fibroids are detected in a timely manner and the size of the node is small, surgery can be replaced by innovative methods of tumor removal.

Modern removal methods

Currently 2 are used high-tech methods, which allow you to destroy myomatous nodes without penetrating into the patient’s body cavity. After such an operation, patients practically do not need hospitalization.

UAE is a minimally invasive procedure in which a catheter is inserted into the femoral artery. They feed into the tube special drug which causes blockage of the lumen small vessels, feeding the tumor.

Due to the lack of oxygen and nutrients the tumor quickly necrotizes, and its tissues are replaced by fibrous fibers. A small scar remains in the muscle of the uterus, which does not interfere normal life organ. The woman spends only 1 day in the hospital.

FUS ablation is a method of influencing the tissue of a node with a beam of ultrasonic waves. Under their influence, the connective tissue that makes up the fibroids heats up to a high temperature, and the tumor cells die. Subsequently, a scar forms at this site.

It is carried out without punctures or incisions, so no trace of the impact remains on the skin. No hospitalization required. The disadvantage of this method is that it is only suitable for removing fibroids containing connective tissue fibers (fibromas, fibromas). Leiomyoma cells are not able to warm up.

So that doctors can carry out treatment quickly and in minimally traumatic ways, the woman reproductive age You need to be systematically examined by a gynecologist (once every 6 months). Special attention Ladies who have not given birth before the age of 30 or who have undergone abortions and other operations affecting the uterine cavity, mucous membrane and myometrium should devote themselves.

Subserous fibroid- a benign hormone-sensitive neoplasm, which consists of smooth muscle cells of the myometrium and is located under the serosa of the uterus. In 60-70% of cases the disease is not clinically manifested. Some patients are bothered by pain in the lower abdomen and lower back, impaired reproductive function, and signs of pressure on the pelvic organs. To confirm the diagnosis, ultrasound, angiography and Dopplerography of the uterus, tomography are prescribed pelvic organs, laparoscopy. Treatment involves the use of hormonal drugs, myomectomy and radical interventions.

General information

Subserous, or subperitoneal, fibroids (leiomyomas) are most often detected in women over 30 years of age. However, the current prevalence of the disease in age group 20-30 years increased by 30-35%. Women during menopause become ill extremely rarely; usually the cessation of menstrual function is accompanied by tumor involution. In girls before menarche, subserous myomatous nodes are not detected. These statistics confirm the leading role of the hormonal factor in the development of subperitoneal leiomyoma. The incidence among city dwellers is significantly higher than among women living in rural areas.

Causes of subserous fibroids

According to many experts in the field of gynecology, the main factors provoking the development of leiomyoma with subperitoneal nodes are endocrine disorders and pathological changes at the level of myometrial cells. The immediate causes of hormonal imbalance are:

• Central regulation disorders. Injuries and damage to the blood vessels of the brain, tumors, and constant stress affect the secretory activity of the hypothalamic-pituitary region. One of the manifestations of such disorders is the hyperproduction of FSH and LH - gonadotropic hormones that regulate endocrine function ovaries.
• Extragenital endocrine pathology. Hypothyroidism, autoimmune thyroiditis, diabetes mellitus, adrenal diseases and some other diseases are accompanied by impaired estrogen production and changes in the ratio of their individual fractions.
• Ovarian diseases. For neoplasms, inflammatory processes, traumatic injuries uterine appendages, the secretion of estrogen and progesterone, the main female hormones, affecting the proliferative activity of myometrial cells.
• Obesity. Adipocytes have endocrine secretory activity and are capable of secreting estrogen.
• Long-term hormonal contraception . Long-term suppression of ovulation using synthetic sex hormones can disrupt their natural production.
• Congestion in the pelvic organs. Low physical activity, irregular sex life without sexual release lead to venous stagnation in the uterus and appendages with the subsequent development of hormonal imbalance.

Because the hormonal disorders are not detected in all patients with subserous myoma; some authors believe that pathological sensitivity or activity of cells in the muscular layer of the uterus plays a significant role in the development of the disease. Such violations lead to:

• Hereditary factor. Scientists have identified two groups of genes that can influence the development of myomatous nodes. Some of them provoke increased proliferation of myometrial cells, others change sensitivity to estrogen and progesterone.
• Myometrial injuries. Frequent abortions, invasive diagnostic and healing procedures, surgical interventions on the uterus cause local changes in smooth muscle cells.

