(I) About the treatment of fibroids
1.Do I have to be treated if I have fibroids?
Fibroids do not necessarily need to be treated. This is actually a misconception in the treatment of fibroids. Generally speaking, most fibroids do not require treatment, or immediate or active treatment.
There are two principles for not treating patients with uterine fibroids: firstly the vast majority of the disease is benign, with very few malignant changes, and if the fibroids are not large and cause no obvious clinical symptoms, treatment is generally not recommended and we can observe them. Observation is also a treatment method, through observation, the growth rate of fibroids and the changes in clinical symptoms of patients can be known, and it is better to observe the need for treatment only when treatment is needed.
Secondly, if the fibroids have grown to 4-5 centimeters and clinical symptoms have also appeared, but the patient has reached menopause and is close to receiving menstruation, you can also choose not to treat them. Since fibroids are estrogen-dependent, they will slowly shrink when estrogen decreases after menopause.
Therefore, for an experienced obstetrician and gynecologist, sometimes it is actually a good suggestion not to treat fibroids (observation).
2. What kind of fibroids need to be treated?
Another classification of fibroids is into symptomatic fibroids and asymptomatic fibroids. If they are clinically symptomatic and the fibroids are not large, they do not need treatment and regular observation is sufficient.
If the fibroids are symptomatic and not large, they do not require treatment and can be observed regularly. If the fibroids are symptomatic, they require treatment and are classified as urgent or elective depending on the severity of the clinical symptoms. Urgent treatment is needed when there are life-threatening clinical symptoms, such as hemorrhage due to fibroids or severe abdominal pain due to fibroid degeneration. If the symptoms are not urgent, such as slightly heavy menstrual flow or pressure on the bladder and rectum, the patient does not need urgent treatment. So what kind of fibroids need to be treated which? There is a treatment standard: firstly, if the fibroid is larger than the third trimester of pregnancy, treatment should be taken; secondly, clinical symptoms such as excessive menstruation or infertility should be treated, even if the fibroid is not large.
In addition, if fibroids cause serious endocrine hormone disorders, treatment is necessary. The reason is that after the fibroids grow to a certain extent, the fibroids themselves will secrete some hormones, besides supplying themselves, too much hormones will cause multiple fibroids in the surrounding area; too much hormones will also cause lesions in other homologous organs such as the breast and endometrium, and in serious cases, breast cancer and endometrial cancer will appear.
3.How many treatment methods are there for fibroids? The treatment methods for fibroids are divided into non-surgical treatment and surgical treatment. Non-surgical treatment is mainly medication, including Chinese medicine and Western medicine. Surgical treatment is divided into hysterectomy surgery, and surgery to preserve the uterus, such as myoma removal surgery and interventional treatment.
4.How many kinds of medication are there? Is it effective? When to choose medication?
Medication for fibroids is a big concept, and medication is generally not recommended. Although hormonal drugs are effective, they should not be used for more than 6 months, or else they have greater side effects. The mechanism of action is to inhibit the secretion of ovarian estrogen, which puts the body in a state of low estrogen level or menopause, resulting in more serious side effects such as dry skin, low libido, irritability, osteoporosis, etc. Also, after stopping the drug, the fibroids will rebound, that is, the fibroids will return to the size before the drug was used. Therefore, we generally use it as an adjuvant in clinical practice, and there are strict rules for its application.
The first situation with the drug is that if the patient is relatively young and wishes to get pregnant and the fibroids are not too large and affect the pregnancy, this drug can be used to shrink the fibroids and achieve pregnancy.
The second situation is that if the fibroids cause particularly heavy menstrual flow and anemia that is not suitable for immediate surgery, the drug can be used to make the menstrual flow decrease.
In the third case, they are used to correct clinical symptoms before surgery and to make the fibroids shrink in order to facilitate surgery.
The fourth condition is to speed up the collection of menstruation so that the fibroids shrink faster.
The two main hormonal drugs used in clinical practice are: gonadotropin agonists and mifepristone. .
However, no matter which drug is used, long-term application is not recommended due to the side effects, and it should be applied purposefully, and the use of medication does not cure the disease, and the disease will rebound after stopping the medication. It should be clear that there is no good drug that can cure uterine fibroids.
Some people say that after giving birth to a child, the uterus is useless, so if you have fibroids, you can have your uterus removed to save your time and get rid of them. Is that right?
There is a misconception here because people do not know much about the function of the uterus. Firstly, the uterus has a menstrual function. Secondly, the uterus has a reproductive function. Third, the uterus has an endocrine function, the uterus itself will secrete trace hormones to participate in the regulation of the balance of the endocrine system in the body, at the same time, the uterus also has the function of blood supply for the ovaries, if the uterus is removed, the ovaries will lose half of the blood supply, the secretion of hormones will also be reduced accordingly; in 1987, there was a study in the UK, women who had their uterus removed would age 4 years earlier than those who did not have their uterus removed, the reason for aging The reason for aging is hormonal problems. The earlier the hysterectomy, the more severe the aging process and the more severe the menopausal symptoms. Fourthly, the uterus is also part of the immune system and has an immune function, participating in the regulation of the immune function of the whole body. Finally, the uterus also has a supportive function for the pelvic floor, and if the uterus is removed, a piece of the pelvic floor is missing and the supportive function is impaired.
