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Fibroids treatment

Main disturbing symptoms of fibroids are bleeding and pain; and in these cases fibroids treatment is necessary. But if women have so called “sleeping fibroids” without any symptoms, treatment is not required. It is well known that fibroids can naturally shrink over time – mostly after 45-50 (menopausal shrinking). In some cases uterine fibroids will either stay the same size or never grow. This is why it is important to evaluate and monitor fibroids “behavior” before making decision about treatment approaches.

Several treatment options are available – different types of medical drugs and few surgical methods. Selection of the method for fibroids treatment depends on a number of things – fibroids location, size and number, intensity of symptoms (bleeding, pain), age of woman, future plans for having baby and previous history about hormonal treatments or hormonal contraception.

Fibroids treatment – medical drugs

Fibroids are benign hormone-depending tumors. This is why most effective methods for fibroids treatment include hormones. Medical drugs cannot cure or permanently shrink fibroids but hormone-based drugs could help to relieve symptoms and slow down tumor grow.

Gonadotropin-releasing hormone analogues
Gonadotropin-releasing hormone (GnRH) analogues (goserelin, leuprorelin acetate, nafarelin) can lower estrogen levels, which usually shrinks fibroids and treat bleeding by developing “menopausal status”. GnRH analogues may be injected once a month or implanted as a pellet under the skin. Nafarelin can be used as a nasal spray. This treatment can be disturbing because of side effects such as hot flushes, mood swings and osteoporosis (if used long). GnRH analogues usually recommended for maximum of six months and can be also used before surgery.

Progestins (medroxyprogesterone acetate, megestrol) may help to treat heavy bleeding during menstrual periods. Progestins can control bleeding by preventing the endometrium (internal lining of uterus) from growing too much. As a result, the menstrual bleeding may be reduced.
Progestins can be used orally or be injected every few months or inserted in intrauterine contraceptive devices (IUDs). Progestins worked also as contraception (preventing unwanted pregnancies). Most disturbing side effects include weight gain, depression and irregular bleeding or brown discharge.

Mifepristone or similar drugs (antiprogestins) sometimes could be recommended. This medicine inhibits activity of progesterone (main female hormone) which is responsible for menstrual shedding.

Raloxifene and selective estrogen receptor modulators (SERMs) are able to reverse some estrogen biological effects including uterine bleeding.

Danazol is an androgen similar to testosterone – it is a synthetic steroid that is used primarily in the treatment of endometriosis. Danazol cannot be considered as a standard fibroids treatment but danazol demonstrated significant relief in young women suffering from uterine bleeding during menstrual periods – it works by decreasing the amount of hormones made by the ovaries (estrogen and progesterone). Unpleasant side effects include weight gain, acne, hirsutism (increased body hair), swollen ankles, loss of scalp hair and lowering of the voice.

Tranexamic acid
Tranexamic acid or mefenamic acid are not a common fibroids treatment but these drugs work by preventing blood clots helping to stop bleeding. Tranexamic acid can decrease bleeding.

Anti-pain medication
Non steroidal anti-inflammatory (NSAID) drugs (ibuprofen) can help to relieve pain triggered by fibroids. Non steroidal anti-inflammatory drugs may relieve pain but can not stop or reduce the bleeding.

Fibroids treatment – surgery

Fibroids treatment

Surgery would be recommended to women:

  • If fibroids growing fast,
  • If uterine bleeding continues or recurs despite of medical treatments,
  • If woman suffer from severe or persistent pain,
  • If urinary tract is blocked by large fibroids,
  • If fibroids cause infertility.

In many cases surgery is the most effective method of fibroids treatment.

During myomectomy only uterine fibroids are removed which gives women another chance to have children. Some women choose myomectomy based on physochlogical reasons – just feeling better when they keep their uterus. Myomectomy can be performed abdominay or through laparoscope.
Unfortunately myomectomy cannot stop appearance of other new fibroids after surgery because surgery is not elimination of fibroids’ causes. According to health experts, about 25% of post-myomectomy women need hysterectomy after 4-8 years after surgery.

Hysterectomy is a uterine removal – it is the only permanent solution to fibroids. After hysterectomy women cannot have children anymore. Hysterectomy also can be done through laparotomy (abdominal incision) or through laparoscopy (few small abdominal incisions with surgical instruments through the incisions). Sometimes doctors suggest vaginal hysterectomy when the uterus is removed through the vagina.

Fibroids treatment – other alternatives

  • Uterine artery embolization,
  • High-intensity focused sonography,
  • Radiofrequency ablation,
  • Cryotherapy,
  • Magnetic resonance-guided focused ultrasound surgery.

Above mentioned treatments can be used to destroy rather than remove fibroids. These treatments may relieve symptoms, but how long symptom relief lasts has not been determined yet.

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