Mayo Clinic Minute: Know your uterine fibroid treatment options

• By

  Deb Balzer

  February 24, 2022

Uterine fibroids are noncancerous tumors that grow in the wall of the uterus. Up to 80% of those who are born with a uterus may experience these benign masses of muscle in their uterus.

While fibroids are usually benign, they can cause reproductive issues, such as infertility or pregnancy loss, difficult menstrual periods, and pain.

Dr. Michelle Louie, a Mayo Clinic gynecologic surgeon and fibroid specialist, says it is important to know about the different approaches to treating fibroids so you can be sure you are given all the options to figure out the best one for you.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:33) is in the downloads at the end of this post. Please “Courtesy: Mayo Clinic News Network.” Read the script.

They are not uncommon and can be harmless, but for some, uterine fibroids can affect quality of life.

“Fibroids can cause predominantly two groups of symptoms. One is bleeding symptoms, where the person experiences very heavy or prolonged periods,” says Dr. Louie.

“The second category of symptoms most commonly experienced by people with fibroids are called ‘bulk symptoms,’ Dr. Louie says. “That’s just when fibroids get so large that they begin to exert a lot of pressure or heaviness in the pelvis, or they can press on surrounding organs like the bladder or the colon.”

Treatment can depend on the size and the location of the fibroids. Nonsurgical options may include monitoring the fibroids if they don’t cause bothersome symptoms, or medications to shrink the fibroids.

“The most traditional treatment option is a surgery called a myomectomy. It’s done by your gynecologist or a fibroid specialist. It’s a procedure where we cut into the uterus to remove the fibroid and then sew the uterus back up so that it’s preserved for future pregnancy,” she says.

Newer minimally invasive options include radio frequency fibroid ablation and uterine fibroid embolization that allow most patients to go home the same day with shorter recovery times.A variety of surgical options are available, but the No. 1 message Dr. Louie wants patients to know is: “Help is available, and we can help them achieve a higher quality of life. They don’t have to suffer from fibroid-related symptoms.”

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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Radiological appearances of uterine fibroids

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Omission and prolapse of the uterus: symptoms, causes, diagnosis.

Uterine prolapse

• Description
• Organization of treatment
• Cost of treatment

Description

In some cases, the uterus is practically in its place, and there is a prolapse of the cervix associated with its hypertrophy and elongation. It so happened historically that any prolapse of the patient (sometimes doctors) is called prolapse of the uterus, although, as mentioned above, this is not entirely true.

Symptoms

Signs of uterine prolapse consist of dysfunction of those organs that are involved in the pathological process. By itself, the displacement of the uterus causes:

• foreign body sensation in the vagina
• sexual discomfort
• Pulling sensations in the lower abdomen.

It is important to remember the fact that the uterus lies at the top of the vagina, so its prolapse is inevitably accompanied by prolapse of the anterior / posterior wall of the vagina, and hence the bladder / rectum.

That is why patients with “uterine prolapse” complain:

• for urination disorders (difficulty urinating, feeling of incomplete emptying of the bladder, frequent urination, loss of urine during exertion or against the background of sharp urges, etc.)
• for problems with defecation (difficult defecation, defecation in portions, the need to adjust the prolapse to completely empty the bowel, etc.).

Reasons

The causes of uterine prolapse can be described according to the life path model. At the beginning, a person has one or another predisposition to the development of this pathology. Further, various aggressive factors begin to act on it, which lead to the onset of the disease. At the first stage, the body copes with the damage that has occurred, however, age and the accumulation of breakdowns lead to its manifestation and, in fact, to the complaints that were described above. All pathological factors can be divided into the following:

• Heredity. It has been proven that if the next of kin has the disease, the likelihood of occurrence increases several times. Most often, there is a congenital weakness of the connective tissue, which also affects other body systems, manifesting itself in diseases of the musculoskeletal system, varicose veins, and hemorrhoids. However, heredity is still a predisposition not a sentence, but what makes it a reality are the risk factors, which will be discussed below.
• Childbirth and pregnancy. Perhaps the main factor that leads to changes in the qualitative composition of the supporting apparatus of the pelvic floor and its partial damage. Unfortunately, with severe tissue failure, complete prolapse of the uterus can develop immediately after childbirth. On the other hand, in most parturient women, the prolapse completely regresses within the first year.
• Increased loads. And this is not only hard physical labor, but also chronic constipation, lung diseases, accompanied by a constant and severe cough, obesity. All these factors lead to damage to the ligamentous apparatus of the pelvic organs and their prolapse.
• Age. This factor has a complex effect on all supported structures of the pelvic floor. Firstly, with age, the hormonal background changes, and with it the quality of the connective tissue (it becomes looser and weaker). In some patients, hormonal changes lead to deformation and changes in the cervix, according to the type of its elongation and hypertrophy. Secondly, muscle tone decreases, including that of the pelvic floor. In this regard, once received, injuries of the ligamentous apparatus are deprived of support and become obvious

Diagnosis

Diagnosis of uterine prolapse does not raise questions from specialists. To do this, it is necessary to conduct a standard gynecological examination, on the basis of which the stage of prolapse is set and the vaginal section involved in the pathological process is determined.

