How to treat gynecological uterine fibroids

Nowadays, too many women suffer from gynecological diseases because there are too many factors that endanger women's health. In severe cases, they may cause some bad damage to women. There are many types of gynecological diseases in women, and uterine fibroids are one of the common ones. If uterine fibroids are not treated well, the impact is also very large, which will have a certain impact on women's fertility. How should this uterine fibroids be treated?

1. Follow-up observation

If the patient has no obvious symptoms and no signs of malignancy, regular follow-up observation can be performed.

2. Medication

(1) Gonadotropin

GnRH-a agonists (GnRH-a) Currently, the commonly used GnRH-a in clinical practice include leuprorelin (Enanton), goserelin (Zoleide), triptorelin (Dapiga), etc. GnRH-a should not be used continuously for a long time. It is only used for pretreatment before surgery, generally for 3 to 6 months, to avoid causing severe menopausal symptoms caused by low estrogen. A small dose of estrogen can also be supplemented at the same time to counteract this side effect.

(2) Mifepristone is a progesterone antagonist that has been clinically tried in recent years to treat uterine fibroids. It can reduce the size of fibroids, but the fibroids often grow again after discontinuation of the drug.

(3) Danazol

Used for preoperative medication or treatment of uterine fibroids that are not suitable for surgery. Uterine fibroids may grow larger after medication is stopped. Danazol can cause liver damage and androgen-induced side effects (weight gain, acne, hoarse voice, etc.).

(4) Tamoxifen can inhibit the growth of fibroids. However, long-term use may cause enlargement of uterine fibroids in some patients, and may even induce endometriosis and endometrial cancer, so this should be paid attention to.

(5) Commonly used androgen drugs include methyltestosterone (methyltestosterone) and testosterone propionate (testosterone propionate), which can inhibit the growth of fibroids. The dosage should be used carefully to avoid virilization.

During the bleeding period of patients with uterine fibroids, if the amount of bleeding is heavy, uterine contractants (such as oxytocin, ergot) and hemostatic drugs (such as hemostatic acid, aminobenzoic acid (hemostatic aromatic acid), lizhihemostasis, Panax notoginseng tablets, etc.) can also be used, which can play a certain degree of auxiliary hemostatic effect.

3. Surgery

Surgical treatment of uterine fibroids includes myomectomy and hysterectomy, which can be performed abdominally or vaginally, or endoscopically (hysteroscopy or laparoscopy). The choice of surgical procedure and approach depends on factors such as the patient's age, whether or not they have fertility requirements, the size and location of the fibroids, and medical technology conditions.

(1) Myomectomy

Surgery to remove uterine fibroids while preserving the uterus is mainly used for young women under 40 who wish to retain their fertility. It is suitable for patients with larger fibroids, heavy menstruation, compression symptoms, infertility due to fibroids, submucosal fibroids, and fast-growing fibroids without malignant transformation.

(2) Hysterectomy

For patients with obvious symptoms, those with the possibility of malignant transformation of fibroids, and those with no desire to have children, hysterectomy is recommended. Hysterectomy can be performed with total hysterectomy or subtotal hysterectomy. For older women, total hysterectomy is more appropriate. The possibility of cervical malignancy must be excluded before surgery.

(3) Uterine artery embolization

Through the method of radiological intervention, an arterial catheter is directly inserted into the uterine artery, and permanent embolic particles are injected to block the blood supply to the uterine fibroids, so as to achieve the shrinkage or even disappearance of the fibroids. UAE is currently mainly suitable for uterine fibroids with symptoms such as abnormal uterine bleeding leading to anemia. Caution should be exercised when choosing interventional treatment for uterine fibroids, especially for those with uncontrolled pelvic inflammation, those who wish to retain their fertility, those with arteriosclerosis, and those who have contraindications to angiography, which should be listed as contraindications to this treatment. 5% of patients may experience premature ovarian failure after surgery, and there are also rare reports of pelvic infections.

4. Focused Ultrasound Therapy

By focusing ultrasound waves and raising the temperature locally inside the tumor to over 65°C, the tumor undergoes coagulative necrosis, which in turn has a therapeutic effect. The treatment can cause the fibroids to shrink and relieve symptoms. Indicated for symptomatic uterine fibroids. The advantages are that there are no surgical scars after treatment and recovery is fast. Adverse reactions have been reported including skin burns, adjacent intestinal damage, and hematuria.

The above are various types of treatment methods. For uterine fibroids, different disease types and symptoms have different treatment methods. When choosing treatment methods, you should also pay special attention to the treatment of uterine fibroids. You should decide according to the size of your fibroids. If it is too small, there is no need for surgical treatment. When treating uterine fibroids, you should also decide according to your fertility.