The uterus also has many undiscovered important functions, so it cannot be easily removed.
6.How many ways are there to remove fibroids?
Myomectomy is one of the more important methods of treating fibroids. However, in developed countries such as Europe and the United States, even older women between the ages of 50 and 60 are now opting for myomectomy because the concept of uterine function has changed. As a result, fewer people are having hysterectomies and more people are having resections.
There are various ways to remove fibroids, the most classic and common being open excision, which requires less skill on the part of the surgeon. Laparoscopic resection of fibroids is also used in clinical practice, which is characterized by fewer abdominal wounds, but is slightly more costly. The advantage of this procedure is that there is no incision and the recovery is fast, but it requires a high level of skill and is not yet commonly performed. In case of submucosal fibroids less than 5 cm in diameter, hysteroscopy can also be used to remove them.
7. Can multiple fibroids be removed?
The maximum number of fibroids that can be removed is 312 in foreign literature, but in my personal case, 33 fibroids were removed, which means that the uterus can still be preserved.
8. Can fibroids recur after myomectomy?
One of the biggest problems and headaches of myomectomy is recurrence. Smaller fibroids are difficult to be completely removed during surgery, which leads to continued growth after surgery. In addition, the internal conditions for fibroid growth still exist because there is no fundamental change in the individual’s constitution, lifestyle and genetic factors, so there is still a root cause of fibroid recurrence. According to statistics, the recurrence rate 2 to 5 years after myoma removal is 20 to 50%, and one third of recurrence patients need to be treated again.
9.When can I get pregnant after my fibroids are removed? What should I pay attention to?
As I said earlier, 40% of patients cannot get pregnant because of fibroids, but patients can still get pregnant after removal. However, we should pay attention to the first issue is the time, according to the type of fibroids to determine the time of pregnancy after surgery, such as subplasma fibroids can be relatively short, one year after the removal of surgery can be pregnant; if it is interstitial fibroids, it is safer to get pregnant two years after surgery; if it is submucosal fibroids, you can get pregnant a few months to six months after hysteroscopic treatment (if it is open, it will take more than 2 years after surgery). (or more).
Since the surgical procedure for submucosal fibroids and interstitial fibroids involves cutting open the myometrium and the healing is performed in a scarred manner, there is a higher risk of wound rupture if pregnancy occurs too early.
10.Can I get pregnant without treatment of fibroids?
It mainly depends on the location of the fibroids. The most obvious type of fibroid that affects pregnancy is submucosal fibroid, which grows in the uterine cavity, and the fetus also grows in the uterine cavity, that is to say, the fibroid affects the fetus to be bedded, even if it has been bedded, the fibroid will affect the pressure on the fetus and cause miscarriage, so the submucosal fibroid should be treated before pregnancy. Some other types of fibroids are possible to get pregnant, such as less large subplasmic fibroids and smaller interstitial fibroids, but before getting pregnant, you should clarify which type of fibroid it is and consult your doctor for professional advice.
11.What is interventional treatment? How long has the history of interventional treatment for fibroids been?
Nowadays, interventional technology is a big treatment method, officially named in 1967, which is widely used in various diseases due to its minimally invasive and is a very mature technology,. The first international application of interventional techniques in the treatment of uterine fibroids can be traced back to 1974, and has a history of 20 years in China. The mechanism of interventional treatment for fibroids is very simple. A special thin catheter is used to percutaneously puncture into the arterial vessel at the root of one thigh (a rice-sized incision is made in the skin), and under the guidance of X-ray, an absorbable embolic agent is applied to embolize the blood supplying artery of the fibroid, resulting in ischemia and hypoxia of the fibroid, and the fibroid will be necrotic. The embolic agent will also be absorbed as fructose which can be used by human body.
12.What is the difference between interventional treatment and traditional surgical treatment?
In 1993, the Ministry of Health of the People’s Republic of China listed interventional therapy as one of the three major treatment methods alongside medical treatment and surgical treatment. It has solved some of the problems that previously required complex surgical treatment (such as some heart surgeries), simplified the treatment methods, and made it possible to treat some diseases that were previously untreatable by medical and surgical procedures. Interventional treatment differs significantly from traditional surgery in that it does not require organ destruction. For example, in the treatment of uterine fibroids in obstetrics and gynecology, one of the methods is the removal of the uterus, which allows the treatment of fibroids while losing a normal organ DD uterus that is very important to women; another treatment for fibroids is myomectomy, in which the myometrium has to be dissected in order to remove the fibroids, which destroys the normal myometrium and is harmful to women with fertility requirements. This can be harmful to women with fertility requirements. In contrast, interventional treatment is to block the blood supplying arteries of fibroids and embolize them outside the body, without entering the abdominal cavity, without cutting open the myometrium, without affecting the normal tissues and organs, and with less physical damage to the body.
13.What kind of uterine fibroids are suitable for interventional treatment?
