什么是肌瘤?

肌瘤 are growths made of smooth muscle cells and fibrous connective tissue. These growths develop in the uterus and appear alone or in groups. They range in size, from as small as a grain of rice to as big as a melon. 在某些情况下，肌瘤可以生长在子宫腔内或从子宫向外生长.

An estimated 20% to 50% of women of reproductive age currently have fibroids, 高达77%的女性会在生育期间患上肌瘤. 只有大约三分之一的肌瘤大到可以在体检时被医生发现, 因此，他们往往无法确诊.

在超过99%的肌瘤病例中, the tumors are not cancerous and do not increase the risk for uterine cancer.

什么导致了肌瘤?

肌瘤的病因尚不清楚. 研究表明，每一种肿瘤都是从子宫内的一个异常肌肉细胞发展而来的，当遇到雌激素时，它们会迅速繁殖, 什么促进了肿瘤的生长.

谁有患肌瘤的风险?

Women in their reproductive age are most likely to be affected by fibroids.

其他风险因素可能包括:

• 肌瘤家族史
• 肥胖
• 多吃红肉
• 高血压

Black women are more likely to develop fibroids than other women, they are diagnosed at younger ages and they more often require treatment. It is not clearly understood why fibroids disproportionately affect Black women.

子宫肌瘤的症状

It is common that women who have fibroids do not experience any noticeable symptoms. 其他患有肌瘤的女性会经历严重的症状，影响她们的日常生活. 常见的肌瘤症状包括:

• 严重或长时间的月经
• 月经间出血
• 腹部不适和/或饱腹
• 盆腔痛
• 腰痛
• Bladder symptoms, such as frequent urination or difficulty emptying the bladder
• Bowel symptoms, such as constipation or excessive straining with bowel movements

Women with fibroids can also experience:

• 不孕不育
• 妊娠并发症
• 性交疼痛

紧急肌瘤症状

In rare cases, women with fibroids need emergency treatment. You should seek emergency care if you have sharp, sudden pain in the abdomen that is unrelieved with pain medication, or severe vaginal bleeding with signs of anemia such as lightheadedness, 极度疲劳和虚弱.

如何诊断肌瘤?

肌瘤 are most often found during a routine pelvic exam. 在这次考试中, your health care provider will press on your abdomen and may feel a firm, irregular mass that might indicate a fibroid.

To diagnose uterine fibroids, your doctor may order one of the following tests:

• 盆腔超声检查. A procedure during which a small instrument, 称为换能器, 是插入阴道还是压在腹部，利用声波产生内部器官的图像. 医生可以看到子宫的大小，形状和质地，并评估任何生长.
• 磁共振成像(MRI). 这是一种先进的成像技术，可以提供内部器官的非常详细的图像. 这些图像可以帮助医生确定子宫肌瘤的确切位置和特征, 如果需要, 计划微创治疗.
• Hysterosalpingography. This is a type of X-ray exam of the uterus and fallopian tubes. 你的医生会使用一种特殊的染料来更容易地观察这些器官，并确定肌瘤是否阻塞了你的输卵管.
• 子宫镜检查. 这是一种通过阴道插入的观察仪器(宫腔镜)对子宫颈管和子宫内部的视觉检查.

肌瘤如何治疗?

Since the growth of most fibroids slows as you approach menopause, 如果你的症状是可以忍受的，你的医疗保健提供者可能会简单地建议“观察等待”. 通过这种方法, 医疗保健提供者密切监测你的症状，并进行频繁的随访和超声波检查，以确保你的病情没有明显变化.

Treatment may be necessary if your fibroids cause significant symptoms. Treatment options include medicinal and surgical approaches. Your doctor will recommend treatment based on your symptoms, 子宫肌瘤的位置和大小, 你的年龄和病史, and your health goals such as a desire for pregnancy.

在某些情况下, 由于月经过多或经期过长，妇女也需要治疗缺铁性贫血, or because of abnormal 月经间出血.

药物治疗方案

消炎止痛药 如布洛芬或萘普生可以减少子宫肌瘤引起的月经出血，并提供疼痛缓解. 这是最保守的治疗方法，推荐用于偶尔盆腔疼痛或肌瘤引起的不适的妇女.

