UTERINE LEIOMYOMA – ETIOLOGY, PATHOGENESIS, TREATMENT IN THE REPRODUCTIVE AGE (LITERATURE REVIEW)

Uterine leiomyoma (fibroid) is the most common benign tumor, which leads to the reduction of the ability to work and the loss of the reproductive function in women of fertile age. Women's reproductive health is a very topical issue in the contemporary gynecology and obstetrics, therefore, the solution to it lies in a stage-by-stage etiopathogenetic approach, taking into consideration the patients' age, their reproductive anamnesis, the presence of concomitant genital or somatic pathologies. In the pathogenesis, certain role is attributed to hereditary predisposition, which manifests itself more often in women of young age (younger than 30). The contemporary studies point out the influence of estrogens, growth factors and immunoreactive insulin on myometrium. From the immunological point of view, uterine myoma is regarded as a regenerative proliferation that develops in reaction to myometrium lesion (hypoxia, inflammation, hormonal effect, mechanical injury). Uterine leiomyomas are classified according to their localization, the direction of growth and according to the clinical ultrasonographic classification. Patients with uterine leiomyoma usually have a clinical course without any or few symptoms (feeling of heaviness in the lower abdomen, frequent urination, increased volume and duration of blood loss in the men-strual period). In 20-50% of cases, patients complain about symptoms that are clinical manifestations of com-plications of uterine leiomyoma: uterine hemorrhages and the development of anemia, tumor necrosis, infarction and torsion of tumor pedicle with subsequent development of the acute abdomen syndrome, compression of adjacent organs (functional disorders in the urinary bladder, ureters or the rectum). The diagnosis of uterine leiomyomas is based on the following examinations: 1. Ultrasonography (transabdominal and trans-vaginal). 2. Computer-aided tomography (CAT) and magnetic resonance imaging (MRI) for precise tumor visualization. 3. Histological examination of the total curettage from the cervical canal and the uterine cavity or of the endometrial pipelle sampling as well as cytological examination of aspiration samples from the uterine cavity. 4. Hysteroscopy. 5. Metrosalpingography. 6. Examination based on functional diagnostic tests and, if necessary, measuring the levels of sex hor-mones in blood serum. 7. Diagnostic laparoscopy. When choosing the method of treatment of uter-ine leiomyoma, one should take into consideration the size of the tumor, the localization of fibroids, the symp-toms, the woman's age and reproductive disposition. Nowadays, the treatment lies in the ‘complex conservative management' of patients with uterine myo-ma, suggested by I. Kulakov in 1997, which means a combination of early surgical (with minimization of sur-gical injury) and chemical myomectomy. Such approach ensures the recovery of the reproductive function in the majority of patients. However, the main method of treat-ment of uterine myoma, which guarantees good results, is the surgical one. The possibilities of the surgical method have significantly expanded with the introduction and development of endoscopic technologies. The combination of drug therapy and organ-preserving surgeries reduces the risk of complications related to surgery and contributes to the preservation of fertility.