Treatment of uterine fibroids
|All about of Treatment of uterine fibroids|
In recent years, doctors' presentations about uterine myoma have changed. So, previously it was thought that the uterine myoma develops as a result of hormonal imbalance. At present, it is known that this factor does not influence the appearance of myoma nodes. For a long time, gynecologists believed that myoma can become cancer. In fact, the myomatous nodes are transformed into a malignant tumor - leiomyosarcoma - no more than healthy uterine tissues. A necrosis (death) of the node should be considered not as a complication, but as one of the ways of recovery.
Changed and tactics of treatment. Previously, gynecologists for a long time observed the woman, scheduled a periodic ultrasound, and when the fibroid reached a large size, offered to perform an operation to remove the node or uterus entirely.
At present, it is considered that removal of the uterus is an extreme measure. Increasingly popular are minimally invasive techniques, for example, uterine artery embolization. However, about everything in order.
Do I always need to treat a uterine myoma?
The presence of myomatous nodes is not a reason to treat myoma of the uterus. The need for a course of therapy is determined by four factors:
Presence of symptoms that reduce the quality of life: anemia, urination disorders due to compression of the bladder.
The woman's desire to become pregnant soon or in the long term.
The growth of nodes recorded on the basis of the results of two or three consecutive ultrasound of the abdominal cavity.
Age of the woman
Myoma of the uterus is a disease that in the postmenopausal period stops to cause inconvenience to women: the nodes cease to grow.
Modern methods of treatment of uterine myomas
Among all the proposed methods of treatment, effectiveness has been proven only for three: surgical intervention, embolization of uterine arteries and, very limited, drug treatment with the group of progesterone receptor blockers.
Removal of uterine myoma by surgical means - myomectomy - can be performed in a classical way (through the incision) or laparoscopically. Currently, "open" surgery is a thing of the past, doctors prefer less traumatic interventions - laparoscopic. The nodes that grow into the uterine cavity are removed through the vagina with a special endoscopic instrument with a loop - a resectoscope.
The main advantage and at the same time the lack of surgery is that it is a surgical technique. On the one hand, a benign tumor is removed and this is good. But on the other hand, the risks associated with surgical intervention and anesthesia are very significant.
As the statistics show, the frequency of relapse after myomectomy is 7-14% per year. This means that in about four years, half of the operated women will again be diagnosed with fibroids and such patients will again become candidates for surgical treatment. To reduce the risk of relapse, it is necessary to take hormonal drugs.
Removal of fibroids is not always the optimal solution for women who in the future plan a pregnancy. One of the possible complications of the operation is a spike in the small pelvis and, consequently, tubal peritoneal infertility: the passableness of the fallopian tubes is impaired, and for this reason, a fertilized egg can not enter the uterus.
In the most extreme cases, with huge fibroids, which can not be managed in other ways, resort to the removal of the uterus - a hysterectomy. However, even if a woman does not intend to become pregnant, problems due to the absence of the uterus may be more serious than those caused by the myoma.
Embolization of uterine arteries (EMA)
EMA is a procedure during which the doctor injects into the vessels feeding the myoma through the catheter an embolizing drug. The latter consists of particles that block blood flow in the vessels of myoma and deprive pathologically expanded tissues of oxygen. Myomatous node dies, replaced by connective tissue and decreases in size.
EMA is by no means a new procedure. It was developed at the end of the seventies of the last century, and since the mid-nineties, it has been actively used to treat myoma in Western countries
The main advantages of the method are:
1. High efficiency: there are almost no relapses, most women do not need other methods of treatment.
2. 96% of women have a normal menstrual cycle, 98% have problems with urination caused by a large myoma contracting the bladder.
3. Safety: there are no risks that exist during the operation. EMA does not require anesthesia, it takes a little time (about 15 minutes). After 2-3 days a woman is discharged from the clinic, the rehabilitation period lasts only 5-7 days.
Embolization of uterine arteries is shown:
1. Women (regardless of reproductive plans) with heavy menstruation, signs of compression of the pelvic organs and frequent urination. Symptoms "leave" an average of 1.5 months after the procedure.
2. If according to the data of the last two or three ultrasound examinations (which are performed every 3-6 months) the nodes grow, even if the symptoms of uterine fibroids are not detected and the woman does not plan a pregnancy.
3. Patients planning the pregnancy, in which the uterine myoma is growing. Surgical treatment could solve the problem, but, as we said above, after it a much higher risk of recurrence. There is a possibility that by the time the woman decides to have a baby, the myomatous nodes will grow again.
4. At multiple sites of medium and large size, regardless of the location and direction of growth.
From the above, we can conclude that EMA is possible for any localization of nodes and any number of them. The question is whether this intervention is necessary at the moment - will the procedure improve the patient's quality of life and will the troubling problems solve it?
Is medication effective?
At the moment, for the treatment of fibroids, it is advisable to use - the progesterone receptor blocker has used up acetate. The drug is most effective when taken in 2-3 cycles (but not more than 4) with interruptions of 2 months and an assessment of the dynamics of changes using ultrasound. At the same time up to 60% of cases, there is a regression of myomatous nodes. The advantage of this approach is that the drug is well tolerated. But there are also disadvantages:
1. It is not known how long the result will remain, after what time and with what probability there will be a relapse.
2. There is no evidence of how different myomatous nodes respond to the drug equally. While some decrease, others do not change in size.
Drug therapy is indicated for young patients with primary small nodes detected up to 3 cm.
It is also worth mentioning that hormonal drugs have a temporary or preventive effect. Moreover, all kinds of dietary supplements, phytopreparations and homeopathic remedies are not helpful in myoma. Doing self-medication, you lose time: the tumor can grow stronger and require more complex treatment.
Uterine fibroids are a disease that can be treated and often do not carry a serious health risk. However, even with such a state of affairs, letting the disease into its own right is a dangerous decision. This diagnosis requires serious monitoring by specialists.