Management of Fibroids

Management of fibroids includes investigations and treatment

Investigations

•Hb, blood group

Ultrasound: location, size, number,for follow up of fibroids after menopause and during GnRH therapy

Hysterosalpingography and salpingography: to identify submucous fibroid and to check patency of fallopian tubes in infertility.

Hysteroscopy: to identify a submucous polyp and excising it under direct visualisation.

•D and C to rule out endometrial carcinoma.

Laparoscopy: to excise myomatous polyp in inverted uterus and to identity associated endometriosis and PID

Radiography

MRI to recognise sarcomatous changes, useful in virgins and old women where pelvic examination is not possible due to a narrow cervix.

Intravenous pyelography for broad ligament fibroid to check anatomy of ureters


Medical treatment

1.Anemia: iron therapy

2.Menorrhagia: Tranexamic acid 1g iv 6 hourly,
Ethamsylate 500 mg qid,
Mirena IUCD: 52mg levonorgestrel ,
GnRH analogues 4 weekly injections,
COC Pills,
Danazol 100-200 mg daily.

3.Pain: NSAIDS like Mefenamic acid 500 mg TID


Surgical treatment :

Surgery is considered in the following cases:
-if patient has a completed family
-if large fibroid >12 weeks size
-if medical treatment is not effective

The different surgeries are:

1.Myomectomy: removal of fibroids leaving the uterus behind.
Indicated in:
-infertile women
women desirous of childbearing
women who wish to retain the uterus.

2.Vaginal myomectomy: for submucous fibroid polyps, cervical fibroids, pedunculated fibroids

3.Hysteroscopic myomectomy: for submucous fibroids which are not removable by vaginal route.
It is done under laparoscopic guidance to avoid perforation of uterus.
Excised by cautery, laser or resectoscope.

Newer minimally invasive procedures:

4.Uterine artery embolization: to reduce vascularity and size of fibroid. Menorrhagia and volume of fibroid is decreased.

5.MRI guided laser ablation: high intensity focused ultrasound beam that heats and destroys the fibrous tissue. It is guided by MRI in targeting the beam to the fibroid and it is a non invasive technique.

6.Laparoscopic myolysis: Nd:YAG laser, cryoprobe or diathermy is used to coagulate a subserous fibroid.

7.Hysterectomy is the removal of the uterus

Types of hysterectomy are:
Abdominal
Vaginal
Laparoscopic assisted vaginal hysterectomy (LAVH)

Mrunali Gondane

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