Pathogenesis

At the first stage of the formation of the subserous node, pathological changes occur at the cellular level. In some smooth muscle cells, under the influence of sex hormones, metabolic processes are accelerated, and an increase in tissue permeability is noted. The second stage of pathogenesis is characterized by the appearance of cellular accumulations, defined as microscopic nodes. At the third stage, neoplasms are determined macroscopically. Nodes can form on a wide base or a thin stalk along which the vessels feeding them pass. An important point The pathogenesis of subperitoneal fibroids is a gradual decrease in the sensitivity of proliferating cells to the stimulating influence of hormones and further tumor development under the influence of their own autocrinoparacrine factors. As the disease increases, it manifests itself clinically as a decrease in the contractility of the myometrium and pressure on adjacent organs.

Classification

Subserous leiomyomas may have different sizes, number of nodes, histological structure and features of location in relation to the uterus. Accordingly, the disease is classified according to the following criteria:

• By size. There are small fibroids ranging in size up to 4-5 weeks of pregnancy (up to 20 mm), medium ones - from 4-5 to 10-11 weeks (20-60 mm) and large ones - from 12 weeks (more than 60 mm).
• By number of nodes. Subperitoneal fibroids can be single or multiple.
• According to morphological structure. Based on the type and proliferative activity of smooth muscle cells, tumors are classified as simple, proliferating, and presarcoma.
• According to location features. Subserous neoplasms can grow on the surface of the uterus facing the abdominal cavity or between its ligaments; have a wide base or stem.

Symptoms of subserous fibroids

Clinical symptoms are detected only in 30-40% of patients and indicate a significant age of the disease. Single and small neoplasias usually develop asymptomatically and are first detected when gynecological ultrasound. Subperitoneal growth of nodes is not characterized by menstrual irregularities. If the tumor has a wide base, the contractile activity of the myometrium may be impaired, which is clinically manifested by heavy and prolonged periods, the development of anemia with pale skin, and complaints of general weakness, fatigue, low performance, periodic dizziness and headaches.

With large tumors, pain and signs of pressure on adjacent organs are observed. Patients complain of periodic lower back pain, which may intensify during menstruation. Especially strong painful sensations occur when the myomatous node fuses with the peritoneum. When neoplasia puts pressure on the bladder, the urge to urinate becomes more frequent. Compression of the rectum is manifested by constipation, increased urge to defecate, increased hemorrhoids. Much less often fibroids disrupt venous drainage from the extremities, which is accompanied by swelling. Unlike submucosal tumors, subperitoneal neoplasms have less impact on reproductive function– the inability to get pregnant or bear a child is usually noted only by those women whose growth of the node has led to the formation of a bend in the uterus or significant deformation of its cavity.

Complications

Most dangerous complications subserous fibroids are peduncle torsion, necrosis or infarction, which are accompanied intense pain in the lower back and lower abdomen, severe weakness, sweating, vomiting, fever, dysfunction of the rectum and bladder. With a subperitoneal location of the tumor, secondary anemia due to blood loss, infertility and premature termination of pregnancy, myxomatous transformation of the tumor, and hyperplastic processes in the endometrium can also be observed. Malignancy occurs extremely rarely (no more than 0.25-0.75% of cases).

Diagnostics

When diagnosing subserous fibroids, a special role is played by special methods studies that make it possible to detect neoplasms, determine their size, and clarify the characteristics of the blood supply, location, and structure. In diagnostic terms, the most informative are:

• Gynecological examination. During a bimanual examination, an enlarged uterus and nodes on its surface are palpated.
• Transvaginal and transabdominal ultrasound. Fibroids associated with the uterus and growing towards the abdominal cavity are identified, their size, structure and location are determined.
• Dopplerography and angiography of the uterus. Allows you to assess the intensity of blood flow and visualize circulatory system uterus and detect signs indicating a malignant process.
• MRI and CT of the pelvic organs. They provide the most accurate topographic picture of the pelvic organs and myomatous nodes.
• Diagnostic laparoscopy. Subperitoneal leiomyomas are defined as round, pale pink formations with a shiny, smooth surface.