After a series of studies, we found that 95% of fibroids are suitable for interventional treatment. Since the mechanism of interventional treatment is to deal with blood vessels, the blood supply of fibroids must be clear. According to the number of myoma vessels, we divide them into four categories, which are classified into the cluster blood flow type, indicating a particularly large number of vessels, and the paramyocardial, general blood flow, and non-cluster blood flow types. The reference is the intermuscular wall of the uterus. The first three types are suitable for interventional treatment, while the fourth type represents not richly vascularized and does not work well with interventional treatment, accounting for about 5.77%.
In general, submucosal fibroids, interstitial fibroids, most of the subplasma fibroids, and fast-growing fibroids are suitable for interventional treatment, and those of young women are more suitable, while slow-growing fibroids are not suitable for interventional treatment.
14.What is the effect of interventional treatment for uterine fibroids? Firstly, the improvement of clinical symptoms is very obvious, such as excessive menstruation, after the treatment, the volume of menstruation is obviously less; secondly, infertility can be pregnant after the treatment; thirdly, common complications such as excessive secretion of hormones will be reduced after the treatment; fourthly, the volume of fibroids can be reduced, according to statistics, it can be reduced by 50% after 3 months, 70% after 6 months, 80% after the 12th month, and 90% after 2 years. After two years, it can shrink up to 90%, and finally it can shrink up to 93.3%, and some patients can be completely cured.
15.What are the advantages and disadvantages of interventional treatment for uterine fibroids?
First of all, it is minimally invasive, no incision is needed, only a small hole of 0.3cm at the root of the thigh is needed. Secondly, it is comfortable. Patients can go down to the floor after lying down for 6 hours and it does not affect their daily life. Thirdly, the uterus can be preserved, not only the shape of the uterus, but also the function of the uterus, and menstruation and pregnancy can be restored to normal. Fourthly, the recurrence rate is low. According to statistics, the recurrence rate of our hospital is 3% in 5 years, while the international statistics is 10%, which is related to the technology and the genetic factors of the patients.
The disadvantage is that the efficacy is slower than that of excisional surgery, and it takes 1 month to see the effect and 6 months to see the obvious effect.
16.Can I get pregnant after interventional treatment of fibroids? What is the best time?
After a long period of clinical research, it is concluded that patients with fertility requirements can still undergo interventional treatment. However, there are risks in any treatment. It is safer to get pregnant six months to one year after the operation, and we generally recommend contraception for six months, which is the time when the fibroids shrink most obviously. The advantage of interventional treatment is that there is no destruction of the uterus and there is no problem of uterine rupture in pregnancy.
The pregnancy is similar to the normal situation, but the patient should first tell the doctor that they have had interventional treatment before. Currently, the pregnancy rate after interventional treatment in our hospital is 25.9%, and the children born after the treatment are healthy.
17.If I choose interventional treatment, what tests do I need to do before the operation?
In addition to routine gynecological examination, MRI is also required because it is necessary to know very precisely how many tumors there are and where they are located, and most importantly, to assess the blood flow so as to determine whether it is suitable for interventional treatment.
If more than 50% of the fibroids have benign lesions, they are not suitable for interventional treatment, because the tumors are absorbed slowly, and it is better to do the removal surgery directly. If the fibroids have malignant lesions, interventional treatment is needed to control the growth of the tumor in the early stage and then proceed to the next step of treatment.
(b) Prevention of fibroids: What are the ways to prevent fibroids?
It is difficult to prevent fibroids if there is a genetic factor and hormone receptor allergy. Since this disease is estrogen-dependent, the preventive approach in life is to minimize hormonal pollution of the environment.
In terms of diet, we should eat as little meat as possible, and eat more deep-sea fish to reduce hormonal contamination in our diet; we should not eat anything “hot”, i.e. fried food. In terms of life, women who love beauty should be careful in the choice of cosmetics and not to choose cosmetics containing estrogen. In addition, do not use drugs such as sheep placenta easily.
(iii) What should I do if I have fibroids?
This depends on the patient’s specific situation, such as age, clinical symptoms, physical signs, their own requirements, economic situation, etc. There are probably the following priorities.
1. For those who can be treated or not, those who do not have clinical symptoms and do not endanger their lives, they should not be treated, but should be observed. If the tumor is removed when it is small, but the hormonal environment has not changed, it will still recur. It is better to wait until the fibroid grows and clinical symptoms appear then treat it at once, so that the number of treatments can be reduced. For example, if a 1cm fibroid grows at the age of 30 and is then removed, it will still grow at the age of 35 and recur at the age of 40. It is better to wait until the 1cm grows to 4cm and then remove it, so it will suffer less stabbing.
2.If the uterus can be removed or not, choose not to remove the uterus, choose interventional treatment or tumor removal.
3.If the treatment is invasive and minimally invasive, choose minimally invasive treatment, and if intervention is compared with myoma removal, choose intervention; among myoma removal, transvaginal myoma removal is preferred.
4.Cautiously choose drug treatment, because no drug has very definite efficacy in treating fibroids, and the side effects are large.
The general rule is to choose a good hospital, and a professional gynecologist, and to express your wishes and requirements clearly, and to choose the treatment carefully.