Fibroids are a common and frequent disease in women and the most common benign tumor in the female reproductive organs. The size of fibroids varies widely, from the smallest microscopic fibroids to those exceeding the size of a full-term pregnant uterus; their symptoms are also varied, and there are various treatment methods, such as expectant therapy, drug therapy, and surgery, depending on whether the patient is fertile or not. Therefore, the treatment of fibroids needs to be decided according to the patient’s age, the size of fibroids, the growth rate, the severity of clinical symptoms, and whether there is a requirement for childbirth.
At present, there are several methods for the treatment of uterine fibroids as follows.
1. Expectant treatment.
In most cases, uterine fibroids are asymptomatic. For fibroids that are not large (<5cm) and have no symptoms or mild symptoms, no special treatment is needed, only regular (ranging from every 3 months - 1 year) follow-up review. During the follow-up period, pay attention to whether the uterus is enlarged, whether symptoms appear, perform gynecological examination, and if necessary, ultrasound review. It should be reminded that before menopause, uterine fibroids do not shrink naturally due to the continuous effect of estrogen, so regular check-ups are necessary. For patients who are not pregnant, it is especially necessary to make regular checkups to avoid adverse effects on pregnancy.
2.Drug treatment.
At present, there are no special drugs for the treatment of uterine fibroids, but the drugs chosen now are GnRH-a, Ru486, etc. These drugs are mainly used to control the size of fibroids before surgery or when the patient is near menopause, and the fibroids can be slightly reduced after using the drugs to reduce the difficulty of surgery or make the patient near natural menopause to avoid surgery. Because of the non-curative treatment, the fibroids will increase again after stopping the medication. In addition, Chinese herbal medicine also has a certain therapeutic effect. Contraindications to drug treatment: ① fast growth of myoma, malignancy cannot be ruled out; ② degeneration of myoma, malignancy cannot be ruled out; ③ obvious symptoms of submucosal myoma, which affects conception; ④ torsion of subplasma myoma; ⑤ myoma causes obvious compression symptoms, or myoma occurs in pelvic entrapment and cannot be reset.
3.Ultrasound treatment.
High intensity focused ultrasound (HIFU) is a newly developed ultrasound treatment method in recent years, which focuses high-energy ultrasound on the treatment area and can rapidly raise the temperature of the target area to over 70℃ within 0.5 seconds, thus causing rapid coagulative necrosis of proteins in the cells in the treatment area and producing a therapeutic effect. A distinctive feature of the treatment is its non-invasive nature, and the treatment has few side effects. This treatment method, due to its non-invasive nature, will be a new direction in the treatment of uterine fibroids in the future. For fibroids that were previously only observable (e.g., fibroids of 1-5 cm, which are not enough for surgery), HIFU treatment can now be considered, allowing patients to avoid surgery. In 2003, we started HIFU treatment for uterine fibroids and adenomyoma, and have accumulated rich experience in treatment.
4.Arterial embolization therapy.
It is a newly developed treatment method. It is done by inserting a catheter into the uterine artery at the femur and infusing some embolic agents (such as gelatin sponge) into the uterine artery to block the blood supply to the fibroids and make the fibroids necrotic. Uterine artery embolization is an effective treatment for symptomatic fibroids (especially for patients with refractory uterine bleeding) and can be an alternative to myomectomy, hysterectomy or other surgical treatments.
5. Surgical treatment.
Surgery is still the main treatment for fibroids.
Surgical treatment options are required for fibroids with the following conditions.
(1) the uterine body is enlarged such as the size of 10 – 12 weeks of pregnancy.
(2) symptoms of pressure, such as frequent urination and rectal irritation
(3) Large menstrual flow secondary to anemia.
(4) rapid growth of myoma in a short period of time, which cannot be excluded from having malignant changes.
(5) found before or after menopause or enlarged after menopause.
(6) Combined ovarian tumors cannot be excluded.
(7) It is the cause of infertility.
(8) Fibroids in special locations, such as cervical fibroids, submucosal fibroids, and subplasmalemmal fibroid torsion.
Surgical treatment of uterine fibroids can be performed in the following ways
(1) Transabdominal surgery.
(1) uterine fibroid excision.
(ii) subtotal hysterectomy.
(3) Total hysterectomy.
(2) Transvaginal surgery.
① submucosal myomectomy.
② total hysterectomy in the negative.
(3) laparoscopic hysteroscopic surgery.
① laparoscopic total hysterectomy (LTH).
(ii) laparoscopic subtotal hysterectomy (LSH)
③ laparoscopic myomectomy (LM)
(iv) laparoscopic-assisted total negative hysterectomy (LASH)
⑤ laparoscopic intrafascial hysterectomy (LISH)
⑥Hysteroscopic myomectomy (HM).
6. Others, such as radiofrequency treatment.
Radiofrequency energy is applied to fibroids by transvaginal, transdermal or translaparoscopic application to destroy the fibroid tissue.