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Fibroids, also known as Fibromyoma uteri or leiomyoma uteri, are benign tumors originated from the muscle tissue that adhere to either the inner or outer of the uterine wall. According to the statistic from National Uterine Fibroid Foundations approximately 80% of all women have uterine fibroids with the majority usually have no symptoms. Every 10 minutes, 12 hysterectomies are performed in the United States alone.
A. In conventional medicine perspective
According to the study of "Uterine Myomas: An Overview of Development, Clinical Features, and Management" by Wallach, Edward E. MD; Vlahos, Nikos F. MD, researchers indicated that Treatment choices are wide and include pharmacologic, surgical, and radiographically directed intervention. Most myomas can be followed serially with surveillance for development of symptoms or progressive grow. The past century has witnessed development of highly sophisticated diagnostic and therapeutic technology for myomas. The tools currently at our disposal permit greater management flexibility with safe options, which must be tailored to the individual clinical situation.
1. Oral contraceptive pills
a. According to the article of "American Society of Reproductive Medicine Patient Booklet: Uterine Fibroids, 2003" Published by the American Society for Reproductive Medicine under the direction of the Patient Education Committee and the Publications Committee., Oral contraceptive pills can be prescribed to reduce uterine bleeding and cramps.
b. Levonorgestrel (a progestin)
With the implant of the Mirena if the fibroids are small enough to keep the device in place, Levonorgestrel release from the device can effectively shrink the fibroids. According to the study of "The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review" by Antony Stewart, Carole Cummins, Lisa Gold, Rachel Jordan, Wendy Phillips researchers found thatEffectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient-centred outcomes in women with menorrhagia.
2. GnRH(Gonadotropin-releasing hormone) agonist
GnRH agonist, Lupron is effective to decrease in GAGs, leading to the shrinking of the fibroids by dehydrating them. Some researchers suggested that Lupron increase the production of estradiols thus reducing the production of estrogen that cause fibroid to shrink.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs therapy is one most effective medicine to relieve menstrual cramping and reduce heavy menstrual bleeding for many women with fibroids as the medication reduce inflammation by inhibiting the effects caused by over production of prostaglandins hormones.
A. 2. Surgery
a. Most women with fobrois do not need suhery, unless the sympyoms have become so sever, depending the size and location of fibroids. Myomyectomy is a procedure to remove the fibroids that cause sever symptoms but does not interfere with future conception by uterus reconstruction.
b. Risk and side effect
b.1. Surgerical and anesthesia risk
b.2. New fibroid develop
b.3. Scar tissue that may cause infertiltiy
b.4. Childbirth complcation.
a. Hysterectomy is the surgical procedure to remove the entire uterus, if infertility is not the concern or you have exausted other options. Please make sure you under stand the risks and side effects of hysterectomy before operating.
b. Risks and side effects
b.1. Surgical and anesthesia risks
b.3. decreased sexual desire
3. Fibroid embolization
Uterine artery embolization (UAE) is surgical procedure to shrink the fibroids by cutting off the blood supply to the woman's uterus performed by a radiologist. According to the ACOG NEWS RELEASE, January 30, 2004, ACOG Office of Communications, (202) 484-3321
firstname.lastname@example.org "ACOG Issues Opinion on Uterine Artery Embolization For Treatment of Fibroids" the release indicated that To date, most data on patient satisfaction, fibroid and uterine size reduction, fertility, and complications are from case reports. In general, the reports have shown a short-term reduction in the size of fibroids and uteri, as well as short-term improvement in menstrual bleeding and other symptoms caused by fibroids. The complication rates associated with UAE are low, but in rare cases can include hysterectomy and death. ACOG recommends that all patients be informed about the potential complications with UAE.
Approximately 50 pregnancies have been reported in women who have had UAE. Nearly 60% of the resulting births were delivered by cesarean, 28% were preterm births, and 13% of patients had postpartum hemorrhage. According to ACOG, this procedure is still considered investigational for patients who may want to become pregnant, as further data are needed to draw conclusions about the safety of UAE in these patients.
4. Surgery with the guide of MRI (magnetic resonance image)
These 2 techniques are new and required further study
a. Ultrasound waves
With the guide of MRI to the precised location of the fibroids in the uterus, then using utrasound waves to destroy them
b. Laser beams
With the guide of MRI to the precised location of the fibroids in the uterus, then using laser beam to destroy them
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