1 / 23

DEFINITION OF UTERINE FIBROIDS.

DEFINITION OF UTERINE FIBROIDS. Uterine Fibroids are benign (non-cancerous) tumors of the uterus. They are clinically apparent in up to 25% of women and, with newer imaging techniques, the true clinical prevalence may be higher up to 77%)

lucien
Download Presentation

DEFINITION OF UTERINE FIBROIDS.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DEFINITION OF UTERINE FIBROIDS. • Uterine Fibroids are benign (non-cancerous) tumors of the uterus. • They are clinically apparent in up to 25% of women and, with newer imaging techniques, the true clinical prevalence may be higher up to 77%) • Most do not cause symptoms, uterine fibroids can cause severe problems for some women.

  2. Types of and location of uterine fibroids.

  3. CAUSES • The exact reasons why Uterine Fibroids develop is unknown. However, two factors have been identified by researchers. They are GENETICS and HORMONES. • - Genetics: There is a strong genetic component to fibroid development, which causes fibroids to occur at least three [3] times more frequently among black women.

  4. Causes (continued) • Hormones: Uterine Fibroids can dramatically increase in size during pregnancy. It is thought that this effect is due to increase in the amount of estrogen - the female hormone - that naturally occur during pregnancy. After delivery, the fibroids usually shrink to the size they were before pregnancy.

  5. SYMPTOMS • Heavy menstrual bleeding in 84.5% • Pain in 62.1% • Bulk related symptoms in 82.9% • Heavy menstrual bleeding being the most troublesome feature.

  6. DIAGNOSIS • Uterine Fibroids are usually first diagnosed during a gynaecologic internal examination. This pelvic examination allows the physician to check the size of the uterus. An ultrasound examination may detect if fibroids are present, as well as determine their location and size. • The presence of fibroids can also be diagnosed using a more precise investigation - magnetic resonance imaging scanning (MRI).

  7. MRI

  8. TREATMENT • MEDICAL THERAPY - Use of drugs to control symptoms i.e. birth control pills, Hormones and NSAIDS. • SURGICAL THERAPY - Myomectomy which removes individual fibroids from the uterus. • HYSTERECTOMY- is a surgical procedure which removes the entire uterus. • NON-SURGICAL THERAPIES - (Uterine Fibroid Embolisation or Uterine Artery Embolisation, MRI guided focused Ultrasound ablation, MRgFUS)

  9. 2007 NICE HMB Guideline • ‘When surgery for fibroid related heavy menstrual bleeding is felt necessary then UAE, myomectomy and hysterectomy must all be considered, discussed and documented’ NICE clinical guideline 44January 2007

  10. FIBROID EMBOLISATION

  11. NON SURGICAL TREATMENT

  12. Work-up • Counselling and informed consent. Sent info booklet and then seen in IR OPD clinic • Imaging with MRI (at least US) • Recent Gynae assessment • Exclude infection • Pregnancy test • Baseline pre-procedure FSH

  13. Technique – Principles • Occlusion of uterine artery branches with particles • Ischaemic necrosis of the highly vascular fibroids • Unilateral or bilateral femoral artery approach.

  14. COMPLICATIONS • Pain should be pre-empted and treated expectantly • Infection • Post Embolisation syndrome. • Non-target Embolisation, ovarian failure • Vaginal discharge and expulsion of fibroids • No histology obtained, risk of missing a malignancy.

  15. FOLLOW UP • Pain management • Early detection of infection • Prompt treatment of infection • Continuity of care by team • Follow up scan at 6 and 12 months • Coordination of care by Clinical Nurse Specialist • Dedicated contact phone number .

  16. After treatment patient feedback

  17. ADVANTAGES OF FIBROID EMBOLISATION • LESS INVASIVE • PRESERVES THE UTERUS & FERTILITY • TREATS MULTIPLE FIBROIDS • SHRINKS FIBROIDS • EXCELLENT SYMPTOMATIC RELIEF • REDUCED TIME OFF WORK 6-10 DAYS

  18. Modern Woman Normal life and quality of life has resumed – thank you! ‘My life has completely turned around’ ‘I would recommend the procedure thoroughly. The symptoms that affected me have disappeared completely.’ ‘Overall I feel a lot better and improving each month.’ ‘I can now chair a meeting at work without having to get up and rush out of the room midway through.’

  19. Fertility Issues UAE Was not initially indicated for women wishing to retain fertility due to fears about IUGR. All large series now report pregnancies post UAE Advise against pregnancy within 12 months Effective symptomatic treatment of fibroids that keeps fertility options open Patient choice

  20. MR Guided Focused US Ablation • MRI used to image and target fibroids • High powered US generator in base of MR table focuses beam on point in fibroid and it is ablated using the MR scanner as a thermal imaging camera • Completely non-invasive • Can take 3-4 hours per treatment!

  21. MR Guided Focused US Ablation

  22. REFERENCES • www.drpaulcrowe.com • Boston Scientific Corporation 2007 “Uterine Fibroids” • Royal College of Obstetricians and Gynaecologists “Modern Management of Fibroids Embolisation” • www.birminghamfibroidclinic.co.uk • www.insightec.com

  23. THE END ANY QUESTIONS

More Related