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|Posted By : Dr.Piyush S. Goyal, MD (ObGyn), Diploma in Advanced Endoscopic Surgery(Germany)|
|Posted On : 06 Oct 2008 (Total Views : 17532)|
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There's no single best approach to uterine fibroid treatment. Many treatment options exist. In most cases, the best action to take after discovering fibroids is simply to be aware they are there.
If you're like most women with uterine fibroids, you have no signs or symptoms. In your case, watchful waiting (expectant management) could be the best course. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly and tend to shrink after menopause when levels of reproductive hormones drop. This is the best treatment option for a large majority of women with uterine fibroids.
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:
Gonadotropin-releasing hormone (Gn-RH) agonists. To trigger a new menstrual cycle, a control center in your brain called the hypothalamus manufactures gonadotropin-releasing hormone (Gn-RH). The substance travels to your pituitary gland, a tiny gland also located at the base of your brain, and sets in motion events that stimulate your ovaries to produce estrogen and progesterone.
Medications called Gn-RH agonists (Lupron, Synarel, others) act at the same sites that Gn-RH does. But when taken as therapy, a Gn-RH agonist produces the opposite effect to that of your natural hormone. Estrogen and progesterone levels fall, menstruation stops, fibroids shrink and anemia often improves.
Androgens. Your ovaries and your adrenal glands, located above your kidneys, produce androgens, the so-called male hormones. Given as medical therapy, androgens can relieve fibroid symptoms.
Danazol, a synthetic drug similar to testosterone, has been shown to shrink fibroid tumors, reduce uterine size, stop menstruation and correct anemia. However, occasional unpleasant side effects such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you elect to have your ovaries removed also, it brings on menopause and the question of whether you'll take hormone replacement therapy.
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. If you want to bear children, you might choose this option. With myomectomy, as opposed to a hysterectomy, there is a risk of fibroid recurrence. There are several ways a myomectomy can be done:
Variations of myomectomy — in which uterine fibroids are destroyed without actually removing them — include:
Cryomyolysis. In a procedure similar to myolysis, cryomyolysis uses liquid nitrogen to freeze the fibroids.
The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.
Uterine artery embolization
Small particles injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include:
Complications may occur if the blood supply to your ovaries or other organs is compromised.
Focused ultrasound surgery
MRI-guided focused ultrasound surgery (FUS), approved by the Food and Drug Administration in October 2004, is a newer treatment option for women with fibroids. Unlike other fibroid treatment options, FUS is noninvasive and preserves your uterus.
This procedure is performed while you're inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. A single treatment session is done in an on- and off-again fashion, sometimes spanning several hours. Initial results with this technology are promising, but its long-term effectiveness is not yet known.
Before you decide
Because fibroids aren't cancerous and usually grow slowly, you have time to gather information before making a decision about if and how to proceed with treatment. The option that's right for you depends on a number of factors, including the severity of your signs and symptoms, your plans for childbearing, how close you are to menopause, and your feelings about surgery.
Before making a decision, consider the pros and cons of all available treatment options in relation to your particular situation. Remember, most women don't need any treatment for uterine fibroids.
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