The other night I sat in a restaurant with a group of friends. We share laughter, good conversation and great wine. Looking around, I realized that we were ready to share something else: uterine fibroids. Of the ten women who were sitting at the table, there was a good chance that seven of us have uterine fibroids at some point in our lives. There is no "best" treatment
Considering how uterine fibroids are common, you might think that there would be a lot of research comparing treatment options. In fact, there are only a few randomized trials to guide treatment. In an article in clinical practice in the current New England Journal of Medicine, Dr. Elizabeth A. Stewart, professor of obstetrics and gynecology at the Mayo Clinic, set options and factors that women and their doctors should be analyzed consideration when making treatment decisions.
First, are the fibroids cause symptoms? If not - as is often the case - no treatment is necessary.So what are the symptoms? These can be divided into two categories: menstrual bleeding and symptoms "in bulk". Bulk symptoms such as pelvic pain and frequent urination are caused by the presence of large fibroids in the abdomen.
"I think that the severity of symptoms and impact of symptoms on women's quality of life to be the basis for making treatment decisions," said Dr. Aaron Styer, obstetrician-gynecologist affiliated with Harvard Hospital Massachusetts General. "For example, women's unemployment, which require frequent hospitalizations, or missing in normal life, every day? If so, this information will recommend treatment. "
If a woman wants to have children, your age, and how close you are to menopause, you can also ninfluence the treatment decision. Once a woman enters menopause, fibroids often shrink or even disappear. But until menopause, they can continue to train or to return after retirement.
Hysterectomy, hold the power of fragmentation
The removal of the uterus (hysterectomy) is a popular choice for women who are done with children. The uterus is gone, new fibroids can not be formed. But traditional hysterectomy, wherein a surgeon makes a large incision in the abdomen, is a major surgery.
In laparoscopic hysterectomy, the surgeon removes the uterus through three or four small incisions in the abdominal wall. Recovery is faster and there are usually fewer complications than traditional hysterectomy.
Laparoscopic hysterectomy has always been accompanied by a procedure called power fragmentation. A device is used to cut the uterus into fragments so that it can be removed through small incisions. But the FDA recently recommended limiting the use of the power of fragmentation due to small chance that a woman has surgery to remove uterine fibroids may have an undiagnosed cancer. If the fragmentation is carried out feeding in these women, there is a risk that the cancer of the spreading procedure throughout the abdomen and pelvis. This is precisely what happened in the highly publicized case of Dr. Amy Reed, an anesthesiologist at Boston Brigham and Women's Hospital.
Treatment options for heavy bleeding
Women with heavy bleeding that do not want a hysterectomy can convert options for both medical and surgical. Some drugs reduce heavy bleeding by helping blood clot. Hormonal birth control works by thinning the endometrium. This is the rich nutrient lining of the uterus that is shed during a woman's period. Medicines can relieve symptoms but not treat the underlying problem.
One surgical option to treat heavy bleeding is hysteroscopic myomectomy. In this procedure, a thin tube called an endoscope is passed through the cervix and into the uterus. The fibroid is shaved and removed, but the uterus is left intact. If a woman does not want children, you can opt for endometrial ablation. In this procedure, it destroys the endometrium is often hot or cold.
Treatment options for bulk symptoms
When fibroids cause pelvic pain or frequent urination, the goal of treatment is to reduce the size of fibroids. Drugs called GnRH agonists effectively shrink fibroids. However, fibroids grow back once treatment is stopped, and these drugs are not intended for long term use.
Myomectomy - this time done through a large incision in the abdomen - can reduce the size of fibroids while preserving the ability of a woman to have children. However, fibroids can return after myomectomy. Another option is embolization of the uterine artery. This procedure blocks the blood supply to the fibroids, causing them to shrink and die. Women are much more likely to have a successful pregnancy and delivery after myomectomy after embolization.
A treatment option that is increasingly used for the treatment of uterine fibroids is ultrasound guided surgery MRI. It uses ultrasonic waves to shrink fibroids and reduce heavy menstrual bleeding.
Which treatment is right for you?
While there are many treatment options for uterine fibroids, there is no clear winner. This means that you and your doctor may choose according to their preferences and plans of reproduction, as well as other processing of medical considerations.When deciding, ask your doctor:
* What treatment gives me the best chance of having a healthy pregnancy?
* Which treatment is most likely to provide permanent removal of fibroids?
* What are my personal risks and benefits of options for medical or surgical treatment?Tell your doctor:
* if you plan to have more children
* if you want to keep your uterus, even if their fertile days are over
* symptoms that are most bothersome and how they affect your quality of life.
It may not be "best" treatment for uterine fibroids. But there is a better treatment for you.
0 komentar:
Post a Comment
"Thank you for visiting my blog, please leave a comment in the space provided."