Медицински третмани

Јер већина фиброиди материце do not cause symptoms (they are said to be “asymptomatic”), doctors often offer “vigilant observation” of the development of the fibroid. Usually, a fibroid that does not cause symptoms does not require treatment.

When treatment is needed, the decision to choose one over another depends on various factors: the severity of the symptoms, the desire to have children or not, age, personal preferences, etc. Only theхистеректомија, that is, removal of the uterus, offers a definitive solution.

Савети за ублажавање симптома

• Applying warm compresses (or ice) to painful areas can help relieve pain. бол.
• Over-the-counter medications help relieve stomach cramps and back pain. These medications include acetaminophen or paracetamol (including Tylenol®,) and ibuprofen (such as Advil® or Motrin®).
• Да се ​​супротставим Затвор, you should consume five to ten servings of fruits and vegetables per day, as well as a good amount of dietary fiber. These are found in whole grain cereal products (whole grain bread and pasta, brown rice, wild rice, bran muffins, etc.).

  NB To accompany a diet rich in fiber, it is essential to drink plenty to avoid clogging the digestive tract.

• Ако Затвор persists, we can try a mass laxative (or ballast), based on psyllium for example, which acts gently. Stimulation laxatives are more irritating and are generally not recommended. For other tips, see our Constipation fact sheet. These tips are not necessarily effective when suffering from a large fibroid, since constipation is linked to a compression of the digestive tract, and not to a bad diet or a bad transit.
• У случају'честе потребе за мокрењем, drink normally during the day but avoid drinking after 18 p.m. so as not to have to get up too often at night.

фармацеутски

The drugs act on the menstrual cycle regulation to reduce symptoms (especially heavy menstrual bleeding), but they do not decrease the size of the fibroid.

There are three solutions for women who have troublesome fibroids:

– the IUD (Mirena®). It can only be implanted in the uterus on condition that the fibroid is not submucosal (formal contraindication) and the fibroids are not too large. This IUD gradually releases a progestin which leads to a significant reduction in bleeding. It should be replaced every five years.

– tranexamic acid (Exacyl®) may be prescribed for the duration of the bleeding.

– mefenamic acid (Ponstyl®), an anti-inflammatory drug may be prescribed during bleeding.

If the fibroid is too large or has severe bleeding, other hormonal drugs may be prescribed to decrease the size of the fibroid before surgery. An iron supplement can be prescribed to women who suffer from significant bleeding, in order to compensate for the loss of iron in their body.

Pre-surgical treatment of uterine fibroids.

– Gn-RH analogues (gonadorelin or gonadoliberin). Gn-RH (Lupron®, Zoladex®, Synarel®, Decapeptyl®) is a hormone that reduces estrogen levels to the same level as that of a postmenopausal woman. Therefore, this treatment can decrease the size of fibroids by 30% to 90%. This medication causes temporary menopause and is accompanied by symptoms, such as hot flashes and low bone density. Its side effects are numerous, which limits its long-term use. Gn-RH is therefore prescribed in the short term (less than six months) while waiting for surgery. Sometimes the doctor adds tibolone (Livial®) to the Gn-RH analogues.

– Danazol (Danatrol®, Cyclomen®). This medicine inhibits the production of estrogen by the ovaries, which normally results in interrupting menstrual cycles. It can help reduce bleeding, but its side effects are painful: weight gain, hot flashes, increased cholesterol levels, acne, excessive hair growth … It is effective over 3 months, to reduce the symptoms of fibroids, but none study did not evaluate its effectiveness over a longer period of time. It appears to have more side effects and less efficacy than GnRH analogues. It is therefore no longer recommended

хирургија

Surgery is mainly indicated for uncontrollable bleeding, infertility, severe abdominal pain or lower back pain.

La myomectomie is to remove the fibroid. It allows the woman who wishes to have children. You should know that myomectomy is not always a definitive solution. In 15% of cases, other fibroids appear and in 10% of cases, we will intervene again by surgery6.

When fibroids are small and submucosal, myomectomy can be done by hysteroscopy. Хистероскопија is done using an instrument equipped with a small lamp and a video camera that the surgeon inserts into the uterus through the vagina and cervix. The images projected on the screen then guide the surgeon. Another technique, laparoscopy, allows the surgical instrument to be inserted through a small incision made in the lower abdomen. In cases where the fibroid is not accessible to these techniques, the surgeon performs a laparotomy, the classic opening of the abdominal wall.

ТХЕembolisationfibroids is an endosurgical technique that dries up fibroids without removing them. The doctor (an interventional radiologist) places a catheter in an artery that irrigates the uterus in order to inject synthetic microparticles that have the effect of blocking the artery supplying the fibroid. The fibroid, which no longer receives oxygen and nutrients, gradually loses about 50% of its volume.

In addition to preserving the uterus, this procedure is less painful than myomectomy. A convalescence of seven to ten days is sufficient. By comparison, a hysterectomy requires at least six weeks of convalescence. According to a study published in 2010, uterine artery embolization (UAE) offers results comparable to five years compared to those of hysterectomy, allowing the uterus to be preserved. However, this technique cannot be used for all fibroids. For example, it is not recommended for treating submucosal fibroids.

A method called uterine artery ligation can also be done by laparoscopy. It consists of putting clips on the arteries. But it seems less effective than embolization over time.

– The ablation of the endometrium (the lining of the uterus) may, in some cases, be suitable for women who do not want any more children in order to reduce heavy bleeding. When the endometrium is removed by surgery, menstrual bleeding in most cases goes away, but it is no longer possible to become pregnant. This surgery is mainly performed in cases of heavy bleeding and numerous small, small submucosal fibroids.

Other recent methods are more and more often available:

Thermachoice® (a balloon is introduced into the uterus and then filled with liquid heated to 87 ° for several minutes), Novasure® (destruction of the fibroid by radiofrequency with an electrode introduced into the uterus), Hydrothermablabor® (saline serum and heated to 90 ° introduced into the uterine cavity under the control of a camera), thermablate® (balloon inflated with liquid at 173 ° introduced into the uterine cavity).

Other techniques of myolysis (destruction of the myoma or fibroma are still in the field of research): myolysis by microwave, cryomyolysis (destruction of the fibroid by cold), myolysis by ultrasound.

– Hysterectomy, or removal of the uterus, is reserved for the heaviest cases where the previous techniques are impossible, and for women who no longer wish to have children. It can be partial (preservation of the cervix) or complete. The hysterectomy can be performed abdominally, through an incision made in the lower abdomen, or vaginally, without any abdominal opening being made, or by laparoscopy when the size of the fibroid allows it. This is the “radical” solution against fibroids, since there can be no recurrence after removal of the uterus.