Medical Management of Fibroid:
- To treat anemia and recover Hb levels before surgery.
- To reduce the size of large fibroid and facilitate surgery.
- Treatment of women approaching menopause to avoid surgery.
- In women with medical contraindication to surgery or those who are postponing surgery.
- For Preservation of fertility in women with large myomas before conservative surgery like myomectomy.
- Gonadotropin-releasing hormone agonists (GnRH agonists):
- This approach lowers levels of estrogen and triggers a “medical menopause.”
- Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
- Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids.
- Anti-progestins, which block the action of progesterone, are also sometimes used.
- Selective progesterone-receptor modulators: Mifepristone, Ulipristal acetate
- Selective estrogen-receptor modulators:tamoxifen or raloxifene
- Levonorgestrel intrauterine system (LNG-IUS)
- Tranexamic acid(antifibrinolytic drug)
- Aromatase inhibitors: Aromatase is an enzyme that converts androgens to estrogen
- Anti-inflammatory painkillers
- This type of drug is often effective for women who experience occasional pelvic pain or discomfort.
Surgical Management of Fibroid:
Asymptomatic fibroid :
- Fibroids larger than 12-14 weeks pregnancy.
- Rapidly growing fibroids.
- Subserous and pedunculated fibroid prone to torsion.
- If it is likely to complicate a future pregnancy
- If there is doubt about its nature
- Unexplained infertility and unexplained recurrent abortion.
- Uncertain diagnosis.
- Pressure symptoms : Urinary Retention (by a cervical or broad ligament fibroid)
- Chronic pelvic pain with severe dysmenorhea
- Acute pelvic pain as in torsion of a pedunculated fibroid or prolapsing Sub-mucosal fibroid
- Infertility caused by cornual fibroid
- Recurrent abortions due to submucous fibroid.
- Fibroids remain the number one reason for hysterectomies in the United States.
- Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids
Conservative surgical therapy:
- Conservative surgical therapy uses a procedure called a myomectomy
- Indicated in a pregnant female with red degeneration of fibroid
- With this approach, physicians will remove the fibroids by LASER or surgically, but leave the uterus intact to enable a future pregnancy.
Uterine artery embolization:
- Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally-invasive (without a large abdominal incision) technique.
- The arteries supplying blood to the fibroids are identified, then embolized (blocked off).
- The embolization cuts off the blood supply to the fibroids, thus shrinking them.
- Done using polyvinyl alcohol or gel foam
- Health care providers continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.
- Methods of managing fibroid uterus include Myomectomy, Embolisation of uterine artery & Laser myomectomy
- Drugs that reduce the size of fibroid are Danazol and GnRH analogues
- Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids Is Total abdominal hysterectomy (TAH)
- Conservative surgical therapy is Indicated in a pregnant female with red degeneration of fibroid