Fibroid Management

Fibroid Management


Medical Management of Fibroid:

INDICATIONS:

  • 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.

METHODS:

  • 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.

Anti-hormonal agents:

  • 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:

INDICATIONS:

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.

Symptomatic fibroids:

  • Menorrhagia
  • 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.

METHODS:

Hysterectomy:

  • 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.
Exam Question
 
  • 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
Don’t Forget to Solve all the previous Year Question asked on Fibroid Management

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