Eulalee ThompsonUterine fibroids are the most common solid pelvic tumours. About 80 per cent of women have fibroids, though they are not always troublesome. Fibroids are the leading indicator for hysterectomies the surgical removal of wombs.
EVEN WITH large fibroids in the walls of the womb, Dr. Horace Fletcher, consultant gynaecologist, says that many women prefer to conserve their wombs. They feel like this for many reasons some of them would like to maintain their childbearing capacities, others consider psychological and even religious reasons. Dr. Fletcher said too that studies show that in about two years after hysterectomy, many women have ovarian failure which can lead to premature menopause.
Although many gynaecologists, including Dr. Fletcher, view hysterectomy as the guaranteed treatment for uterine fibroids, they acknowledge the alternatives which are, no treatment at all, medical treatment or conservative surgical treatment.
Dr. Fletcher said that no treatment of fibroids is considered when they are asymptomatic, when the woman is pregnant and when she is peri-menopausal or post-menopausal.
Generally, he said, the gynaecologist would not trouble fibroids in women who are not experiencing symptoms which include abnormal menstrual bleeding, anaemia due to heavy bleeding, pelvic pressure, pain in the abdomen or lower back, infertility or miscarriage, pain during sexual intercourse and difficult or frequent urination (from fibroid pressure).
During pregnancy, fibroid removal is too high a risk and Dr. Fletcher said doctors would not remove them even during a Caesarean section.
No treatment is considered for peri-menopausal women since fibroids tend to get smaller in that age group. (Fibroid growth is linked to oestrogen production which declines dramatically at menopause).
Post-menopausal and peri-menopausal women have higher risks for mortality and morbidity during surgery than younger women and generally no treatment is considered for this group. Post-menopausal women might be on hormone replacement therapy (HRT), but Dr. Fletcher said there are other drugs that could benefit these women with fibroids.
There are many options available for the medical treatment of fibroids. Dr. Fletcher said, for example, drugs known as gonadotropin-releasing agonists, or GnRH agonists, reduce the symptoms of fibroids, reduce oestrogen and shrink fibroids, but they are expensive and their effect is temporary. Depo-Provera is inexpensive and reduces the heavy menstrual bleeding; mifepristone (RU-486) is more recently used to medically treat fibroids it is a progesterone agonist and works like GnRH.
Other options for medical treatment of fibroids are: myolysis the coagulation of the fibroid with a current or laser (used when the fibroids are not too big); endometrial ablation (surgical removal) used to control the bleeding but not a good method, Dr. Fletcher said, for the large fibroids seen by local gynaecologists; hydrothermablator using free-flowing saline within the uterine cavity to treat excessive bleeding; uterine artery embolisation the sealing off of the artery that feeds the uterus and fibroid.
Conservation surgical treatment of fibroids is usually myomectomy removal of the fibroids, but leaving the womb in tact. Dr. Fletcher said this is still the standard treatment for fibroids in Jamaica. This procedure relieves the symptoms of fibroids for a longer time than medical treatment. He said that instead of the tourniquet, local gynaecologists use a peri-vascular injection of the drug, vasopressin, during the surgery to reduce bleeding. This procedure was pioneered by local specialists and has been published in international journals.
He said that hysteroscopic and laparoscopic techniques can be used in surgery. These techniques involve the insertion of long thin instruments, with lights and video cameras. A small incision is made below the navel in the case of laparoscopy and in both cases the patient heals quicker than in the conventional surgical technique and with little scarring.
