Uterine fibroids are benign tumors. They are one of the most common (10-27%) tumors of the female reproductive system. Uterine fibroids are currently found in women aged 30-40 years, but are often detected in women aged 20-30 years and younger. This tumor is found in 15-20% of women over 30 years of age and in almost 40% of women over 40 years of age. Eighty percent of indications for gynecological surgery are due to the presence of uterine fibroids and their complications. Myomas (leiomyomas, fibroids) develop from the muscle and connective tissue of the uterus. There is currently no consensus on the causes of uterine fibroids. Most researchers prioritize hormonal imbalances and the hormone-dependent growth of myomatous nodes. Others believe that infection (intrauterine contraceptives, abortions, inflammation, and sexually transmitted infections) plays a role in the development of fibroids. Disturbances in immune defense, peripheral hemodynamics, and water-salt metabolism are of particular importance. A genetic predisposition to the development of myoma has been discovered. Classification. By localization in different parts of the uterus: in 95% of cases, the tumor is located in the body of the uterus and in 5% - in its cervix (cervical myoma). In relation to the muscular layer of the uterus, three types of myoma node growth are distinguished: intermuscular (the tumor is located in the thickness of the uterine wall), submucosal (the myoma grows towards the uterine cavity) and subperitoneal (the myoma grows towards the abdominal cavity). In cases where the submucosal tumor is located predominantly in the muscular layer (more than 1/3 of the node volume), the term "intermuscular uterine myoma with centripetal growth" is used. Among submucous fibroids, a special form is distinguished—nascent tumors, which grow into the uterine cavity toward the internal os. The prolonged development of nascent fibroids leads to smoothing and widening of the edges of the uterine os and is often accompanied by tumor protrusion beyond the external uterine opening. The location of fibroids in relation to the muscular layer of the uterus is as follows: - intermuscular - subperitoneal - submucosal - centripetal growth. The clinical presentation of uterine fibroids varies widely and depends on the patient's age, disease duration, tumor location and size, and the presence of concomitant pathological processes. Uterine fibroids are often asymptomatic—that is, there are no complaints or menstrual irregularities. The main symptoms of uterine fibroids are pain, bleeding, dysfunction of adjacent organs, and tumor growth. Pain is typically localized in the lower abdomen and lower back. Severe, prolonged pain is often associated with rapid tumor growth. Acute pain occurs primarily due to disruption of the tumor's blood supply, the progression of which can lead to the development of an acute abdomen. Cramping pain during menstruation may indicate a submucosal location of the tumor. Bleeding is the most common manifestation of fibroids. Heavy and prolonged menstrual bleeding is typically observed with submucosal fibroids, but can also occur with other tumor locations, especially in combination with endometriosis of the uterine body. Intermenstrual bleeding is also possible. Myoma growth is usually slow. Rapid growth is defined as an increase in uterine size equivalent to a 5-week pregnancy within a year or less. Impairment of adjacent organ function occurs with large tumors, as well as with subperitoneal, cervical, and interligamentous locations of the tumors. The most common complication is necrosis of the myomatous node. This causes pain, often fever, and can even lead to the development of acute abdomen. Torsion of a pedunculated node is also possible. Another complication is anemia (decreased hemoglobin levels). Diagnosis of uterine myoma. In the early stages of tumor formation, clinical diagnosis is not always possible. Bimanual (manual) examination data is essential to obtain an idea of ??the shape, size, and location of the tumor. To clarify the diagnosis, additional tests are performed, including ultrasound, endoscopic, and radiographic. The most commonly used endoscopic tests are hysteroscopy, colposcopic examination, cervicoscopy, laparoscopic examination, and culdoscopy. The condition of the endometrium and ovaries is assessed, myoma is differentiated from tumors of the uterine appendages, and material is collected for cytological and histological verification of the diagnosis. When making a diagnosis and assessing the effectiveness of treatment, it is important to consider the days of the menstrual cycle; examinations and ultrasound scanning should be performed dynamically, on the same days of the cycle. Ultrasound scanning data can