Intramural Fibroids at posterior part of the uterus. In this patient, myomectomy with bilateral tubal ligation was performed. Even though, patient do not wish to preserve the fertility, she refuse definitive treatment of uterine fibroids which is hysterectomy because of taboo that removing the uterus will reduce sexual desire. Introduction
Uterine fibroid is the most common tumor of the female pelvic which is usually asymptomatic in most of the patient. However, nearly half of them have significant symptoms affecting their life such as menorrhagia, pain and compression effect to the adjacent structures.
Factors need to be considered in managing the uterine fibroids
1)Severity of the symptoms
2)Recurrent of the problem
3)The age of the patient
4)Patient’s wish to preserve the fertility or not
5)Whether patient has completed the family or not.
6)Position, size and number of the fibroids
2)Recurrent of the problem
3)The age of the patient
4)Patient’s wish to preserve the fertility or not
5)Whether patient has completed the family or not.
6)Position, size and number of the fibroids
Management
a) Surgical management:
1)As a general rule, hysterectomy is the definitive treatment of the fibroid. It is however reserved for the older age patient who has completed their family or do not wish to preserve the fertility.
2)In patient who wishes to preserve the fertility, or young age, they may undergo myomectomy. The main problem with myomectomy is that, fibroid tend to recur.
3)Depending on the type of incision to the uterus, patient will have different risk of uterine rupture in trial of scar delivery after the myomectomy. Those who have vertical incision to the uterus or if the surgery reach uterine cavity, therefore they are at a higher risk and trial of scar is not recommended.
b) Medical management:
1)NSAIDs particularly Mefenamic acid is the first line treatment in managing the fibroids.
2)In patient with severe bleeding, IV Trexanemic acid 1g stat, followed with oral route may be considered.
3)Oral contraceptive (progesterone only or combines) has also to be shown to be effective in managing the menorrhagia.
4)GNRH agonist/analogues and synthetic steroid (Danazol, 100–400 mg/day for 4–6 months are not for the long term use and usually being use to reduce the size of fibroid prior to the myomectomy or in which women are nearly-menopause.
5)Anti progesterone like progesterone receptor antagonist (mifepristone, 5 to 50 mg daily for 3 to 6 months) and selective progesterone receptor modulator with mixed agonist/ antagonist activity (asoprisnil, 5 to 25 mg for 3 months) are the current drug use to reduce the size and blood supply to the fibroids
Other alternatives:
1)Levonorgesterol intra-uterine device (LNG-IUS)
2)Uterine artery embolization or occlusion.
Other management:
1)Treat the anemia. Mild anemia may only require hematinic or double hematinic supplement
2)Blood transfusion in symptomatic anemia.
3)Oxygen supply to increase hemoglobin oxygenation.
4)Psychosocial support
5)Other evaluation to exclude differential diagnosis.
1)As a general rule, hysterectomy is the definitive treatment of the fibroid. It is however reserved for the older age patient who has completed their family or do not wish to preserve the fertility.
2)In patient who wishes to preserve the fertility, or young age, they may undergo myomectomy. The main problem with myomectomy is that, fibroid tend to recur.
3)Depending on the type of incision to the uterus, patient will have different risk of uterine rupture in trial of scar delivery after the myomectomy. Those who have vertical incision to the uterus or if the surgery reach uterine cavity, therefore they are at a higher risk and trial of scar is not recommended.
b) Medical management:
1)NSAIDs particularly Mefenamic acid is the first line treatment in managing the fibroids.
2)In patient with severe bleeding, IV Trexanemic acid 1g stat, followed with oral route may be considered.
3)Oral contraceptive (progesterone only or combines) has also to be shown to be effective in managing the menorrhagia.
4)GNRH agonist/analogues and synthetic steroid (Danazol, 100–400 mg/day for 4–6 months are not for the long term use and usually being use to reduce the size of fibroid prior to the myomectomy or in which women are nearly-menopause.
5)Anti progesterone like progesterone receptor antagonist (mifepristone, 5 to 50 mg daily for 3 to 6 months) and selective progesterone receptor modulator with mixed agonist/ antagonist activity (asoprisnil, 5 to 25 mg for 3 months) are the current drug use to reduce the size and blood supply to the fibroids
Other alternatives:
1)Levonorgesterol intra-uterine device (LNG-IUS)
2)Uterine artery embolization or occlusion.
Other management:
1)Treat the anemia. Mild anemia may only require hematinic or double hematinic supplement
2)Blood transfusion in symptomatic anemia.
3)Oxygen supply to increase hemoglobin oxygenation.
4)Psychosocial support
5)Other evaluation to exclude differential diagnosis.
Reference:
1)Giovanna Tropeano, Sonia Amoroso & Giovanni Scambia, "Non-surgical management of uterine fibroids", Human Reproduction Update, Vol.14, No.3 pp. 259–274, 2008
2)Srividhya Sankaran & Isaac T. Manyonda, "Medical management of fibroids", Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 22, No. 4, pp. 655–676, Elsevier, 2008
2)Srividhya Sankaran & Isaac T. Manyonda, "Medical management of fibroids", Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 22, No. 4, pp. 655–676, Elsevier, 2008
Fibroid breast tumors seem to be more common in women who experience irregular menstrual cycles - oral contraceptives may be useful in regularizing periods and thereby hormone levels.
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