Uterine artery embolisation for the treatment of symptomatic uterine fibroids (original) (raw)
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Updated approaches for management of uterine fibroids
International Journal of Women's Health, 2017
Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient's quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations. Moreover, the development of several noninvasive surgical techniques, especially the appearance of ulipristal acetate as a medical etiological treatment, has substantially changed the clinical indications. As a consequence, after almost 2 decades without relevant updates, it has been necessary to update the protocols for the management of UFs in the Spanish Society of Gynecology and Obstetrics twice. Accordingly, we believe that it is necessary to translate our experience to protocolize the medical care for patients with UFs, incorporating these new therapeutic options, and selecting the best treatment for them. We highlight the importance of achieving the patient's goals and decisions by improving the clinical diagnosis for these type of pathologies, allowing enhanced personalized treatments, as well as the reduction of potential risks and unnecessary surgeries.
Updates of Uterine Fibroid Management
2020
Uterine fibroids (in any case called leiomyomas or myomas) are the most notable uterine tumors. Clinical presentations consolidate irregular bleeding, pelvic masses, pelvic pains, bulkyn symptoms, mass results and obstetric disarrays .Almost 33% of women with leiomyomas will request treatment due to signs. Current organization methods generally incorporate cautious mediations, yet the choice of therapy is guided by patient's age and need to preserve fertility or avoid 'extremist' clinical system, for instance, hysterectomy. The management of uterine fibroids moreover depends upon the number, size and location of the fibroids. Other surgical and non-surgical systems join myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine arteries embolization and intervention performed under radiologic or ultrasound guide to start thermal ablation of the uterine fibroids. Further assessments are required as there is a need of solid confirmation of suitability an...
Non-surgical treatment approach of uterine fibroids: a new therapeutic dilemma?
OA J Surg, 2017
Uterine fibroids are benign tumors and most commonly affect women of reproductive age [1-6]. Despite the fact that a wide variety of symptoms can be associated with them (heavy menstrual bleeding, abdominal and pelvic pain, pressure upon adjacent organs, fertility issues and adverse pregnancy outcomes), most of them are asymptomatic [1-3,5-8]. Although there are many therapeutic protocols, the surgical approach with either myomectomy or hysterectomy and preoperative administration of GnRH analogues, represents the primary treatment [1-3,5,8-15]. The non-surgical management with either embolization of uterine vessels or focused ultrasound energy, represents a promising alternative approach in well selected patients [2-6,10,16-23]. However, the final therapeutic decision should be carefully individualized based on fibroid location and features, patient's general medical status and desire of fertility preservation [2-6,10,16-23].
EMAS position statement: Management of uterine fibroids
Maturitas, 2014
Introduction: Uterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract. Aim: The aim of this position statement is to provide and critically appraise evidence on the management of women with uterine fibroids. Methods: Literature review and consensus of expert opinion. Results and conclusions: Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth. Fibroid-associated symptoms include heavy menstrual bleeding and pain or pelvic discomfort. The association between infertility and fibroids increases with age. Fibroids do not increase the risk of malignant uterine disease and leiomyosarcomas are extremely rare (less than one in 1000). It is unknown at present whether leiomyosarcoma represents de novo growth or malignant transformation from benign uterine fibroids. Treatment options for symptomatic fibroids include pharmacologic, surgical and radiologically guided interventions. The range of medical treatments allows flexible management of fibroid-related symptoms; the options include tranexamic acid, non-steroidal anti-inflammatory drugs, contraceptive steroids, gonadotropinreleasing hormone analogs, antiprogesterone, and selective progesterone receptor modulators. However, these medical options do not remove the tumors and symptoms may return when treatment is stopped. Surgical and radiologically guided procedures may be tailored to age, general health, and individual patient wishes. Hysterectomy is the most effective treatment, although in some cases myomectomy may be sufficient to control symptoms. Alternatives to surgery include uterine artery embolization, myolysis and ablation by high-intensity focused ultrasound (guided with magnetic resonance imaging or ultrasound). The choice of treatment depends on fibroid size, the underlying symptoms and their severity and the woman's desire for subsequent fertility and pregnancy, as well as efficacy and need for repeated interventions.
Medical Management of Uterine Fibroids
Current Obstetrics and Gynecology Reports, 2012
Uterine leiomyomas are the most common benign tumors of the uterus. Though benign, they can affect the quality of life for many women. Compared with the standard surgical treatments, medical therapy is attractive and avoids possible surgery-related complications. No medical therapy currently exists that can induce rapid regression of the myoma and symptoms with minimal side effects without affecting fertility. This review evaluates medical treatments that are currently available for the treatment of uterine fibroids.
Therapeutic management of uterine fibroid tumors: updated French guidelines
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2012
The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids.
Journal of the Turkish German Gynecology Association, 2013
Uterine fibroids (UF) are the most common gynecological tumors in premenopausal women. Hysterectomy remains the major and definitive therapeutic option. Minimally invasive surgical techniques for performing hysterectomy have many advantages over laparotomy. Current drug therapies for UF remain unsatisfactory. Unquestionably, continued investigation of novel agents is necessary. The currently used drugs for UF treatment which exclusively modulate a single target, typically either the estrogen or progesterone signaling pathways, are limited in their therapeutic effects. By contrast, multi-target drugs which simultaneously modulate multiple critical hubs in the network of the signaling pathways underlying UF pathogenesis should achieve robust and durable therapeutic effects.
Pharmacological treatment of uterine fibroids
Annals of Medical and Health Sciences Research, 2014
Uterine fibroids (UF) are common, benign gynecologic tumors, affecting one in three to four women, with estimates of up to 80%, depending on the population studied. Their etiology is not well established, but it is under the influence of several risk factors, such as early menarche, nulliparity and family history. More than 50% of affected women are asymptomatic, but the lesions may be related to bothersome symptoms, such as abnormal uterine bleeding, pelvic pain and bloating or urinary symptoms. The treatment of UF is classically surgical; however, various medical options are available, providing symptom control while minimizing risks and complications. A large number of clinical trials have evaluated commonly used medical treatments and potentially effective new ones. Through a comprehensive literature search using PubMed, EMBASE, CENTRAL, Scopus and Google Scholar databases, through which we included 41 studies out of 7658 results, we thoroughly explored the different pharmacological options available for management of UF, their indications, advantages and disadvantages.
Exploring uterine fibroids and its treatment in current scenario
IP International Journal of Comprehensive and Advanced Pharmacology
Uterine Fibroids (leiomyoma) are made of muscle cells and other grow tissues grow in and around of the wall of the uterus. Uterine fibroids benign tumors in women reproduction age worldwide. Many are discovered incidentally on clinically examination. Approximately 30% of women with uterine fibroids will present with severe symptoms, which can include abdominal uterine bleeding, anemia, pelvic pain and constipation. Infertility and recurrent miscarriage may also be symptoms of fibroids, depending on their location and size, especially for sub mucous and intramural myelomas distorting the uterine cavity. Current option for symptomatic fibroid treatment includes expectant medical and surgical management radiology procedures. Ultrasound can be done, when a patient is symptomatic of uterine fibroids. Fibroids are generally classified by their location; intramural fibroids, subserosal fibroids, submucosal fibroids. The cause of uterine fibroids is unknown, But research and clinical experi...