accurately determine the location, size, and condition of myomatous nodes in order to determine the management tactics and the extent of surgical treatment for women of reproductive age. The general diagnostic algorithm for examining a patient: - identifying risk groups for developing myoma; - early diagnosis by ultrasound; - determining the pathogenetic factors of myoma based on a patient examination to identify urogenital infections, assess the state of the immune system and neuroendocrine-metabolic status, oncocytological studies, and the detection of tumor markers. Ultrasound scanning should be performed once a year for women under 30 years of age at risk and for all women over 30 years of age for the early detection of "young" myomas, which are more promising for conservative treatment. Treatment of uterine myoma. Indications for surgical treatment of uterine fibroids: - bleeding leading to anemia; - large fibroids (more than 15 weeks of pregnancy); - a tumor 12-13 weeks in size and symptoms of dysfunction of adjacent organs; - rapid tumor growth; - a subperitoneal node on a pedicle; - necrosis of the myomatous node; - submucous uterine fibroids; - intraligamentary tumor; - cervical uterine fibroids; combination of uterine fibroids with ovarian tumor, endometriosis; infertility due to atypical location of nodes; suspicion of malignancy (cancerous transformation) of fibroids; centripetal growth of the myomatous node; combination of uterine fibroids with a precancerous condition of the cervix. There are two generally accepted indications: pathological blood loss and rapid tumor growth. Surgical treatment: - laparoscopic myomectomy; — hysteroscopic myomectomy; — laparotomy with myomectomy; — hysterectomy (laparoscopic and laparotomic); — Laparoscopic myomectomy (removal of nodes while preserving the uterus). Indications: subserous and intramurally located nodes with a diameter of more than 2 cm, nodes on a pedicle, lack of effect from conservative therapy. Contraindications: any diseases that contraindicate increased pressure in the abdominal cavity, more than three myomatous nodes with a diameter of more than 5 cm; uterine size more than 16 weeks of pregnancy; myomatous node with a diameter of more than 15 cm. Hysteroscopic myomectomy. Indications: submucous (submucous) location of the node. Contraindications: depth of the uterine cavity more than 12 cm; suspicion of endometrial hyperplasia or adenocarcinoma; infection of the upper and lower genitals; severe diseases of the liver, kidneys and heart (risk of hypervolemia); Suspected leiomyosarcoma (a malignant tumor). Laparotomy with myomectomy is used as an alternative to laparoscopic surgery when this equipment is unavailable in the clinic or when the fibroids are large and numerous. After conservative surgery, new fibroids may develop. Hysterectomy (uterine removal) is indicated if all other methods listed above are contraindicated or have proven ineffective. Conservative treatment of uterine fibroids involves inhibiting tumor growth and prescribing symptomatic medications to treat complications. Currently, there is no generally accepted treatment regimen, nor are there any drugs for the radical treatment of fibroids. Conservative treatment should be performed in the early stages of tumor development, as well as after surgery. Preoperative medications that suppress tumor growth may also be administered to reduce operative blood loss. Unfortunately, fibroid growth resumes after discontinuing medications. The most effective medications typically have a significant number of side effects. Selecting patients for hormonal treatment is as important as determining the indications for surgical intervention. Hormonal therapy can be prescribed to a woman at any stage of her life. However, it is contraindicated in patients with an unspecified diagnosis, rapidly growing or submucosal tumors, or large tumors. With conservative treatment with hormonal medications, the tumor shrinks against the background of characteristic reproductive system changes caused by hypoestrogenism and the onset of drug-induced amenorrhea. Side effects of their use include hypoestrogen-related conditions (hot flashes, sweating, headache, vaginal dryness, frequent mood swings, depression, and decreased bone density). Preventing myometrial damage from abortions and diagnostic curettage can play an important role in the prevention of uterine fibroids. Good results have been achieved in preventing infectious diseases after uterine curettage by prescribing antibacterial medications in the pre- and postoperative periods. Hormonal contraceptives play a significant role in preventing uterine fibroids. Regular visits to a gynecologist for the prevention and early detection of uterine fibroids are essential.