Uterine leiomyoma or fibroid is a type of myometrium tumor cause by immature proliferation of smooth muscle cells. It grows from the muscular layer of uterus (myometrium). When the leiomyoma is surrounded by muscular layer, it is called intramural leiomyoma; if the fibroid grows towards the serous layer, bulging to the uterine surface, it is called subserosal leiomyoma; when the fibroid progresses towards endometrial cavity, beneath the endometrium, it is called submucosal leiomyoma. Most of leiomyomas may be asymptomatic, they are only discovered during physical examination, but the submucosal leiomyoma or large intramural leiomyoma can cause excessive menstruation or continuous menstrual dripping; the large leiomyoma can also cause increased of vaginal discharge(leucorrhea) or compression of neighbouring organs; leiomyoma that causes endometrium neoplastic changes(with menstrual abnormalities, lower abdominal pain, inflammatory reaction, angiogenesis, leukocytosis, fever, vomitting and etc) or the submucosal leiomyoma that twisted the peduncles, may resulted in severe abdominal pain. Besides, 1/3 of patients may impaired fertility.
Generally, the main pathogenic factor is long-term large dosage of estrogen stimulation, especially when there is only estrogen but no progesterone. But the leiomyomas may also related to other unknown factors.
Usually, the leiomyomas are not difficult to diagnose according to its clinical signs e.g uterus enlargement, menorrhagia and so on. If it cannot be assured with clinical examination, it can be confirmed with examination of cervix and cervical biopsy, B-sonography. But one must becareful to distinguish from uterus leiomyosarcoma(cancer), endometrial position changes, ovarian tumor and etc.
The modern medicine usually uses surgical and non-surgical treatment according to patients age, fertility condition and clinical symptoms. The non-surgical method consists of uterine curettage and androgen hormones therapy; they are used against tiny leiomyoma with menorrhagia. If the leiomyoma is large with significant symptoms and the conservative treatment is not effective, the surgical method is used e.g extirpation submucosal leiomyoma through vagina of infero median laparatomy and partial or whole cervicectomy.
In the traditional chinese medicine (TCM), leiomyoma is categorized as zheng jia (lump in abdomen). It is mainly caused by decrease of flowing Qi (energy), bruise, accumulation of moist heat and phlegm. While some said that it is due to functional regulation disturbances of liver, spleen and kidney, in addition of presence of cold Qi in zi men (a point in acupunture in cervix), bruised blood accumulate and changed into heat which then mixed with internal moist, and lastly it became leiomyoma after certain time. The principles of treatment are correction and adjustment of Qi and blood, relieving of heat and moist congestion, eliminating of bruise and phlegm, and symptomatic therapy. When there is rupture of leiomyoma, one may also uses the so-called han liu , deng yuan , fu jiu method (a method to stop bleeding and regulate Qi, blood and functions of spleen, kidney and liver according to patients clinical signs).
Clinical treatment result
There were 166 cases adopted TCM; 125 cases recovered clinically (symptoms disappeared, leiomyoma resolved, uterus returned into normal size), 29 cases shown curative effect (symtoms disappeared basically, shrinkage of leiomyoma), 12 cases turned out better (improvement of symptoms but no significant shrinkage of leiomyoma).