Uterine fibroids according to ICD 10 in adults

Keywords

• Gonadotropin-releasing hormone agonists;
• Pregnancy;
• Levonorgestrel intrauterine system;
• Magnetic resonance imaging;
• Menopause;
• Uterine fibroids;
• Non-steroidal anti-inflammatory drugs;
• Tranexamic acid;
• Ultrasonography;
• Ulipristal acetate;
• FUS ablation;
• In vitro fertilization;
• Embolization of the uterine arteries.

https://youtu.be/g3QXWS6mzbk

Bibliography

GnRH agonists - gonadotropin-releasing hormone agonists

ART - assisted reproductive technologies

GnRH - gonadotropin-releasing hormone

SHBG - sex hormone binding globulin

BMI - body mass index

COCs - combined oral contraceptives

CT – computed tomography

LNG-IUD – levonorgestrel-containing intrauterine system

MHT - menopausal hormone therapy

ICD 10 - International Classification of Diseases, Tenth Revision

MMK - intermenstrual uterine bleeding

MRI - magnetic resonance imaging

https://www.youtube.com/watch?v=ytcopyrightru

MSCT - multislice spiral computed tomography

NSAIDs - non-steroidal anti-inflammatory drugs

OMC - heavy menstrual bleeding

SPRM (ulipristal acetate) - selective progesterone receptor modulators

SERM - selective estrogen receptor modulators

Ultrasound - ultrasound examination

FUS – ablation – focused ultrasound ablation

Color Doppler mapping

UAE - uterine artery embolization

ESHRE – European Society for Human Reproduction

MRgFUS—ultrasound ablation under magnetic resonance imaging control (FUS ablation)

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Pharm Group

Conflict of interest: Members of the working group are members of the Russian Society of Obstetricians and Gynecologists and the Russian Association of Gynecologists and Endoscopists.

All members of the working group declare that they have no conflict of interest.

 • Hormones of the hypothalamus, pituitary gland, gonadotropins and their antagonists. • Antitumor hormonal agents and hormone antagonists.

Pharmacological action – antiandrogenic, antitumor, antigonadotropic, antiestrogenic. Competitively binds to gonadotropin-releasing hormone receptors in the cells of the anterior pituitary gland. With initial or intermittent administration, buserelin stimulates the release of gonadotropins (LH and FSH) by the pituitary gland, which, in turn, causes a short-term increase in the level of sex hormones in the blood plasma.

Chronic use leads to blockade of the gonadotropic function of the pituitary gland and cessation of the release of LH and FSH (on average after 12–14 days). As a result, there is a suppression of the synthesis of sex hormones in the ovaries and a decrease in the concentration of estradiol in the blood to postmenopausal values. Long-term daily use of buserelin in the treatment of prostate cancer leads to a decrease in testosterone concentration to a level characteristic of the condition after orchiectomy, etc.;

to “medicinal castration”. After discontinuation of buserelin, the levels of testosterone and estrogen in the blood are gradually restored. Preoperative treatment for endometriosis reduces inflammation, the size of pathological lesions and their blood supply. As a result of postoperative therapy, the frequency of relapses and the severity of adhesions decreases.

It is well absorbed from the nasal mucosa and after subcutaneous administration. Cmax with intramuscular administration of 3.75 mg is (0.32±0.12) ng/ml, bioavailability when administered once a month is 53%. Excreted in small quantities into breast milk. In vitro studies using bacterial systems (Ames test with Salmonella typhimurium and Escherichia coli) and mammalian cell systems (micronuclear test in mice) did not reveal a mutagenic effect.

In two-year studies on rats with daily subcutaneous administration in doses of 0.2–1.8 mcg/kg, no signs of carcinogenicity were detected. Suppression of testosterone secretion leads to impaired fertility. It is not known whether fertility is restored after discontinuation of buserelin (it is restored after discontinuation of its analogues).

ICD-10 code

D26 Other benign neoplasms of the uterus

Pharm. gr. Substance Drugs for treatment

Appendix B: Patient Information

Uterine fibroids are one of the most common tumors of the female genital organs; they account for 27% of gynecological diseases. In addition, it can occur again in 7-28% of patients, sometimes even degenerating into a malignant tumor. If previously it was believed that uterine fibroids mainly affected 40-year-old women, today the problem is even more pressing, since fibroids are increasingly being found in eighteen- and twenty-year-olds. Who has yet to give birth to children? And uterine fibroids can become a serious obstacle in this.

https://www.youtube.com/watch?v=ytcreatorsru

The development of this benign tumor is largely influenced by inflammatory diseases and abortions. In a woman who has had 10 abortions by the age of 30, the risk of developing uterine fibroids by the age of 40 increases by 2 times. It is absolutely certain that uterine fibroids are much more common in nulliparous women.

In 30-40% of cases, the tendency to form uterine fibroids is still inherited: from mother to daughter. There are so-called “familial forms” of uterine fibroids, when all women in the family - grandmothers, mothers, aunts, sisters - had fibroids.

