Uterine Fibroids Treatment
FIBROID UTERUS ( LEIOMYOMA)Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years.
WHERE DO THEY DEVELOP FROM ?
They develop from the smooth muscular tissue of the uterus (myometrium).
WAHT IS THE AVERAGE SIZE OF A FIBROID ?
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus
WHAT ARE THE SYMPTOMS CAUSED BY FIBROIDS ?
Fibroids, particularly when small, may be entirely asymptomatic
Symptoms depend on the location of the lesion and its size.
Important symptoms include excessive bleeding per vagina, abdominal discomfort , urinary frequency or retention, and in some cases, infertility
WHAT ARE THE TYPES OF FIBROIDS ?
Types based on location
- 1. submucous ( in the endometrium): most inner layer
- 2. intramural ( in the myometrium): middle layer
- 3. subserous( in the perimetrium): outer layer.They can also grow out in a papillary manner to become pedunculated fibroids. These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma.
HOW TO DIAGNOSE ?
WHAT TO DO WHEN YOU ARE NEARING MENOPAUSE ?
Watchful waiting for minimal fibroid symptoms or when nearing menopause
If you have uterine fibroids but you have few or no symptoms, you may not treatment. Instead, the doctor will recommend regular follow up. This means that you will have regular pelvic exams and ultrasound to check the fibroid growth and symptoms.
WHAT ARE THE DRUGS FOR FIBROIDS WITH PAIN AND BLEEDING PER VAGINA ?
NON STEROIDAL ANTI INFLAMMATORYDRUGS
WHEN IS SURGERY NEEDED ?
- • Heavy uterine bleeding and/or anemia has continued after several months of therapy with birth control hormones and a nonsteroidal
- • If the Fibroid grow after menopause.
- • History of repeated miscarriages or causing infertility.
- • pain or pressure due to fibroid affects the quality of life of the patient.
- • Presence of urinary or bowel problems
- • There is a possibility that cancer is present.
anti-inflammatory drug (NSAID).
Surgical treatment options include:
- • Myomectomy, or fibroid removal. It is done when the uterus is being preserved for eg., the the patient has not completed her family,wants to become
During this procedure a laparoscope (a thin fiber-optic device that transmits light and a video image) is inserted through a small incision, usually in the navel, to view the uterus. Two or three small (half-inch) incisions are made below the public hairline and 5mm instruments are inserted through these incisions to perform the surgery. The fibroids are detached from the uterus and removed. Following removal of the uterine fibroids, the defect is closed by either vicryl no.1 / barbed sutures. The enucleated fibroid is churned into pieces by a morcellator. Usually the advantages of laparoscopy are quiker recovery, lesser pain, early ambulation and early return to work/ duty.Usually the patient is fit to be discharged in 1-2 days.The interesting thing is that not all surgeons are trained in laparoscopic surgery; because of the small size of the incisions, removing uterine fibroids with laparoscopic myomectomy requires special training.
MYOMA BEING ENUCLEATED LAPAROSCOPICALLY
MYOMA BED BEING CLOSED LAPAROSCOPICALLY
Abdominal myomectomy removes fibroids through a big incision in the abdomen. It is preferable if the the fibroid is really so big that it is laparoscopically not feasible, or the surgeon is not trained in laparoscopy or facilities for laproscopy are not available.The disadvantages of abdominal myomectomy are that due to the invasiveness of the procedure the surgery requires a larger incision, general anesthesia, and has risk factors associated with abdominal surgery such as blood loss, pain and infection, and longer recovery. The hospital stay can last from 4-5 days and recovery time is generally 2-6 weeks
OPEN MYOMECTOMY ( SEE THE INCISION SIZE ON THE ABDOMEN)
MYOMA BED CLOSURE AFTER MYOMA REMOVAL IN OPEN SURGERY
Hysteroscopic myomectomy involves inserting a hysteroscope through the vagina and the cervix into the uterus. Hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Because the instruments are inserted through the cervix no abdominal incisions are needed. The hysteroscope is a thin, telescope-like instrument that allows the doctor to view the fibroids. A resectoscope, which is a hysteroscope fitted with a wire loop that uses high-frequency electrical current to cut or coagulate tissue, is then inserted to remove the fibroids. The loop is placed around the fibroid, electrical energy passes through the loop, and the fibroid is cut loose. The fibroid can then be removed through the vagina.
MYOMA SEEN ON HYSTEROSCOPE
MYOMA BEING RESECTED HYSTEROSCOPICALLY ( TRANSCERVICAL RESECTION OF MYOMA)
Hysterectomy, or uterus removal. This is only recommended for women who have no future pregnancy plans, she has completed her family and is above 40 years of age. Hysterectomy is the only fibroid treatment that prevents regrowth of fibroids. It improves quality of life for many women. There are various methods of going about it.
LAPAROSCOPY IN PROGRESS