From laboratory tests may be indicative general analysis blood (erythropenia and low level hemoglobin) and study of the level of sex hormones (FSH, LH, estradiol, progesterone). Differential diagnosis carried out with pregnancy, uterine sarcoma, ovarian tumors and retroperitoneal neoplasms. If necessary, the patient is consulted by a gynecological oncologist, endocrinologist, urologist, surgeon, or therapist.

Treatment of subserous fibroids

For patients with small subperitoneal nodes with preserved reproductive function, no complaints or signs of neoplasia growth, it is recommended dynamic observation with examination by a gynecologist once a year. For other forms of the disease, the specialist suggests appropriate conservative, combined or surgery. Women with slow-growing tumors up to 12 weeks in size and moderately severe clinical symptoms Hormonal and symptomatic therapy is indicated. The treatment regimen may include:

• Inhibitors of gonadotropin hormone secretion. The administration of antigonadotropins and GnRH agonists (gonadotropic releasing hormones) helps to stabilize and reduce the size of the nodes.
• Progestin and estrogen-gestagen drugs. Allows you to correct hormonal imbalance and stop tumor growth in women of reproductive age, stabilize the effect of GnRH and antigonadotropins.
• Androgens. For the purpose of medicinal cessation of menstrual function, it is recommended for patients over 45 years of age who are not planning a pregnancy.
• Symptomatic remedies. In the presence of pain, analgesics are prescribed; in case of metrorrhagia, hemostatic agents and drugs for uterine contraction are prescribed. According to indications, iron supplements, vitamins, mineral complexes and so on.

One of best solutions for patients of childbearing age with a single or several slow-growing neoplasia measuring 50 mm or more, if present clinical manifestations is combination therapy. The method involves conservative myomectomy, before which GnRH agonists are prescribed to stabilize the growth of myomatous nodes. A course of treatment with drugs that inhibit the secretion of gonadotropic hormones is also recommended in the postoperative period to prevent relapse.

For rapidly growing subperitoneal fibroids larger than 60 mm in size, severe pain syndrome, metrorrhagia, disorders of reproductive function and pelvic organs surgical methods. Unlike submucosal fibroids, uterine artery embolization is not recommended for the treatment of subserous neoplasms due to the high risk of necrosis. Taking into account the reproductive plans of women and the characteristics of the course of the disease, various organ-preserving and radical interventions are performed:

• Laparoscopic and laparotomy myomectomy. For cutting and enucleation of subperitoneal nodes, mechanical, electrical and laser surgical instruments are used.
• FUS ablation. Despite its low invasiveness, the method is used to a limited extent. It cannot be prescribed in the presence of 6 or more nodes, large neoplasia and pedunculated tumors.
• Semi-radical and radical operations . During transvaginal, laparoscopic or laparotomic surgery, defundation, high and regular supravaginal amputation or total hysterectomy are performed.

Prognosis and prevention

Subserous fibroids are benign neoplasm with a low risk of malignancy and a favorable prognosis. Timely detection of the disease and correct treatment tactics make it possible to restore menstrual and reproductive function. To reduce the risk of developing subperitoneal nodes and complications in the presence of a tumor, it is recommended to regularly see a gynecologist (especially in diseases accompanied by hyperestrogenemia), rationally use contraceptive methods, and undergo invasive procedures strictly according to indications.

Subserous uterine fibroids are a fairly common diagnosis in the field of gynecology, which is given to women of reproductive age. There is no need to be afraid of this diagnosis: it can be successfully diagnosed and comprehensively treated.

Subserous fibroids that develop in the uterus are a benign hormone-dependent neoplasm that affects the muscle tissue of the uterus. It is formed on the outside of the organ and most often grows in the pelvic cavity. With this pathology, the neoplasm has a wide base, which is connected to the tissues by a kind of stalk, forming characteristic nodes.

Subserous myoma on a pedicle is when the neoplasm is fed through the canal of this very pedicle, and the node itself can be either single or multiple in nature. Its peculiarity is that growth goes towards the abdominal cavity - doctors often call it subperitoneal.

