What does red degeneration of uterine fibroids mean?

Red degeneration of uterine fibroids refers to the pathological changes of uterine fibroids that cause tissue ischemia and necrosis due to insufficient blood supply, followed by bleeding and hemolysis, making the cut surface of the fibroids appear dark red. Red degeneration is a benign degenerative change of uterine fibroids, which mostly occurs during pregnancy or the puerperium. It is mainly induced by factors such as rapid growth of fibroids, blood vessel embolism or torsion.

1. Pathological mechanism

The core pathological change of red degeneration of uterine fibroids is the rupture or embolization of blood vessels inside the fibroids, resulting in local ischemia and necrosis. Necrotic fibroid tissue releases hemoglobin breakdown products, resulting in the characteristic dark red appearance. Under the microscope, fibroid cell lysis, hemorrhagic lesions, and inflammatory cell infiltration can be seen, but there are no malignant cell characteristics. This kind of degeneration often occurs in fibroids with a diameter of more than 5 cm, especially those that grow rapidly under the stimulation of hormones during pregnancy.

2. Predisposing factors

High estrogen levels during pregnancy are the main trigger. Hormone stimulation causes the size of fibroids to rapidly increase, exceeding the blood supply capacity. Other triggers include torsion of the fibroid band, traumatic impact, or spontaneous vascular embolism. Postpartum uterine contractions may also compress fibroid blood vessels and cause ischemia. Non-pregnant patients who take estrogen drugs for a long time or suffer from blood hypercoagulability may also increase the risk of degeneration.

3. Typical symptoms

Patients often experience severe lower abdominal pain, which is persistent and may radiate to the lumbosacral region, accompanied by fever and elevated white blood cells. Pregnant patients may experience obstetric symptoms such as frequent uterine contractions and abnormal fetal movements. A fibroid mass with obvious tenderness can be palpated during physical examination. B-ultrasound shows uneven echo inside the fibroid with fluid dark areas. MRI can clarify the scope of bleeding. About 30% of patients suffer from gastrointestinal symptoms such as nausea and vomiting.

4. Diagnosis and identification

It needs to be differentiated from acute abdominal diseases such as fibrosarcomatosis, ovarian cyst pedicle torsion, and acute pelvic inflammatory disease. Elevated serum lactate dehydrogenase supports the diagnosis of red degeneration. Contrast-enhanced ultrasound showed no blood flow signal inside the fibroid, and contrast-enhanced MRI showed characteristic peripheral enhancement with central non-enhancement area. Ultrasound-guided needle biopsy can be considered when diagnosis is difficult, but invasive procedures should be avoided during pregnancy.

5. Processing principles

Non-pregnant patients with mild symptoms can be treated conservatively, using analgesics such as acetaminophen tablets, ibuprofen sustained-release capsules, and cefaclor dispersible tablets to prevent infection. Bed rest and progesterone preparations such as progesterone capsules are the first choice for pregnant patients to preserve the fetus. If persistent high fever, fibroid suppuration, or threatened abortion occurs, surgical removal of the fibroids is required. Postmenopausal patients are recommended to undergo total hysterectomy to prevent recurrence.

Patients with red degeneration of uterine fibroids should avoid strenuous exercise and abdominal massage, and fetal heart rate monitoring should be strengthened during pregnancy. Add lean meat, animal liver and other iron-rich foods to your daily diet to prevent anemia. Review ultrasound every 3-6 months to monitor changes in fibroids. If degeneration occurs repeatedly or fibroids grow too fast, surgical intervention should be considered. People with anemia can supplement ferrous succinate tablets or ferric protein succinate oral solution as directed by their doctor.