Uterine Fibroids Overview
Young woman with uterine fibroids who wrote to us: The main problem is bleeding heavier than usual in period. I went to the doctor to check and investigate the cause of this problem.
From a simple ultrasound, came to the point where they say you have fibroids and you have to have surgery, otherwise they will cause trouble and you may not get pregnant!
This fibroid did not bother me at all and did not even know it existed! Why surgery ?!
My sister, who lives in Europe, says that we have all kinds of medical treatments for various problems here and no one can easily undergo surgery.
Please tell me about my problem, which is a problem for many women my age and especially in Advise on new treatments.
Uterine fibroids are a problem for 40% of women.
Uterine fibroids are the most common benign tumor in women. Global statistics report a tumor rate of 25 to 60 percent.
We do not have accurate statistics on the rate of fibroids in Iranian women, but it is estimate that about 40% of women in our country have fibroids. But before I talk about this relatively new drug, I need to say a few things about uterine fibroids.
The first is that about 50% of fibroids may not cause any problems for a woman, and like this woman, fibroids are discover by accident.
For example, a woman goes for an annual test and the doctor notices that the uterus is larger than normal and asks for an ultrasound and it is found that there are several fibroids
Or fibroids in the uterus, which usually results in unnecessary patient concern and frequent visits. To multiple doctors and consecutive ultrasounds and hear different suggestions from different doctors.
Second, all fibroids are essentially treatable; Neither surgery nor medication is need. A fibroid that does not cause any problems for a woman only needs to be check once every 6 of us with an ultrasound, in one place and by an ultrasound specialist and not several different centers.
This is because different sonographers are likely to report different sizes, and this may add to the patient’s concern that, for example, his fibroid has grown 2 cm in 6 months.
Second, the fibroid is a benign mass and is very unlikely to become malignant; Something about 2 in a thousand. Third, fibroids need treatment to cause problems for the patient;
For example, increase bleeding during menstruation, pelvic pain, Yeast Infection Discharge, pressure on the bladder and frequent urination, miscarriage, infertility or very large fibroids, such as larger than a 20-week pregnant uterus, because such fibroids may press on the ureters and gradually Disrupt kidney function, even without the patient noticing.
However, if the fibroid needs definitive treatment, it is a surgical treatment in which multiple fibroids or fibroids are remove or the entire uterus is removed and naturally, if a woman wants to have children, every effort should be made to preserve the uterus.
In fibroid treatment Over the past 50 years, we have made many advances in fibroid surgery.
In the old days, if the patient ask if the uterus might be completely remove during the operation, the doctor would have answer yes, yes, it is possible, but today, with advance three-dimensional vaginal ultrasounds,
It is very accurate to predict what the surgeon will do during the operation. There will be conditions and whether the uterus is likely to be remove or not.
It has long been thought by physicians as well as patients that if someone undergoes uterine fibroids, they are more likely to have severe adhesions and not get pregnant as a result.
Today, this issue is no longer as intense as it use to be, because the techniques of operation have change and facilities and ways have been found to prevent adhesions.
Another thing that has happen in the last 20 years is laparoscopic surgery. Unfortunately, the misconception is found in patients that all fibroids can be operate on laparoscopically, the operation is much easier for the patient and there is no adhesion. Studies have shown that this is not true.
The first is that not every fibroid can be operate with a laparoscope, and the second is that not every surgery can perform a fibroid with a laparoscope because it is not an easy task at all,
And if it is not done correctly, the complications may be even greater than the operation, and so on. Laparoscopy does not cause adhesions.
Also, for another reason that they have notice during the last 2 years, fibroid surgery is perform less with the help of laparoscope.
A very important and valuable development is the operation of intrauterine fibroids with the help of a hysteroscope. Incidentally, these fibroids are very problematic, even when they are small. Severe bleeding, discharge, miscarriage and infertility, and even malignancy are more common in these fibroids than in other types.
In the past, when there was no hysteroscopy to see the fibroid directly and remove it with a hysteroscope, it was very difficult to treat these fibroids, but today, with a hysteroscope, treatment is much easier.
Unfortunately, this is not available to all gynecological surgeons and requires both the device and the skill and training of a physician. All of this has led doctors to look for drugs or other non-surgical methods to treat fibroids.
About 25 years ago, a drug was develop that could inhibit hormones secret by the pituitary gland to stimulate the ovarian cancer. As a result, the ovaries did not make two important hormones, estrogen and progesterone. That is, creating a medicinal menopause.
It was thought that it was estrogen that cause the fibroids to grow, and if estrogen production was inhibited, the fibroids would shrink, and so it was.
From 20 years ago, this drug exist in the form of injectable ampoules in Iran and was and is widely use in fibroids as a monthly injection.
Uterine fibroids, a problem for 40% of women in the
Early days, were thought to be a miracle drug, but gradually it became clear that this not the case. First of all, a woman can not go through menopause for a long time because menopausal symptoms such as hot flashes, osteoporosis and other complications will appear that can be annoying.
Also, if there are such large fibroids, it is more likely that not only the fibroid can be remove during the operation and the doctor will have to remove the entire uterus.
The fact that fibroids cause heavy bleeding or pain or miscarriage and infertility has complex causes that sometimes have nothing to do with the size of the fibroid.
For example, a very large fibroid on the outside of the uterus may not cause any problems for a woman to have fertility, but a small fibroid about 2 to 3 cm inside the uterine cavity can cause infertility or miscarriage.
Therefore, this drug should be use for a short time.
Another is that after the end of the treatment period, for example 4 to 6 months, the fibroid quickly returns to its previous size, sometimes even bigger than before, and finally, when the surgery of the same fibroid becomes necessary, not only is the operation not easier. But it gets harder.
In our country, this drug is still widely use for fibroids. Until in 2009, about 12 years ago, approve in Europe as a treatment for fibroids, and in 2010 the US Food and Drug Administration approve the drug; A drug that, although not currently in Iran, will probably enter our pharmaceutical market soon. This medicine is a pill that the patient should take daily.
Studies have been done on this drug in such a way that the drug is prescribe for 3 months, then discontinue for a while and use again for another 3 months and up to 4 alternating periods. The results were clearly better than the injectable drug.
It is not yet said that this drug completely destroys fibroids, and it is also not use for very large fibroids, such as the size of a 4-month-old uterus. But in general, a very valuable possibility for the treatment of fibroid symptoms and high quality of life of a large group of women.