Subserous uterine fibroids

Causes

As doctors note, the main factor that provokes the formation and growth of such a pathology as subserous myomatous node is a disruption in the hormonal background of a woman’s body. Predisposing factors for the formation of this pathology are:

• surgical interventions in genitourinary system women: this could be an abortion, curettage or laparoscopy, which will ultimately injure muscle tissue;
• genetic predisposition, infectious and inflammatory processes affecting the patient’s genitourinary system;
• course of taking hormonal contraceptive drugs and tumors affecting the appendages or mammary glands;
• malfunction of the thyroid gland and adrenal glands.

Subserous uterine fibroids can vary in appearance

Subserous myomatous nodes and the fibroid itself, as can be seen, can develop as a result of various provoking reasons.

Symptoms of pathology

When diagnosing other types of fibroids, the consequences of the pathology will be that the woman is not able to bear and give birth to a child, or become pregnant. If subserous uterine fibroids of large size or with small nodes are diagnosed, then the woman’s reproductive system will not be affected.

The characteristic symptoms that myomatous nodes exhibit are palpable attacks of pain, which are provoked by the growth of fibroids. In general, subserous fibroids themselves are characterized by the following features:

Types of pathology

Doctors note that a subserous node in the uterus can be either single or multiple: the first is distinguished by the fact that it has a shell in capsule format, and multiple neoplasms manifest themselves somewhat less frequently, but they have more vivid symptoms.

If multiple fibroids grow and reach large sizes, neighboring organs and systems can be compressed and their integrity and functioning are disrupted. In addition, experts divide them into the following types:

1. Intramural subserous fibroids are localized on the outer uterine layer. Doctors call this type of neoplasm safe because it does not affect the uterus. Menstrual cycle and the woman’s reproductive abilities are preserved.
2. Subserous nodes with interstitial myoma form and grow in the thickness of the uterine wall, developing towards the pelvic cavity. This type Doctors classify tumors as a mixed type: it differs from the standard type of subserous tumor. As it develops in the layer muscle fibers, the tumor causes a slight increase in the size of the uterus. Such a node negatively affects adjacent organs and tissues, but rarely its size exceeds 9-10 cm.

Diagnosis of pathology

The presence of subserous fibroids can be determined by taking biomaterial for analysis

Before starting treatment, the doctor conducts a full examination of the woman in a gynecological chair and, if the development of subserous myomatous neoplasms is suspected, uses one or another diagnostic method. Modern methods diagnosing pathological changes in the cavity, body of the uterus are:

• carrying out echolocation and magnetic resonance examination on a tomograph, together they help to obtain an accurate and reliable picture of the growth and development of the tumor;
• collection of biomaterial for research using curettage;
• hydrosonography - with its help the doctor diagnoses the smallest tumors and their location;
• laparoscopy - it is prescribed if it is impossible to differentiate fibroids according to certain indications and limitations.

Therapeutic measures

Treatment of pathology has 2 approaches - conservative and surgical, each of them has its own indications, contraindications, and purposes. A conservative course of treatment basically involves the prescription of hormonal drugs and nutritional correction.

Hormonal therapy for subserous uterine fibroids

Hormonal therapy involves the use of hormonal compounds of 2 groups:

1. This group medications is aimed at suppressing the excessive production of female hormones and ovulation, which makes it possible to stop and suppress the development of fibroids, reducing the latter in size.
2. Group 2 of drugs includes compounds that, by their action, reduce estrogen, which suppresses the growth of the neoplasm itself, but without reducing the latter in its size. Data hormonal agents They have a number of restrictions for use and contraindications; they are prescribed only by a doctor, based on the results of the examination and examination of the woman.

Among the most frequently prescribed hormonal drugs, doctors identify:

1. GnRH agonists, for example, the drug Zoladex: it is able to suppress the secretory work of the pituitary gland and, as a result, reduces the natural production of hormones by the ovaries. This will stop the growth and development of the myoma tumor, promoting its destruction.
2. Antigonadotropic drugs, for example, Danazol - less effective drugs, rather than those presented above, since they are not able to completely remove the tumor. But for the most part they are aimed at suppressing and destroying the tumor.

