Uterine Fibroids Treatments: do you Know the Best Choice?

Uterine Fibroid (or Uterine Leiomyoma) is one of the most frequent benign disease of female genitalia.

myomectomy and fibroids

Myomectomy: the surgical removal of multiple fibroids from the uterus. A recent case in laparotomy conservative surgery.

Its incidence is particularly high after the 40, but it does not spare women even at an early age.

It is a localized or widespread proliferation of uterine muscle fiber cells capable of determining important uterine deformation, sometimes so large to determine a significant increase in its volumetric and its compression on nearby organs. Uterine Fibromatosis often, especially when limited to small fibroids, is completely asymptomatic, but when diffused by medium or large size Leiomyomas may also cause, depending on location, pelvic pain (pelvic pain), menstrual irregularities (often heavy and /or frequent menstruation ), infertility and disorders of pregnancy (threatened miscarriage or premature birth, placental abnormalities, impaired childbirth accomplishment.

Impact on fertility and pregnancy is certainly important considering that on one hand this disease does not spare the younger age groups and on the other there is a more and more tardive reproductive events distribution, particularly in Western countries.

Theraupethic choices were not conservative in the past, but now, to ensure reproduction, a different sensitivity to this disease has resulted in a substantially lower aggressiveness (some fibroids are absolutely not a problem and can be tracked), in non-surgical treatment options (such as embolization and focused ultrasound), in a more and more minimally invasive surgery (Laparoscopy, operative Hysteroscopy) and Uterus conservative (Myomectomy).

Even today, Focused Ultrasound and Uterine Fibroids Embolization have many scientific controversies in place; not all patients are candidates for these techniques but only selected ones, that is, who respond to specific characteristics such as age, reproductive desire, number, location and size of Fibroids. Also regarding Uterine Fibroids LAPAROSCOPIC SURGERY there is a significant increase, but it still is a prerogative of hospitals with adequate technology and experience and the most serious Fibroid forms can not always be faced with this methodology. Recent criticism also have recently been advanced because of the difficulty of interpreting the histology of uteri undergoing morcellation.

Abdominal surgery (myomectomy) is still the definitive alternative for all those not suitable to other methods cases; developed over the years, often ensures uterus preservation even in very dangerous cases. Surgical risks include, however, always the chance to sacrifice (removal) Uterus, but, fortunately, this occurrence is becoming rarer. Intraoperative bleeding is a quite common complication but also in this case a preparation of pre-operative autologous blood and taking particular intra-operative technical tends to reduce transfusions.

Concerning Medical Therapy of uterine fibromatosis, unfortunately it must be said clearly that we do not have a definitive cure: all available treatments (GnRH Analogs, Ulipristal, progesterone, progestogens) have a temporary action and is particularly effective on symptoms, sometimes on the size of the fibroids, but we are far from a cure. Their employment, however, has resulted in a significant improvement in disease control and sometimes can be particularly useful in preoperative phase to reduce Anemia and when the volume reduction is made in anticipation of a by vaginal intervention (Colpohysterectomy). In our Medical Center for many years now we no longer routinely use GnRH Analogues (drugs which cause a temporary menopause) because they create difficulties in identifying Fibroids capsules and then invalidate the making of an accurate Myomectomy because reducing smaller milmos could make them invisible to an intraoperative recognition.

In particularly complex fibromatosis we conduct a real OPERATING STRATEGY that, through sophisticated imaging techniques, is studied and planned before surgeries. It is important to know the relationship of individual fibroids between them and with uterine cavity and vascular and urinary structures (Bladder and Ureters). In this way, the surgical technique has become so conservative in terms of body reconstruction that there are an increasing number of women who give birth naturally (vaginally) after Myomectomy.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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