Fibroids, Uterine Polyps and Adenomyosis Treatments

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Fibroids, Uterine Polyps, and Adenomyosis Treatment

Most women have suffered from PMS at one point in their lives, but once its symptoms affect their lifestyle negatively, then it is high time they visit an expert who deals with issues of women’s health. Health problems associated with reproduction are often mistaken for other illnesses, and many women visiting the doctor in search of a solution are misdiagnosed. In cases where you have extreme symptoms of PMS, then four main causes could be the source of the problems, and they all manifest in much the same way.

Adenomyosis Explained

Also referred to as the sister disease of endometriosis, adenomyosis is characterized by the growth of the endometrial tissue, the inner lining of the uterus, into the myometrium, which is the muscular wall of the uterus.

While adenomyosis is sometimes called internal endometriosis, the key difference is that with adenomyosis, there is a physical thickening of the uterus due to the lining growing deep into the muscle wall. The lining does not go past the uterus itself, whereas with endometriosis, the lining spreads outwards and attaches to nearby pelvic structures.

What are Fibroids?

Uterine fibroids, also known as leiomyomas and myomas, are benign tumors composed of smooth muscle tissue that typically develop in the uterus walls. These tumors are capable of causing menstrual bleeding, painful cramping, pelvic pressure, and complications with urination and defecation. Depending on their size and rate of growth, fibroids may affect conception and pregnancy as well.

Diagnosis of Fibroids

There are several ways in which one may diagnose fibroids, contingent upon the size and location of the latter.

Physical Examination: Should the tumor or tumors be very large, they may be detected through physical examination of the pelvic area.
Routine Pelvic Ultrasound: It is an ultrasound scan that allows for examining the uterus lining; it is generally considered to be the most effective method to detect a fibroid. During an ultrasound examination, a thin device known as a transducer is inserted into the vagina. To assess whether fibroids will affect the uterus lining, this test must be conducted close to ovulation.
Hysterosonogram Ultrasound (Saline Sonogram or Water Sonogram): This vaginal ultrasound exam involves injecting sterile saline (salt water) into the uterine cavity. This solution expands the uterus, making it easier to see and measure any fibroids that may be located there. This test is best for locating submucous fibroids, those found in the uterus itself.
Hysteroscopy: Hysteroscopy is a minimally invasive surgical procedure in which a lighted telescoping instrument, called a hysteroscope, is inserted into the cervical opening of the uterus. Abnormalities in the wall of the uterine cavity are then inspected visually. Any fibroids discovered are often be removed.
Magnetic Resonance Imaging MRI: An MRI uses powerful magnetic fields, radio waves, and computers to generate extremely detailed images of soft tissues, as well as all other body structures. With fibroids, an MRI is helpful in pinpointing multiple tumors of varying sizes, allowing for their removal. Due to its sensitivity, an MRI can also help to differentiate fibroids from adenomyosis, another uterine condition that can mimic symptoms similar to fibroids.

Treatment of Uterine Fibroids

There is a surgical treatment known as myomectomy that allows the removal of fibroids but still maintains both the uterus and the ovaries, making fertilization possible. Myomectomy can be done through several techniques according to the position, number, and size of fibroids.

Myomectomy via Laparotomy: In the case where fibroids are found to lie within the uterine walls, then surgery would be carried out via laparotomy where a cut is made through the abdominal cavity. The laparotomy is considered the most appropriate way of treating large or many fibroids lying within the muscle walls of the uterus. Such a surgical process can be undertaken by almost all gynecologists. However, since this surgery involves opening of the abdomen, two to three days' hospitalization and four-six weeks' recovery period is expected from the surgery. Women undergoing abdominal myomectomy would definitely require cesarean delivery during future pregnancies.
Myomectomy through Hysteroscope (Hysteroscopic Resection): If the fibroid is mostly found inside the uterus, the recommended method for removing it is via a hysteroscope, which is a thin instrument that is inserted via the vagina into the uterus. The hysteroscope has specialized equipment for surgery, which will allow the doctor to see and cut the fibroids. This kind of surgery can only be conducted by highly trained gynecologists in the field of hysteroscopic procedures. Since no cuts are involved, this is a day-surgery procedure, meaning you can go home on the same day, and recovery period is quick - less than a week - and no cuts.
Myomectomy using a Laparoscope (Laparoscopic Myomectomy): This surgery involves the use of a laparoscope, a tool that is inserted into the abdominal cavity through a small cut. Although this method is less invasive than open surgery, it needs to be performed by gynecologists who are specially trained in such techniques. Recently, some laparoscopic surgeons have used robotics to conduct laparoscopic surgeries.
Uterine Artery Embolization. While promising, this procedure is still under investigation concerning its long-term effects and, therefore, is not advised for women wishing to preserve their reproductive capacity. In uterine artery embolization, an interventional radiologist uses imaging guidance to place a catheter into the uterus arteries supplying the fibroid blood flow. Through the catheter, he then injects tiny beads into the arteries to cut off the blood flow to the fibroids.

Endometrial Polyps

These are small growths that protrude from the endometrium, the inner layer of the uterus. Most women may develop them without exhibiting any symptoms. They are common among women aged between thirty and forty years and could be responsible for infertility.

Diagnosis of Polyps: Usually a routine vaginal ultrasound done before ovulation will confirm the presence of a polyp. In some cases, the physician may need to conduct a hysterosonogram or a hysteroscopy procedure (see section on diagnosis of fibroids above). It may not be possible to detect endometrial polyps using a hysterosalpingogram as a radio opaque dye is required during this procedure.
Treatment of polyps: Removal of the polyps through hysteroscopy (see section above) will allow the patient to conceive shortly afterwards.
Uterine Scar Tissue: Occasionally women may develop scar tissues within the uterine cavity after a dilation and curettage procedure. When severe scaring occurs, the condition becomes referred to as Asherman's syndrome.
Asherman's syndrome: The presence of scar tissue makes it impossible for the embryo to implant itself in the uterine wall.
Diagnosis of uterine scarring: Any one of ultrasound, hysterosonogram, hysteroscopy, or hysterosalpingogram can be used to identify scar tissues inside the uterus.
Treatment of uterine scarring: Hysteroscopy and removal of scar tissue.
Uterine Congenital anomalies: In very rare cases women may have been born with abnormalities such as uterine septum or uterine duplication.
Diagnosis of Uterine Congenital Anomalies: Any of these conditions can be diagnosed by using ultrasound, hysterosonogram, hysteroscopy, or hysterosalpingography.
Treatment of Uterine Anomalies: Hysteroscopy and septum resection are recommended as treatment options for patients with a septate uterus. On the other hand, no treatment is needed for patients with uterine duplications except avoiding twins due to increased chances of pre-term birth.