In some cases, at first the fibroid does not manifest itself at all and does not bother the woman. Therefore, fibroids are most often detected during a medical examination by a gynecologist. In this case, the doctor can only state the fact of the presence of uterine fibroids. In other situations, the first signs of fibroids may be pain in the lower abdomen or lumbar region, bleeding, changes in the menstrual cycle, dysfunction of neighboring organs, for example, frequent urination.

Fortunately, in most cases, you can really only get by with an ultrasound. But sometimes, with an atypical location of fibroids, ultrasound results can be unreliable.

In general, fibroids can be located in the outer, middle and inner layers of the uterus. The most “unpleasant” ones are those located in the inner layer. Such fibroids deform the uterine cavity and, as a rule, cause heavy monthly bleeding with a sharp decrease in hemoglobin. Large fibroids, especially those located in the outer layer, put pressure on neighboring organs, disrupting their functions.

The presence of fibroids in itself is not always an indication for surgery. It all depends on the patient’s condition, the severity of the symptoms of the disease and the size of the tumor.

Indications for surgery to remove uterine fibroids are pain, rapid growth in the size of the node, suspicion of degeneration of uterine fibroids into a malignant tumor, impaired blood supply to the fibroid nodes and inflammatory changes in them, dysfunction of neighboring organs (bladder, intestines), infertility (when all other reasons have already been excluded). If surgery is necessary, then indeed, the sooner it is done, the better.

Small uterine fibroids usually respond well to conservative treatment. Uterine fibroids can be observed dynamically (using ultrasound with a vaginal probe). If symptoms are present, conservative therapy can be carried out - with gestagens, ulipristal, gonadotropin-releasing hormone agonists.

Hormone therapy is carried out to prepare the endometrium (inner layer of the uterus) only in cases where the fibroid node is located in the inner layer of the uterus, and a resectoscopy operation is to be performed (removal of the node from below through the uterus). Hormone therapy is prescribed for 3 months, preferably under ultrasound control, in order to prepare for removal of the myomatous node while preserving the uterus.

lasers (carbon dioxide, argon), special ultrasonic scalpels, etc. After laparoscopy, only small “dots” of 0.5-1 cm are noticeable, since only 5 mm punctures are made to insert instruments into the abdomen. The length of stay in the hospital is reduced to 1-2 days, and immediately after discharge the woman is able to work.

If it is possible to perform the operation through vaginal access or using a hysteroscope, there are no external traces of the surgical intervention left at all. Apart from the woman herself and the gynecologist, no one will ever know what kind of operation she underwent.

Uterine fibroid (UF) is a limited benign tumor consisting of smooth muscle and fibrous connective tissue elements. The tumor can be single, but more often multiple nodes are detected (sometimes up to 10 or more); hormonal dependent. Statistical data. Found in 4–11% of all women, 20% of women over 30 years of age and 40% of women over 50 years of age.

Uterine fibroids: Diagnosis

Diagnostics

• Palpation of the abdomen. FM are palpated in the form of dense irregularly shaped nodes. With sarcoma, edema and degeneration of FM, the nodes are usually soft and painful. During pregnancy, the uterus has a soft consistency.

• Examination of the pelvic organs (bimanual vaginal examination, speculum examination) is performed every 3–6 months. The most characteristic symptom is an enlarged uterus. It is usually asymmetrical, with irregular outlines and mobile in the absence of adhesions • Submucous FM is characterized by symmetrical enlargement of the uterus • Some subserous myomatous nodes may not be associated with the body of the uterus and move freely in the abdominal cavity. In these cases, it is necessary to carry out differential diagnosis with tumors of the uterine appendages and extrapelvic neoplasms • FM localized in the cervix and submucosal FM on the stalk can protrude far into the lumen of the cervical canal; sometimes submucosal FM may be visible at the level of the cervical pharynx or vaginal opening.

• Palpation of the rectal uterine ligaments is carried out to identify endometriosis, which is often combined with FM.

• In FM, blood loss during menstruation is increased, so patients undergo regular blood tests. To correct IDA, iron supplements are prescribed.

• Pelvic ultrasound is used in cases where an enlarged uterus fills the pelvic cavity, complicating physical examination, and also to detect hydronephrosis resulting from compression of the urethra by uterine fibroids.

• If submucosal FM is suspected, hysterosalpingography or hysteroscopy is usually performed.

• CT/MRI.

• With the rapid growth of myomatous nodes, it is necessary to exclude malignant degeneration.

Differential diagnosis

Uterine pregnancy • Ovarian tumor • Tumor of the cecum or sigmoid colon • Appendiceal abscess • Diverticulitis • Nephroptosis.

Pathogenesis

First, under the influence of provoking factors near the microvessels, an active zone is formed in the muscular layer of the uterus, in the cells of which metabolic processes are accelerated and tissue permeability increases. Subsequently, the smooth muscle cells of this zone begin to accumulate into microscopically and macroscopically defined nodes.

