Clinical features Clinical symptoms are related to the location and size of myoma. Menstrual changes are the most common symptoms. Larger intramural myomas and submucosal myomas often have more menstrual flow, prolonged menstrual period and shortened cycle, which may be accompanied by different degrees of anemia, irregular vaginal bleeding or abnormal leucorrhea. When the myoma is enlarged, there may be compression symptoms such as frequent urination, urgency or dysuria, and even the tumor can be palpated in the lower abdomen. Subserous myoma torsion or myoma degeneration may cause acute abdominal pain. Some patients may hinder the implantation of pregnant eggs or affect the passage of sperm because of the growth site of fibroids. It can also lead to infertility or miscarriage.
Doctor's diagnosis 1? With typical symptoms, or some patients have no symptoms.
2? Gynecological examination: The uterus is enlarged, with irregular protrusions on the surface, and the mass can be touched in the abdomen of large myoma. When submucosal myoma protrudes from the vagina, a purple smooth ring tumor can be seen. If the myoma degenerates, the uterus becomes soft and tender.
3? B-ultrasound: It is the most commonly used examination method to diagnose uterine fibroids. According to the echo image, it can show the size of uterus, intrauterine conditions, the number, size, location and degeneration of fibroids.
4? Official cavity detection or curettage: you can know the depth and shape of uterine cavity.
5? Hysterosalpingography: it can show the size of uterus, the shape of official cavity and the attachment site of myoma.
6? Endoscopy: The official cavity mirror can peep into the submucosal myoma in the cavity, and the laparoscope can directly look at the uterine shape and myoma.
7? Differential diagnosis (1) pregnant uterus: According to the history of menopause, pregnancy reaction, uterus enlargement and softening, urine pregnancy test positive, etc., it is not difficult to distinguish from uterine fibroids. If myoma is complicated with pregnancy, B-ultrasound is feasible to assist in diagnosis.
(2) Ovarian tumor: Generally, it is not difficult to distinguish between them, but solid ovarian tumor may be misdiagnosed as subserous myoma. On the contrary, submucosal myoma is easily misdiagnosed as ovarian cyst when cystic change occurs. When there is adhesion between ovarian cyst and uterus. It is more difficult to differentiate, but B-ultrasound and laparoscopy can make a definite diagnosis.
(3) adenomyosis: There are also menorrhagia, prolonged menstrual period and enlarged uterus in clinic, but the main clinical symptoms are dysmenorrhea and progressive aggravation. At the time of examination, the uterus is uniformly enlarged, rarely exceeding the size of two months of pregnancy, with the characteristics of enlarged uterus before menstruation and reduced uterus after menstruation. B-ultrasound can help diagnosis. When myoma and adenomyosis coexist, it is not easy to distinguish, and it often needs postoperative pathological confirmation.
Follow-up observation of western medicine diagnosis and treatment (1): If hysteromyoma is asymptomatic, less than 3 months pregnant, and menstruation is normal, it can be reexamined every 3-4 months 1 time.
(2) Hormone therapy: if the patient is near menopause and is not suitable for surgical treatment for some reason, androgen therapy can be used after the malignant transformation is ruled out by endometrial disease. Methyltestosterone, 5 ~ 1 0 mg each time, daily1time; Or testosterone propionate, 25 mg each time, intramuscular injection 2 ~ 3 times a week. The monthly dose should not exceed 300 mg.
(3) According to different conditions, surgical treatment is selected: curettage, abdominal myomectomy, vaginal myomectomy and hysterectomy.
Traditional Chinese medicine prescription (1) Qi stagnation and blood stasis: intracytoplasmic mass, heavy menstrual flow, prolonged menstrual period, dark menstrual color, blood clot, abdominal pain, pain reduction after blood clot, breast pain before menstruation, emotional depression or irritability, dark purple tongue, thin white fur, and astringent pulse.
Methods: Promoting qi and blood circulation, eliminating symptoms and resolving hard mass.
Medication: Radix Angelicae Sinensis, Flos Carthami, Rhizoma Sparganii, Rhizoma Curcumae, Radix Linderae, Rhizoma Chuanxiong, Semen Persicae, Rhizoma Cyperi preparata10g, Radix Paeoniae Rubra, Semen Litchi, and Prunellae Spica15g, 30g of raw oyster and 6g of roasted licorice.
Reference Chinese patent medicine: spiced pill.
(2) Blood stasis due to qi deficiency: accumulation of lumps in the cell, excessive premenstrual, or unclean dripping, pale color, blood clots, abdominal pain, shortness of breath, lack of appetite, loose stool, pale complexion, dull tongue, ecchymosis at the edge, and weak and thready pulse.
Methods: Yiqi Buzhong, Huayu Xiaoshi.
Medication: Radix Astragali Preparata, Prunellae Spica, Atractylodis Rhizoma, Radix Codonopsis, Rhizoma Dioscoreae, Shā rotto Katakuri, Thallus Laminariae15g, Rhizoma Sparganii, Rhizoma Curcumae and Fructus Aurantii10g.
Reference Chinese patent medicine: Gynecological Health Pill.
(3) Stagnation of phlegm and blood stasis: accumulation in the cell, abdominal distension and pain, heavy leucorrhea, thick white color, heavy menstrual flow, infertility after long marriage, fullness in the chest, obesity, tight tongue, greasy fur and heavy and slippery pulse.
Methods: Regulating qi and resolving phlegm, eliminating phlegm and eliminating symptoms.
Medication: Poria cocos, Prunella vulgaris, Sargassum each15g, Pinellia ternata, Pericarpium Citri Tangerinae, Rhizoma Cyperi preparata, Rhizoma Chuanxiong, Areca catechu each10g, Rhizoma Curcumae12g, and Radix Aucklandiae 6g.
Reference Chinese patent medicine: Guizhi Fuling Pill and Erchen Pill.
Prevention and aftercare 1? Regulate emotions, feel comfortable, and keep qi and blood calm.
2? Clean vulva, because uterine fibroids often have prolonged menstrual period, so the vulva should be kept clean to prevent infection.
3? Rational use of sex hormone drugs to prevent long-term excessive use of estrogen.
4? Pay attention to the degree and frequency of sexual life.