Along with a course of hormonal substances, treatment of this type of fibroid requires a mandatory review of your own diet. It is following a diet that will speed up recovery and enhance regeneration at the cellular level. In this case, it is important to remove red meats from the menu and switch to eating fresh vegetables, fruits, and foods of plant origin.

Other therapies

Radical treatment involves surgical intervention to remove fibroids: the question of using this method depends directly on its size. As doctors note, operations can be very different depending on certain factors. In particular, if a woman no longer intends to become pregnant and give birth, the uterus is completely removed.

Endoscopic surgery to remove large subserous uterine fibroids

If the girl still intends to give birth, then the goal will be to preserve reproductive organ and its functions. Therefore, doctors practice more gentle methods of surgical intervention, for example, the use of endoscopic type, combined with a course of hormonal therapy. After such a surgical operation, doctors recommend planning a pregnancy no earlier than six months later, and the delivery process itself should be carried out by cesarean section.

Most complex look surgical intervention is the removal of the interstitial type of subserous nodes, small in size. The thing is that they are located inside the muscle, and their contours are very blurred - this complicates not only the operation, but also the entire diagnosis several times. If such nodes do not exceed 2 mm, most often doctors do not operate on them.

Treatment with surgery is indicated in the following cases:

• in preparation for subsequent pregnancy - for the purpose of prevention, since all diagnosed gynecological diseases and pathologies should be eliminated in a timely manner;
• as stimulation of ovarian functions for the purpose of treatment female infertility: in some cases, it is fibroids that can cause the inability to conceive, bear and give birth to a child.

Before the intervention, the doctor prescribes an ultrasound examination for the patient. This will make it possible to accurately determine, for example, whether it is attached to the anterior wall or to diagnose the size and location of fibroids. In addition, it will help to establish whether the pathology develops according to back wall. As a result, surgeons will receive the necessary data.

Use of folk remedies

Treatment of subserous type of uterine fibroids, in addition to a course of hormonal therapy or surgical intervention, involves the use of means from the arsenal traditional medicine. For the most part, this is the use of medicinal extracts from plants and tinctures, vaginal suppositories and ointments, which contain components of plant and animal origin.

Subserous uterine fibroids can be treated with herbal remedies.

Most often, these products should consist of an extract or contain components from poisonous plants that have an antitumor effect. As doctors themselves note, such drugs can bring positive therapeutic effect, but it is recommended to use them only as an additional, but not the main method of treatment in the absence of restrictions and contraindications or individual intolerance to the component.

Possible complications

The most a common complication is the power supply to its node. If a woman is diagnosed with a subperitoneal type of fibroid, then it is worth knowing what is prohibited to do in this case. First of all, any sudden movements, since they can provoke twisting of her legs. In addition, a woman with this diagnosis is not recommended to practice any thermal procedures, massage sessions: all of them increase blood flow and, as a result, uterine bleeding.

Bleeding may be a consequence of treatment for subserous fibroids

In relation to such a phenomenon as torsion of the legs of fibroids, the pathology is accompanied by pronounced attacks of pain and fainting, excessive sweating and tachycardia. If there is a protrusion of the node towards adjacent systems and organs, they can be compressed or grow together with them. When attacks of pain are prolonged, this may indicate the course of an atrophic process that develops as a result of a disruption in blood flow. Somewhat less often, doctors diagnose situations when the capsule of the node bursts, its contents enter the cavity of the peritoneum and retroperitoneal space. As a consequence, the development of peritonitis, purulent inflammation which amazes reproductive system women, the peritoneal cavity and retroperitoneal space.

Prognosis and prevention

Subserous forms of myomatous myomas are marked by a high percentage of benignity - they are not prone to malignancy. Doctors' forecasts are positive, and even with this diagnosis, the percentage of all women who recover after a course of hormonal therapy or surgery is quite high.

The main thing in this regard is a timely examination, immediate examination if the development of this type of fibroid is suspected and effective treatment. When passed annually gynecological examination pathology can be recognized and prevented by early stages its currents. In addition, in order to prevent the development of fibroids, it is worth preventing abortions, giving birth and breastfeeding the baby, promptly treating all gynecological pathologies, and minimizing consumption hormonal contraceptives. Balanced diet, moderate physical exercise And regular inspection a doctor is the key to women’s health!