Over time, the sensitivity of proliferating tissue to the action of hormones decreases, and its own autocrinoparacrine growth mechanisms are launched. Submucous fibroids are nourished by vessels that have lost their adventitia. A growing submucosal node increases the area of ​​endometrial rejection and reduces the ability of the myometrium to contract, which provokes more heavy, prolonged and painful menstrual bleeding.

Uterine fibroids, being a progesterone-dependent pathological process, develops, as a rule, during the ovulatory menstrual cycle. Tumor myocytes of leiomyomas differ from unchanged myometrium by higher expression of both estrogen and progesterone receptors. Its growth depends on cyclical hormonal changes in a woman’s body.

Description

Uterine fibroids are a benign, hormone-dependent tumor arising from the smooth muscles of the uterus. Uterine fibroids are found in 15–17% of women over 35 years of age. The term uterine fibroids is the most recognized and widely used, since it characterizes the morphogenesis of the tumor - its development from the muscle tissue of the uterus. Other names (fibroma, fibromyoma) are recommended to be used to clarify its histostructure. With uterine fibroids, elements of the connective tissue stroma predominate; with fibroids, there is an equal ratio of muscle and connective tissue cells. Each uterine fibroid, as a rule, is multiple, so the term multiple uterine fibroids has no logical meaning.

Use during pregnancy and breastfeeding

• It is recommended to carry out conservative treatment of pain associated with degenerative changes in the myomatous node in the second trimester: bed rest, hydration, analgesics [56,57].

Strength of recommendation: C (level of evidence: 4)

Hormone-dependent prostate cancer stages III and IV (if it is necessary to inhibit testosterone production in the testes); breast cancer in women with a preserved menstrual cycle and the presence of estradiol/progesterone receptors; hormone-dependent pathology of the reproductive system. Caused by absolute or relative hyperestrogenism (endometriosis.

 Hypersensitivity.

 Contraindicated during pregnancy. During treatment you should stop breastfeeding.

https://www.youtube.com/watch?v=upload

 IM, s/c, intranasal.

Before starting therapy, it is necessary to exclude pregnancy and stop taking oral contraceptives; during the first 2 months of treatment for endometriosis, endometrial hyperplasia and uterine fibroids, barrier methods of contraception (condoms) must be used. When administered intranasally against the background of rhinitis, it is necessary to clean the nasal passages before administration;

The use of vasoconstrictor intranasal drugs should be avoided before and for 30 minutes after the administration of buserelin. Use with caution in patients with depression. For ovulation induction, it can only be prescribed by a doctor experienced in the treatment of infertility. Use with caution during work for vehicle drivers and people whose activities involve increased concentration.

Classification

Submucosal fibroids differ in the number of nodes, location, size and structure. The following criteria are used to classify the disease: • Number of nodes. There are single and multiple submucous fibroids. • Dimensions. Submucosal tumors up to 20 mm in size (up to 4-5 weeks of pregnancy) are considered small, from 20 to 60 mm (from 4-5 to 10-11 weeks) - medium, more than 60 mm (12 weeks or more) - large.

1.5.1 Clinical and anatomical classification (localization in various parts of the uterus and tumor growth in relation to the muscular layer of the uterus):

• intramural;
• submucosal;
• subserous;
• interligamentous;
• cervical;
• parasitic.

0. Pedicled submucosal nodes without an intramural component;

I. Submucosal nodes on a broad base with an intramural component of less than 50%;

II. Myomatous nodes with an intramural component of 50% or more [2,3].

1.5.4 Classification of uterine fibroids according to the recommendations of the European Society of Human Reproduction (ESHRE):

• Small fibroids: up to 5 cm;
• Large fibroids: more than 5 cm [5,6].

Side effects

From the nervous system and sensory organs. Headache (with intranasal administration), mood lability, sleep disturbance, depression, symptoms of eye irritation (when wearing contact lenses). From the gastrointestinal tract. Changes in appetite, nausea, vomiting. From the genitourinary system. Decreased libido, impotence, vaginal dryness, ovarian cysts, pain in the lower abdomen, menstrual bleeding.

Allergic reactions. Urticaria, skin hyperemia, angioedema. Other. Tides. Irritation of the nasal mucosa and nosebleeds (with intranasal administration). Increased sweating (with intranasal administration). Acne. Dry skin and mucous membranes. Demineralization of bones. Gynecomastia. Thrombosis.

Symptoms

In the initial stages of development, uterine fibroids may not make themselves felt. However, you should pay attention to heavy menstruation, as this may be the first sign of the development of fibroids. In this case, you should definitely contact a gynecologist.

With active development, the following symptoms are observed:

1. Pain syndrome in the lumbar region, lower abdomen.
2. Development of anemia.
3. Cutting pain during intimacy.
4. Frequent urge to urinate.
5. Feeling sluggish.