management of uterine fibroids

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educational presentation to help women understand treatment options for fibroids

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management of uterine fibroids

  1. 1. www.ukgynaecologist.comwww.ukgynaecologist.comThe Management of FibroidsbyJimi OdejinmiUkgynaecologist.com
  2. 2. www.ukgynaecologist.comwww.ukgynaecologist.comFIBROIDSThe commonest benign growth ofthe female genital tract
  3. 3. www.ukgynaecologist.comwww.ukgynaecologist.comWhat are fibroids• Fibroids are benign (non cancerous)growths of the uterus (womb)• They arise from single muscle cellswithin the womb
  4. 4. www.ukgynaecologist.comwww.ukgynaecologist.comHow common arefibroids?• No fibroids are quite common– Up to 30-40% of women have them• They are 3 to 9 times commoner in blackwomen than Caucasians– They tend to present at an earlier age in blackwomen– They tend to be more numerous and moresymptomatic in black women at the time ofpresentation
  5. 5. www.ukgynaecologist.comwww.ukgynaecologist.comWhat causesfibroids?• No one knows what causes fibroids• The womb is made up of muscle cellsand fibroids develop as a result ofenlargement of single muscle cells
  6. 6. www.ukgynaecologist.comwww.ukgynaecologist.comWhat are thesymptoms• Symptoms depend– Location of fibroids– Number of fibroids– Size of fibroids
  7. 7. www.ukgynaecologist.comwww.ukgynaecologist.comFibroid locations• Fibroids are categorised according to theirlocation– Subserous• Where most of the fibroid is located superficially– Submucous• Where most of the fibroid is located in the cavity ofthe womb– Intramural• Where most of the fibroid is located within themuscle of the womb– Pedunculated• Where the fibroid is attached to the womb by a stalkcontaining blood vessels
  8. 8. www.ukgynaecologist.comwww.ukgynaecologist.comSubserousSubmucousPedunculatedIntramural
  9. 9. www.ukgynaecologist.comwww.ukgynaecologist.com
  10. 10. www.ukgynaecologist.comwww.ukgynaecologist.comWILL FIBROIDS INTERFEREWITH MY ABILITY TO GETPREGNANTThe majority of women with fibroids will get pregnancy and themajority of women who get pregnant will have no problems.However fibroids have been associated with•Difficulties conceiving•Miscarriage•Degeneration and pain in pregnancy•Preterm delivery•Increased risk of placental separation (abruption)•Obstructed labour•Bleeding after delivery (postpartum hemorrhage)
  11. 11. www.ukgynaecologist.comwww.ukgynaecologist.comFibroids and fertility• Not all fibroids impair fertility• Fibroids most likely to impair fertility are– submucous• Distorting the cavity of the womb– Intramural• In the muscle of the womb distorting the cavity• In women who have difficulty gettingpregnant removing fibroids from theselocations can improve chances ofpregnancy
  12. 12. www.ukgynaecologist.comwww.ukgynaecologist.comWhat aboutcancer?• It is unlikely that fibroids become cancerousparticularly in young women• In the older women the risk is estimated atabout 0.17%• In one Australian study it is estimated at 1in a million• Rapid increase in size of fibroids howeverusually alerts to the possibility of cancer
  13. 13. www.ukgynaecologist.comwww.ukgynaecologist.comWhat treatment optionsare available?Options depend on a number of issues eitherindividually or in combination:•Symptoms•Desire for future fertility•Number of fibroids•Locations of fibroids•Size of fibroids
  14. 14. www.ukgynaecologist.comwww.ukgynaecologist.comThings to consider when thinking abouttreatment• Is treatment necessary?– Only if you have symptoms• if treatment is necessary– Weigh up the risks against possible sideeffects of treatment
  15. 15. www.ukgynaecologist.comwww.ukgynaecologist.comTREATMENT OPTIONS FORSYMPTOMATIC FIBROIDS
  16. 16. www.ukgynaecologist.comwww.ukgynaecologist.comDOING NOTHING?For women who are not ready for intervention
  17. 17. www.ukgynaecologist.comwww.ukgynaecologist.comWHAT HAPPENS IF IDO NOTHING?
  18. 18. www.ukgynaecologist.comwww.ukgynaecologist.comMEDICATION?There is no medication that cures fibroids they onlymake symptoms betterMedication may be appropriate for women who donot want intervention or for shrinking fibroids priorto surgery
  19. 19. www.ukgynaecologist.comwww.ukgynaecologist.comWhat aboutmedication?
  20. 20. www.ukgynaecologist.comwww.ukgynaecologist.comWhat types ofmedication are there?
  21. 21. www.ukgynaecologist.comwww.ukgynaecologist.comGNRH ANALOGUES?These drugs induce false menopause and can shrinkfibroids by up to 30% in first 3 months. May beadvised for shrinking fibroids prior to surgeryNot suitable for long term use
  22. 22. www.ukgynaecologist.comwww.ukgynaecologist.comTypes of hormonal preparations
  23. 23. www.ukgynaecologist.comwww.ukgynaecologist.comUTERINE ARTERYEMBOLISATIONProcedure carried out by radiologists to reduce thesize and symptoms of fibroidsSuitability depends onDesire to retain fertilityAgeLocation of fibroids
  24. 24. www.ukgynaecologist.comwww.ukgynaecologist.comWhat about Uterine arteryEmbolisation?
  25. 25. www.ukgynaecologist.comwww.ukgynaecologist.comWhat can I expectfrom an embolisation
  26. 26. www.ukgynaecologist.comwww.ukgynaecologist.comSURGERYMay be recommended for women with symptomsfrom fibroids
  27. 27. www.ukgynaecologist.comwww.ukgynaecologist.comIf I want to have surgery,what types are available?
  28. 28. www.ukgynaecologist.comwww.ukgynaecologist.comMYOMECTOMY?REMOVAL OF FIBROIDS INDIVIDIALLY TO RETAINWOMB AND REPRODUCTIVE POTENTIAL
  29. 29. www.ukgynaecologist.comwww.ukgynaecologist.comWhat if I chose to have amyomectomy?
  30. 30. www.ukgynaecologist.comwww.ukgynaecologist.comWhat are the complicationsof a myomectomy?Incisions for laparoscopicmyomectomy
  31. 31. www.ukgynaecologist.comwww.ukgynaecologist.comWhat are the advantages oflaparoscopic myomectomy
  32. 32. www.ukgynaecologist.comwww.ukgynaecologist.comAm I a suitable candidate forlaparoscopic myomectomy?
  33. 33. www.ukgynaecologist.comwww.ukgynaecologist.comLaparoscopic myomectomy images
  34. 34. www.ukgynaecologist.comwww.ukgynaecologist.comHYSTEROSCOPICMYOMECTOMYSuitable for selected women with fibroids in the cavity of thewomb
  35. 35. www.ukgynaecologist.comwww.ukgynaecologist.comAm I suitable for aHysteroscopic myomectomy?
  36. 36. www.ukgynaecologist.comwww.ukgynaecologist.comWhat could go wrong withhysteroscopic myomectomy?

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