What is proposed in the case of uterine fibroid treatment?

Uterine fibroid is a very common condition in women. If the causes and installation methods are still being explored, the therapeutic choice is very wide. However, among the various drug treatments and different surgical techniques, the decision is not as easy, several parameters should be taken into account ...
What is a uterine fibroid?

A uterine fibroid is a benign, non-cancerous, which grows at the expense of the uterine muscle and appears at the wall of the uterus in women. Its size is very variable. Tumors can be multiple.

Uterine fibroids usually affects women more than 30 years.

The causes of fibroids are not known, but researchers have suggested the involvement of several factors, including genetic and hormonal. The development and growth of fibroids are carried out under the influence of estrogen. Thus, some associated with high estrogen levels situations increase the volume of uterine fibroids, such as oral contraceptives, pregnancy, perimenopause. And generally, uterine fibroids shrink in volume when menopause is installed.

In the vast majority of cases, the presence of uterine fibroids shows no signs or event in women. The signs may be limited to heavy periods or pelvic pain.

However, a large fibroid may cause compression of organs near the uterus (the urinary system with irritation of the bladder or ureters, irritation and compression of the rectum may be the cause of chronic constipation).

In general, uterine fibroids with no symptoms does not require regular medical checks.

The decision to treat fibroids depends primarily on several factors:

- The Age

- The appearance of signs, severity, signs of compression, the suspicion of a malignant tumor

- The number of children, the desire for pregnancy

- The seat of fibroid: intramural (in the muscle layer), subserosal (outside the wall), submucosal (in the womb)

Several methods are available to treat fibroids, but of course, the choice of therapeutic methods take into account all the parameters raised, but also the patient's choice. There are also indications that are not to be minimized during the treatment decision. Until now, hysterectomy is the only therapeutic agent that can permanently treat uterine fibroids.

Non-surgical treatments

Drugs

The drugs prescribed by doctors generally affect the menstrual cycle and helps regulate hormonal activity. This action affects the growth of uterine fibroids but does not destroy or reduce the size. Drug treatment is usually indicated when the uterine fibroid is small and does not give serious share of heavy or abnormal bleeding symptoms. It is also used before surgery in order to prepare the uterus.

The drugs used are mainly based on hormones (hormonal contraceptives, progestins).

Embolization

Embolization is to "destroy" the fibroids by injecting products that will block the blood supply to the tumor, in order to deprive tumor cells of its oxygen and its nutrients. This technique reduces the volume of the fibroid.

Embolization may not, however, be made in case of submucosal fibroid.

It is generally recommended for women with recurrent fibroids after myomectomy, and no longer wants a new surgery.

Embolization is considered less invasive and is effective according to studies. However, indications are limited. In addition, the recovery time is shorter, the recovery is quick.

Ultrasound

Ultrasound treatment methods are being developed. Its indications are limited to women with fibroids one medium-sized (5-10 cm) sitting outside the uterus.

Surgical treatments

Surgical treatment is available when:

- Uterine fibroid is large

- Signs can not be controlled by medication (abdominopelvic pain, back pain, heavy bleeding may be caused by anemia, ...).

Types d’intervention chirurgicale	Indications/Contre-indications	Inconvénients/avantages
Myomectomie : elle consiste à enlever uniquement le fibrome	Fibrome de petit volume Fibrome sous-muqueux ou sous-séreux Pour les femmes qui désirent encore avoir d’enfant	L’apparition d’autres fibromes après le traitement est possible et conduit à une nouvelle intervention ultérieure Il y a risque de fragilisation de l’utérus (une prochaine grossesse peut engendrer une rupture utérine)
Hystérectomie : elle consiste à enlever l’utérus (avec ou sans le col de l’utérus) soit par voie abdominale soit par voie vaginale	Réservée aux femmes qui ne désirent plus avoir d’enfants Tient compte de l’âge de la femme Fibrome volumineux pouvant engendrer des complications (signes de compression, hémorragie) Aucune autre alternative de traitement	Il n’y a pas de risque de récidive et permet un traitement définitif La récupération est plus longue La convalescence s’étend sur plusieurs semaines (6 semaines au minimum)

Surgical techniques are chosen depending on the indications.
Thus, several therapeutic techniques are opening up for women with uterine fibroids. If the majority of fibroids do not require treatment to disappear after menopause, others will have to resort to treatment. The choice of treatment essentially involves several parameters:

- The age of the patient, the number of children, the desire for pregnancy

- The size and location of the fibroid: intramural, subserosal, submucosal

- The signs and manifestations of fibroid, severity

- Indications and cons-indications of each treatment method

- Knowledge of the advantages and disadvantages, depending on the personal choice of the patient