Abundant and painful menstruation, pain in the lower abdomen, bathing of the lumbar and loins, bleeding between menstruation – symptoms that can signal uterine myoma – a benign tumor of the smooth muscles of the uterus, most often occurring in women aged 30-50 years. There is no shortage of methods for treating this troublesome disease nowadays, and embolization of the uterine arteries, which has been carried out in Lithuania for a decade, is considered one of the most innovative and safe.
A common problem in women
As the obstetrician-gynecologist Vilma Dauderienė, a doctor of medical centers “Northway”, tells us, myoma, otherwise known as leiomyoma or fibroid, is one of the most common benign tumors among women of reproductive age.
“Among women between the ages of 20 and 35, the incidence of a tumor is 20 per cent, and between the ages of 35 and 50, it is up to 75 per cent. This is a fairly common disease that afflicts only women of childbearing age. The appearance and growth of myomas is dependent on hormones produced in the ovaries,” the doctor explains.
According to her, little is known about the causes of the appearance of these tumors to date, but genetic predisposition can be distinguished as the main risk factor.
“This is a genetic predisposition to the appearance of myoma – if the mother had myoma, there is a good chance that it will also appear in her daughter,” says V. Dauderienė.
The gynecologist tells that the symptoms that signal the appearance of myoma are very diverse and depend on the size, number and localization of the formation in the uterus.
Profuse menstrual bleeding that causes anemia, fatigue, chronic vaginal discharge and pain during menstruation – the main symptoms that may indicate the appearance of myomas.
“Myomas are classified according to the ratio of their growth to the wall of the uterus. Myomas growing inside the uterus are called subgereal, if they grow only in the wall of the uterus – intramural, and if they grow outwards, adjacent organs – subserosive. The most common symptom, i.e. y. very abundant menstrual bleeding, which causes anemia, is caused by myomas growing in the uterine cavity. It happens that myomas press on other organs, for example, the bladder, which leads to an increase in the frequency and increase in urination, and the functioning of other abdominal organs may also be disturbed,” says V. Dauderienė.
According to her, with regular examinations with a gynecologist, myoma can be detected very easily.
“If the myoma is very large, it can be seen during the examination – a visual increase in the volume of the abdomen is visible. Otherwise, if you complain of profuse bleeding, it is enough to conduct an ultrasound examination. If other questions arise about its localization, relationship with other organs, an MRI examination can be additionally performed,” says the doctor.
After hearing the diagnosis of “myoma”, according to the gynecologist, one should not be frightened – in modern medicine there are 5 methods of treatment of this derivative: medicamentous treatment, laparoscopic myomectomy, hysterectomy (removal of the uterine body), embolization of the uterine arteries and removal of the uterus / myoma by laparotomy (cutting through the abdominal wall).
“Myomas tend to grow, to increase in size. The younger the patient, the more myoma tends to grow, and the larger it is, the higher the risk of complications. I have had surgery on myoma, which weighed 7.3 kilograms, so you should definitely not delay. Treatment methods depend both on the size, localization of myoma, and on the age and self-determination of the patient herself. For example, hysteroscopic myomectomy, in which submucosal myomas are diagnosed and removed, is performed endoscopically. This is a patient-sparing operation that does not require any incision, does not need to lie in the hospital, the functions of reproduction are not disturbed, and it is possible to return to work at the latest after three days. In the past, doctors often suggested removing the entire uterus – “there is no organ, there is no problem”, but nowadays the approach is individual – a lot depends on the patient’s desire to have children, psychological aspects,” says V. Dauderienė.
Minimally invasive method of treatment
According to the Head of the Interventional Radiology Department of the Republican Vilnius University Hospital, radiologist Andrej Afanasyev, compared to the operation to remove the uterus, embolization of the uterine arteries is a much less traumatic method of treatment associated with a shorter stay in the hospital, a previous return to normal activities, and, what is very important for women, – this is a method of treatment that saves the uterus.
“If there are only one or more myomatous nodes in the uterus, whether growing outwards or inwards – embolization of the uterine arteries is a safe and effective method of treating uterine myomas. The success of embolization of the uterine artery depends on the correct selection of the patient. Embolization of the uterine arteries can be performed on “ideal” candidates, i.e., women who do not have contraindications to the procedure and meet the following criteria: profuse regular menstrual bleeding or dysmenorrhea associated with myomas, premenopause, lack of plans to become pregnant,” says A. Afanasyev.
How is this procedure going? The radiologist tells us that in just a 2-millimeter incision in the groin area, with the help of catheters, the arteries that feed the formation are traveled to the arteries that feed the formation, as close as possible to the myoma itself, and embolizing microparticles are injected, which clog the blood vessels and thus stop the blood flow in the formation.
“Through the incision with a special needle, the general artery of the thigh is punctured. In order to be able to clearly see the place of branching of the uterine artery and the course of the artery, angiography is made – observing the blood vessels by X-ray, a contrast agent is injected into them. Then, with the help of special means, the arteries located on both sides of the uterus are successively accessible. Being in them, as close as possible to the myoma, embolization is performed. After this stage, a control angiography is performed to make sure that the procedure was successful. The procedure itself lasts up to an hour, and after it on the same or the next day, the patient can already travel home. After embolization, due to a decrease in blood flow to the myoma, its volume decreases, so the troublesome symptoms also subside,” says the doctor.
Such a procedure is not only minimally invasive, during it there is no need for general anesthesia, the uterus is preserved, the patient recovers quickly, the risk of complications from embolization of myomas also remains very low.
“The general frequency of complications in the XXI century. fluctuates around 5 percent. As the most common complication, a bruise at the site of the incision / prick can be distinguished, which can lead to prolonged dissection of the groin. Of course, complications such as abscess, pulmonary embolism or ischemia of the buttocks / legs are also possible, but these are extremely rare cases that have not happened in a decade during myomas embolization in Lithuania. I have not heard from patients not only about more serious complications, but also about the fact that after the procedure there was no improvement in well-being, no decrease in symptoms,” says Afanasyev.
Diagnosis: myoma
2023 at the end of the nineteenth century, the embolization of myomas was also performed on Klaipeda’s Victoria. The woman tells that even before she heard the diagnosis, she constantly felt pain in the lower abdomen.
“The lower abdomen began to swell, menstruation became more painful than usual. Moreover, there was a feeling of some kind of formation in the lower abdomen – as it turned out later, in the 6 months between the diagnosis and the procedure, the myoma doubled and its size reached 7 cm,” Victoria shares her experience.
When uterine myoma was detected, Klaipeda doctors recommended two options to a woman: to take hormonal drugs, which cost 100 euros per month, or to remove the entire uterus. However, victoria was not satisfied with any of the options, so she began to look for alternatives.
“I found information on the Internet about the existing procedure for embolization of myomas. I contacted the doctor, this time already in Vilnius, sent him MRI images and went to a consultation. During it, the doctor explained what is visible in the magnetic resonance imaging and that I am suitable for the embolization of myoma,” says Victoria.
Klaipeda remembers that before the procedure she was worried, but at the same time she believed that everything would be fine.
“In my case, myoma was fed from two uterine arteries, which were embolized, so after the procedure I felt satisfactory, nauseous, but the care of the staff was excellent. The next day, I was released home, prescribed anti-inflammatory and pain medication. In my case, I felt uplifting acute pain and stretching, which lasted about 5 days,” says Victoria.
2023 in December, the woman visited her gynecologist, from whom she heard the great news – myoma is rapidly decreasing.
“Today I’m counting for the fifth month after surgery and I’m really feeling good,” Victoria says.
