Tuesday, November 28, 2006

Uterine Fibroids and Treatment Options

We know that many women get fibroids growing in and around their uterus at some point in their lives and that some of us become very uncomfortable because of the symptoms the fibroids produce (these range from urinary frequency to painful and heavy bleeding). Research still has not shown why this happens and what predisposes us to it. I have a previous post in this blog about some of my experience so far and I will be writing more about it as I undergo treatment.

Considering that uterine fibriods have been a problem that has existed long before modern medicine came into being and given that they are the second most common reason for major surgery in women after child-birth (specifically c-section), it is a bit puzzling why we still don't know what causes fibroids. Not only this, what is even harder to understand is the lack of information women are given about the various options available for treatment. I am going to go over the options here in case someone who wants to know stumbles on them on this little outpost of the web.

Do nothing: Most women who have fibroids are aymptomatic and needn't take any course of action. These benign growths do not interfere with their lives. Other women turn symptomatic and still may choose to do nothing if the symptoms do not affect their quality of life. Even if the fibroids do affect the quality of their life, a woman may choose it as the lesser of two burdens given the treatment options. In addition, a woman who has not had children may, depending on location and the affects of the fibroid(s), choose to put off treatment till after childbirth in order to ensure that her fertility is not negatively affected.

Gonadotrophin therapy: Some women are given gonadotrophin drug (Lupron in USA or Prostap in UK) injections to chemically induce menopause. As the levels of estrogen and progesterone drop, reproductive organs (and the fibroids growing in and around them) shrivel. This therapy is associated with all the other wonderful symptoms of menopause such as hot flashes, bone loss (over time), vaginal dryness, etc. Soon as therapy is stopped, the reproductive organs AND the fibroids spring right back. This therapy is used pre-surgery (typically for 3 months) in women who are heavy bleeders and anemic to shore up their blood and help with recovery post-op. It is also supposed to reduce bleeding during surgery. However, this treatment is not indicated pre-surgery for non-anemic women. Surgery is easier on a non-shrunken uterus and fibroids. However, incision size may be larger if the fibroid is extremely large.

Hysterectomy: This has previously been the option of choice for many surgeons (and by extension their patients) as it was often the only option available. It remains a frequently used option and many women are expressing discomfort and displeasure with doctors who seem to present it as the only viable option. On the other hand, for many women who have severe symptoms, recurring fibroids and who are past child birth, this remains an acceptable option. Of course, a hysterectomy entails permanent menopause with its own issues. For women who are younger and who still want to keep their options for reproduction open, this is not an ideal option.

Myomectomy: This comes in two forms. Abdominal myomectomy and laparoscopic abdominal myomectomy. The first is when they manually make an abdominal incision and surgically remove the myoma(s) or fibroids. The second is when they use laparoscopes to do the surgery making small holes in the abdomen to thread in the laparoscope. Healing times and rates of infection differ. Typically the larger the fibroid or the more delicate its position, an abdominal myomectomy would be preferred over a laparoscopic myomectomy. The advantage of a myomectomy is that it is a more uterus conserving surgery and a woman may hope to maintain her reproductive abilities. Even if reproduction is not an important consideration, the avoidance of abrupt menopause alone would make this desirable in my opinion. [Menopaused women are not troubled with fibroids as the reproductive tissue has or is shrivelling.] However, myomectomies do not prevent the fibroids growing back.

Uterine Arterial (or Fibroid) Embolization: UAE involves threading catheters into the two uterine arteries. The catheters are used to deliver silting agents into the blood supply of the targeted fibroids. This results in the fibroid starving and shrivelling away and this relieves most symptoms. There are a couple of issues with this treatment beyond its indication for certain types of fibroids. Firstly, UAE is performed by radiological experts rather than gynecological surgeons. This may create a conflict of interest in that many gynys may not refer their patients away to another specialist for treatment even if they remain the doctor of record. Secondly, UAE is still doubtful for women looking to conceive as the blood supply to the uterus and ovaries should be as little compromised as possible.

Holistic options: There aint no herbs out there that I know of which can target a fibroid specifically and not affect anything else. I can imagine there are herbs that help relieve some symptoms (such as heavy bleeding). However, if a drug claims to shrink fibroids, it is probably functioning as a gonadotrophin. Now we know that menopausal women are outta the fibroid game, which leaves only those of us lucky enough to need these herbs to worry about the consequences of a potentially gonadotrophin herb. And if you are still considering giving birth at some point, you need to make the decision while weighing in your reproductive health and that of any baby that you will carry. In terms of other holistic options such as meditation and exercise, the way I see it, these can't harm us and if they help us- then great. Good food, healthy eating habits, relaxation and exercise are never wrong.

1 comment:

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