What happens to untreated uterine fibroids?
According to the clinical recommendations of 2015 for the treatment of uterine fibroids, this benign tumor is diagnosed in 30–35% of women of reproductive age. In fact, every third woman in the world becomes a victim of this disorder. What to do if you are diagnosed with this issue? Does it require to be immediately prepared for the operation or is it enough to be under the supervision of the doctor?
Is it worth it to agree on the removal of the uterus?
In recent years, doctors' views about uterine fibroids have changed. Thus, it was previously believed that this problem develops due to hormonal imbalance. Currently, it is known that this factor does not affect the myoma nodes development. For a long time, gynecologists believed that fibroids could cancerate. In fact, myomatous nodes transform into a malignant tumor – leiomyosarcoma – no more often than healthy uterine tissue.
The tactics of treatment has changed as well. Previously, a woman has been followed up by gynecologists for a long time, she was prescribed periodic ultrasounds, and when myoma reached a large size, they offered a surgery to remove the node or uterus entirely. Currently, it is believed that the uterectomy is an extreme measure. Minimally invasive techniques, such as uterine artery embolization (UAE), are becoming increasingly popular.
The presence of myomatous nodes is not a reason to treat myoma. The need to undergo a course of therapy is determined by four factors: the presence of symptoms reducing the quality of life: anemia, urination disorders due to compression of the bladder; a woman wishes to become pregnant in the near future or in the long term; the growth of nodes, recorded during two or three consecutive ultrasound examinations of the abdominal cavity; the age of the woman. Myoma is a disease which stops to cause inconvenience to women in the postmenopausal period: the nodes cease to grow.
Among all the proposed methods of treatment, only three have been proven to be effective: surgical intervention, UAE, and, very limitedly, drug treatment with progesterone receptor blockers.
Myomectomy can be performed in the classical way (through an incision) or laparoscopically. Currently, “open” surgeries are a thing of the past, doctors prefer less traumatic interventions – laparoscopic. Nodes that grow into the uterine cavity are removed through the vagina using a special endoscopic instrument with a loop — a resectoscope.
UAE is a procedure during which the physician injects an embolizing drug through the catheter into the vessels feeding the myoma. The latter consists of particles that block the blood flow in the vessels of the fibroids and deprive the pathologically overgrown tissues of oxygen. Myomatous node dies, then it is replaced by connective tissue and decreases in size.
At the moment, it is advisable to use for the treatment of fibroids – progesterone receptor blocker, ulipristyl acetate. The drug is most effective when taken in 2–3 cycles (but not more than 4) with intervals of 2 months including assessment of the changes dynamics using ultrasound. At the same time, up to 60% of cases show regression of myomatous nodes. The advantage of this approach is that the drug is well tolerated.