Most often, there is damage to all three sections of the pelvic floor: anterior, posterior and apical.

In total, four degrees of uterine prolapse are distinguished: the first (initial), when the patient is practically not bothered by anything, the fourth degree is accompanied by a complete prolapse of the pelvic organs.

The study may be supplemented by a digital rectal examination to rule out rectal prolapse.

As instrumental methods, ultrasound of the pelvic organs is performed, and sometimes MRI.

Treatment

Treatment of uterine prolapse includes surgical and conservative methods of treatment.

Conservative methods include:

• Kegel exercises during uterine prolapse are aimed at increasing the tone of the pelvic floor muscles. Due to this, a base appears in the damaged ligamentous apparatus, which prevents the pelvic organs from dropping excessively. Unfortunately, it is quite difficult to perform these exercises correctly, since it is difficult to train what you cannot see and do not control. To solve this issue, biofeedback devices (BFB-therapy) were developed, which increases the effectiveness of exercises several times. This method will be useful for young patients and women after childbirth.
• Pessaries and bandages are designed to create an obstacle in the way of descending organs. When the uterus is lowered, the pessary is placed in the vagina and serves as a kind of spacer. Unfortunately, the presence of a foreign body inside often causes discomfort, chronic inflammation and, most importantly, requires regular visits to the gynecologist to change it. In the case of bandages, it is just tight underwear that does not allow prolapse to come out of the vagina. Sometimes it is combined with a pessary and works like a “cork”. These methods can be used if the operation cannot be done for some reason. This can be compared with a crutch for a limb injury.

Operation

The main method of treatment is still surgical, since the supporting apparatus of the pelvis is not restored. Unfortunately, the most popular method – removal of the uterus often does not help, since not only the uterus descends, but the pelvic organs (bladder, rectum).

For this reason, this approach leads in 30-50% of cases to the development of vaginal stump prolapse.

Another problem of hysterectomy is post-hysterectomy syndrome, which leads to impaired urination, defecation and decreased sexual function, including due to postoperative shortening of the vagina. The most optimal and proven are reconstructive surgeries performed through the vagina. On the one hand, they allow to achieve a good anatomical result, on the other hand, a good cosmetic effect. One of the most modern techniques is hybrid operations, which allow individualizing the operation for each specific patient, while making the most of his own tissues, and, if necessary, supplementing them with a prosthesis only in the busiest places.

Organization of treatment

Hospitalization for the purpose of surgical treatment is carried out according to the principle “one window” . It is enough for the patient (or the person representing him) to write a letter with the wording of his question. At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

CHI and VMP treatment

Citizens of the Russian Federation can receive free treatment under the CHI program for most diseases

No matter where you live

80% of patients come to us from the regions of the Russian Federation and countries of near and far abroad

Many years of experience

Every year more than 3000 operations of any complexity are performed in the Department of Urology

At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

1. Online consultation with a specialist

The organization of hospitalization for the purpose of surgical treatment is carried out according to the principle of “one window”. To do this, it is enough for the patient (or the person representing him) to write a letter with the wording of his question.

Write a letter

2. Appointment of the date of hospitalization

After the consultation, our administrator will contact you within a few days to make an appointment for hospitalization.

3. Examination before hospitalization

Preoperative examination should be carried out only after the approval of the date of hospitalization. You can get most of the examinations at the antenatal clinic or polyclinic at the place of residence free of charge, under the CHI policy.

If in your locality there is no opportunity to be adequately examined – do it in the regional center, if everything cannot be done within the framework of compulsory medical insurance (under the policy) – do it in paid laboratories (clinics).

NOT LATE THAN 14 DAYS before hospitalization, you must send SCANS (not photographs) of the test results to the email address: [email protected]

4. Hospitalization in department

10 days before surgery withdrawal of drugs that affect blood coagulation (aspirin, Plavix, warfarin, etc.) is REQUIRED unless otherwise agreed with the attending physicians.

It is highly desirable to arrive for surgical treatment with pre-selected and purchased surgical compression stockings (white stockings, antithrombotic 2nd class of compression or as recommended by the vascular surgeon).

Cost of treatment

Department doctors

Referrals

Patient reviews

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