Volume 2Number 2, July 2020
Fibroid: A common problem and its advanced management
Shaikh Zinnat Ara Nasreen1 , Nusrat Mahjabeen2 , Naima Sharmin Haque3 , Tasmia Chowdhury4
Uterine fibroids are the most common gynaecological disorder, classically requiring surgery when symptomatic. Although attempts at finding a nonsurgical cure date back to centuries, it is only around the middle of the last century that serious attempts at a medical treatment were carried out. Initially, both progestins and estrogen–progestin combinations have been utilized, although proof of their usefulness is lacking. A major step forward was achieved when peptide analogues of the GnRH were introduced, first those with super agonist properties and subsequently those acting as antagonists. Because both types of analogues produce hypoestrogenism, their use is limited to a maximum of 6 months and, so they can’t be used routinely but utilized as an adjuvant treatment before surgery with overall good results. Over the last decade, new, nonpeptidic, orally active GnRH-receptor blockers Elagolix and another development of selective progesterone receptor modulators, sometimes referred to as “antiprogestins of choice is Ulipristal acetate are promising.Large clinical trials have proven the effectiveness of Ulipristal in the long-term medical therapy of fibroids, caution must taken for liver complications. All selective progesterone receptor modulators produce unique endometrial changes that are today considered benign, reversible, and without negative consequences. Long-term medical treatment of fibroids seems possible today, especially in premenopausal women. Surgical treatments are myomectomy, radiofrequency ablation procedure, endometrial ablation, uterine artery embolization, magnetic resonance-guided focused ultrasound myolysis are effective and reserved for the women who desires to keep uterus, and morcellation . Still Hysterectomy is the definitive treatment for fibroid and the techniques of surgery is inclining towards minimum invasive surgery.
Keywords: uterine myomas, progestin, gonadotropin-releasing hormone receptor blockers, selective progesterone receptor modulators, antiestrogens.
- Professor & Head of Department of Obs. & Gynae
- Assistant Professor, Department of Obs. & Gynae
- Associate Professor, Department of Obs. & Gynae
- Registrar, Department of Obs. & Gynae