Uterine myoma

Diagnosis

Uterine fibroids are usually discovered incidentally during a normal pelvic checkup. The uterus may have anomalies that suggest the presence of fibroids.

Healthcare provider will measure the size of the uterus during the pelvic examination and discuss about the symptoms. They might request to conduct some test to confirm the presence of uterine fibroid, its location, and size. The following investigation helps to confirm uterine fibroids:

• Imaging test:
  • Ultrasound: Soundwaves are used to provide an image of the uterus. This procedure will also help confirm the diagnosis, the location, and the size of the fibroid. To obtain images of your uterus, an ultrasound machine (transducer) is placed across your abdomen (transabdominal) or into your vagina (transvaginal).
  • Magnetic resonance imaging (MRI):  A more precise and detailed imaging of the uterus can be obtained by a MRI to precisely pinpoint the size and location of fibroids, recognize various tumor types, and decide on the best treatment options. When a woman has a bigger uterus or is about to go through menopause, an MRI is most frequently used.
• Hysterosonography: This procedure is used when a woman is trying to get pregnant or is experiencing heavy menstrual bleeding, also known as a saline infusion sonogram, a tiny catheter is inserted transvaginal, and saline is administered into the uterine cavity via the catheter. With the help of the additional fluid, the uterus can be seen more clearly than during a typical ultrasound.
• Hysterosalpingography: The uterine cavity and fallopian tubes are highlighted on X-ray pictures during hysterosalpingography using a dye or contrast. This is more frequently applied to persons who are also having their infertility evaluated.
• Hysteroscopy: A thin, flexible tube with a camera will be inserted to the in the vagina to cervix into the uterus. Saline will be injected into the uterus to expand the uterine cavity and make it more visible to see the walls of the uterus and the openings of the fallopian tubes.
• Laparoscopy: A small incision will be made on the lower abdomen, then a flexible tube with a camera will be inserted to examine the internal organs.
• Laboratory tests: In situations, where the patient have abnormal menstrual bleeding, additional investigations will be recommended to further investigate the cause of the bleeding. These could include a complete blood count (CBC) to see if you have anemia from ongoing blood loss and other blood tests to rule out thyroid issues or bleeding disorders.

Treatment

Treatment options for uterine fibroid can vary depending on the size, number and location of the fibroids, as well as what symptoms they’re causing. If the patient does not experience any symptoms from their fibroids, they may not need treatment.

Small fibroids can often be left alone. Some people never experience any symptoms or have any problems associated with fibroids, so they just need to be monitored closely over time. Periodic pelvic exams and ultrasound may be recommended by the healthcare provider depending on the size or symptoms of their fibroid. If someone is experiencing symptoms from their fibroids, including anemia from the blood loss, moderate to severe pain, infertility issues or urinary tract and bowel problems, then treatment is usually needed.

Uterine fibroids are non-cancerous, and usually do not affect pregnancy. The fibroids can gradually grow and/or remain its size, and they usually shrink after menopausal because the reproductive hormones decrease.

Surgery

Surgical procedures could be recommended especially if the patient does not consider getting pregnant.
Surgical procedure for removing fibroids can include:

• Myomectomy: Is a surgical removal procedure of the fibroids that does not harm the uterus. Myomectomy comes with different kind of procedure, the procedure will depend on the location, size, and quantity of fibroids, which will also determine the appropriate procedure for the patient.
  • Laparoscopic myomectomy: Removal of fibroids through by laparoscopy using 2-3 half-inch incisions. This procedure only works on small fibroids. Uterus remains intact. Morcellation, or the breaking of larger fibroids into tiny pieces, can be done inside a surgical bag or by extending one incision to remove the fibroids. Both methods can be used to remove larger fibroids through smaller incisions. Robotic myomectomy allows for greater precision, adaptability, and agility as it gives the doctor a magnified, 3D picture of the uterus.
  • Hysteroscopic myomectomy: Removal of fibroids by inserting a hysteroscope through the vagina and the cervix into the uterus. Uterus remains intact. If the fibroids are only present inside the uterus, this procedure can be one of the treatment options. Instruments are put into the uterus through the vagina and cervix to access and remove fibroids.
  • Laparoscopic Myomectomy with Mini-Laparotomy: allows for the removal of slightly larger fibroids than what the laparoscope can remove and includes a relatively small incision of 3 inches or less in the abdomen.
• Hysterectomy: Is a surgical procedure that removes the uterus, this will also stop the ability to get pregnant. This procedure was proved and prevent the reccurence of uterine fibroids.