激素治疗 可以包括:

• Gonadotropin-releasing hormone agonists (GnRH agonists). This treatment lowers your estrogen level and triggers a temporary “medical menopause.” GnRH agonists are used to shrink the fibroid(s). 它们也被用来停止你的月经，为手术做准备或提高你的血细胞计数. 医生通常不会使用这种药物超过一年，而且一旦药物离开你的系统，药物的效果就会逆转.
• 口服避孕药 (or a patch or vaginal ring) can help reduce bleeding associated with fibroids.
• Progesterone-containing代理 — pills, implant, injection or intrauterine device (IUD) — may also control bleeding.

程序性治疗方案

保守手术治疗. 子宫肌瘤切除术是一种切除肌瘤但保持子宫完整的手术. This approach is recommended for women who want to preserve their fertility. There are three primary myomectomy methods:

• 传统的开放式子宫肌瘤切除术. The procedure is performed via an abdominal incision and carries some risks, 包括出血和切口处瘢痕组织的形成和较长的恢复时间. This approach may be necessary depending on the size and number of fibroids.
• 腹腔镜或机器人子宫肌瘤切除术. This outpatient procedure uses small “keyhole” abdominal incisions and a laparoscope. 这种微创的方法通常会减少出血和更快的恢复, 但它并不适合所有患者. Most patients go home the day of surgery and recover within a few weeks. Your doctor will determine if you are a good candidate for this procedure.
• 宫腔镜肌瘤切除术. 在这个门诊过程中, 你的医生使用一个通过阴道插入的照相机来刮掉子宫肌瘤可见的部分. This method only treats fibroids that have formed inside the uterine cavity.

子宫动脉栓塞术, also called uterine fibroid embolization, is a newer technique. This minimally invasive procedure shrinks fibroids by cutting off their blood flow. An interventional radiologist performs UAE, using X-rays for guidance. 卫生保健提供者正在研究该手术对生育能力和肌瘤组织再生的长期影响.

Magnetic resonance guided focused ultrasound也是一种较新的技术，将声波聚焦在子宫前部的肌瘤上. The potential effects on fertility are not yet understood.

子宫肌瘤的射频消融 是另一种新技术, 在此过程中，在腹腔镜和超声引导下，对肌瘤进行加热，使其变小、变软. The potential effects on fertility are not currently well understood.

子宫切除术治疗肌瘤

在一次 子宫切除术则整个子宫被切除. 肌瘤 are the #1 reason for hysterectomies in the U.S.

The procedure can be performed vaginally or abdominally via a large incision, 腹腔镜或机器人, 这取决于你子宫的大小, location of the fibroids and your medical history.

Because a 子宫切除术 is a major surgery, 它只推荐治疗肌瘤病例的妇女谁是不感兴趣的保留其生育能力. 这是治疗肌瘤最有效的方法，因为它消除了复发的可能性.

肌瘤与妊娠

Uterine fibroids can affect fertility in a variety of ways. 如果肌瘤生长并阻塞子宫或输卵管，它们可能会使怀孕变得更加困难. They may also have other negative effects on pregnancy including:

• Increased risk of miscarriage and preterm labor
• 胎盘的异常附着
• Increased likelihood of delivery by cesarean section
• 产后出血

If you have fibroids and are experiencing infertility, 咨询专门治疗女性肌瘤的生殖内分泌学家. 生育专家可以制定一个治疗计划，最大限度地提高你成功怀孕的机会. If surgery to treat fibroids is needed before pursuing fertility treatment, 子宫肌瘤切除术可能是你最好的选择.

绝经后肌瘤

一般来说，一旦女性进入更年期，肌瘤就会停止生长或缩小. 因此，绝经后患有肌瘤的妇女通常不会出现与肌瘤相关的症状. 在某些情况下, 然而, 如果女性有明显的症状，包括绝经后出血，手术是必要的, 压力相关症状或疼痛. 如果子宫肌瘤在更年期生长, 它可能预示着一种意想不到的癌症，如平滑肌肉瘤——需要额外的检查来确定肌瘤生长的原因并制定治疗计划.