What are Uterine Fibroids?
Delayed Treatment
We see many patients who have had failed
myomectomy followed by recurrence or
continual growth of remaining fibroids, who
are either advised conservative treatment by
their doctor or who do not wish to face the
prospect of further treatment, especially
surgery. If fibroids grow following
myomectomy, prompt treatment should be
strongly considered before the fibroids
become too large and therefore very
difficult to treat except by radical
surgery.
A Myth about FibroidsMany women in their forties with fibroids
causing significant often debilitating
symptoms will delay treatment having been
told that fibroids shrink after the
menopause. This is inaccurate and
misleading. After the menopause, assuming
that the patient does not have hormone
replacement therapy, oestrogen stimulation
is removed. Thus fibroids can no longer
grow. Occasionally some fibroids die owing
to defective blood supply but this is not
common and in most cases fibroid masses will
remain relatively unchanged after the
menopause. Patients should therefore be wary
of of delaying treatment in the hope that
fibroid masses may shrink after the
menopause. HRT post menopausally can cause
fibroids to grow or bleed. Post embolisation
fibroids are killed and therefore cannot
grow or be affected by oestrogen and
patients can have HRT after the menopause.
A Complication Myth about Fibroid
Embolisation
With regard to fertitlity, statements have
been made suggesting that fibroid
embolisation causes damage to the normal
uterine tissue. Whereas a few cases have
been described in the world literature (tens
of thousands of procedures have been carried
out in Europe and the USA) this complication
is extremely rare and may relate to over
embolisation or use of the wrong size
particles due to inexperience. Particle size
is importatnt in embolisation as the
diameter of vessels in fibroids is different
from that of vessels supplying normal
uterine tissue.
Fibroids and Hormone Replacement Therapy
Oestrogen is the main stimulus of fibroid
growth. After the menopause oestrogen drops
to a minimal level. HRT can stimulate
fibroid growth and therefore fibroid-related
symptoms. After embolisation fibroids are
killed and can no longer be affected by
oestrogen or other hormones. HRT is
therefore not contraindicated after fibroid
embolisation.
Alternatives
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