This procedure might be suggested if the patient have large fibroids or are bleeding heavily from their fibroids.

Hysteroscopy should always be performed using the least invasive method possible when advised. Robotic, laparoscopic, and vaginal procedures are all considered minimally invasive.

Medications

The symptoms of uterine fibroids, such as excessive blood loss during menstrual cycle and pelvic pressure, are treated with medication by targeting the hormones that control your menstrual cycle and pain. They may cause fibroids to shrink, but they do not remove them.

• Gonadotropin-releasing hormone (GnRH) agonists: GnRH agonist medications work to treat fibroids by blocking the production of estrogen and progesterone, which temporarily mimics menopause. Menstruation ceases as a result, fibroids shrink, and anemia frequently gets better. A GnRH agonist may be prescribed by the healthcare provider to help the patient enter menopausal stage or to reduce the size of the fibroids prior to a planned operation.

The use of GnRH agonists is frequently accompanied by severe hot flashes in females. Since symptoms recur after stopping the medicine and prolonged use can result in bone loss, GnRH agonists are normally only administered for three to six months at most.

• Tranexamic acid (Lysteda, Cyklokapron): To reduce painful menstrual cycles, people take this nonhormonal medicine. Only days with significant bleeding are taken.
• Progestin-releasing intrauterine device (IUD): An IUD that releases progesterone can stop excessive bleeding brought on by fibroids. A progestin-releasing IUD relieves symptoms; it does not reduce or eliminate fibroids. It also avoids getting pregnant.
• Other medications: such as oral contraceptives can help regulate menstrual bleeding, they have little effect on fibroid size.

Non-hormonal medication such as nonsteroidal anti-inflammatory drugs (NSAIDs) might be helpful in reducing fibroid-related discomfort, but they do not stop the bleeding that fibroid-related pain causes. In addition, if you have anemia and excessive menstrual flow, your doctor can advise you to take vitamins and iron.

Noninvasive procedures

• MRI-guided focused ultrasound surgery (FUS): is a non-invasive, outpatient procedure that does not involve an incision and keeps your uterus intact for the treatment of uterine fibroids. The MRI scanner uses a high-energy ultrasound transducer that could locate the uterine fibroids by providing an images. The ultrasonic transducer concentrates sound waves (sonications) into the fibroid at the chosen site, where they cause small patches of fibroid tissue to heat up and be destroyed.

Minimally invasive procedures

Uterine fibroids could be eliminated by minimally invasive procedures without using any surgical procedure to remove them.

• Uterine artery embolization: This method has the potential to reduce fibroids and the symptoms. This procedure will block blood supply to the uterus, and stopping the blood supply to the fibroids, which will shrink the fibroids and it will eventually die. If the blood flow to the ovaries or other organs is disrupted, complications could happen. The risk of transfusion is significantly lower based on the recent studies.
• Endometrial ablation: Endometrial ablation is an outpatient procedure with short recovery time and few complications. Endometrial ablations remove or destroy the lining of the uterus to control heavy bleeding with either laser, microwaves, freezing, boiling water, etc. This procedure treats bleeding symptom but not the fibroids. Endometrial ablation is not indicated for future fertility.
• Radiofrequency ablation: A laparoscopic, transvaginal, or transcervical technique can be used to administer this safe and efficient treatment for persons with symptomatic uterine fibroids. Radiofrequency energy eliminate the uterine fibroids by shrinking the blood vessels.

Healthcare provider will create two tiny incisions in abdomen to insert a laparoscope with a camera at the tip during laparoscopic radiofrequency ablation (Acessa), also known as Lap-RFA. The healthcare determines where the fibroids are that need to be treated using the laparoscopic camera and a laparoscopic ultrasound instrument.