Myomectomy

Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makespregnancy more likely than before. Myomectomy is the preferred fibroid treatment for women who want to become pregnant. After myomectomy, your chances of pregnancy may be improved but are not guaranteed. Before myomectomy, shrinking fibroids with gonadotropin-releasing hormone analogue (GnRH-a) therapy may reduce blood loss from the surgery. GnRH-a therapy lowers the amount of estrogen your body makes. If you have bleeding from a fibroid, GnRH-a therapy can also improve anemia before surgery by stopping uterine bleeding for several months.

Uterine fibroid symptoms can develop slowly over several years or rapidly over several months. Most women with uterine fibroids have mild symptoms or none at all and never need treatment. For some women, uterine fibroid symptoms become a problem. Pain and heavy menstrual bleeding are the most common symptoms. In some cases, difficulty becoming pregnant is the first sign of fibroids.

Uterine fibroid symptoms and problems include: o o o o o o o o o o o o o o Abnormal menstrual bleeding. Up to 30% of women with fibroids have menstrual period changes, such as:1 Heavier, prolonged periods that can causeanemia. Painful periods. Spotting before or after periods. Bleeding between periods. Pelvic pain and pressure, such as: Pain in the abdomen, pelvis, or low back. Pain during sexual intercourse. Bloating and feelings of abdominal pressure. Urinary problems, such as: Frequent urination. Leakage of urine (urinary incontinence). Kidney blockage following ureter blockage (rare). Other symptoms, such as: Difficulty or pain with bowel movements. Infertility. Sometimes, fibroids make it difficult to become pregnant. Problems with pregnancy, such as placental abruption and premature labor. Miscarriage.

Your health professional may suspect that you have a uterine fibroidproblem based on: The results of a pelvic exam. The history of your symptoms and your menstrual periods. You will probably also have a pelvic ultrasound or hysterosonogram to confirm that you have one or more uterine fibroids. A hysterosonogram is done by filling the uterus with sterile saline during a transvaginal pelvic ultrasound.
Recommended Related to Uterine Fibroids
Uterine Fibroids Uterine fibroids (leiomyomata) are non-cancerous growths that develop in or just outside a womans uterus (womb). Uterine fibroids develop from normal uterus muscle cells that start growing abnormally. As the cells grow, they form a benign tumor. Read the Uterine Fibroids article > >

If you have had heavy menstrual bleeding, you may have a complete blood count (CBC) to check for anemia. Laparoscopy may be used to look for and locate fibroids on the outer surface of the uterus before removal (myomectomy). Additional testing If you have severe pain, bleeding, or pelvic pressure or have had repeat miscarriages or trouble becoming pregnant, you will probably have other tests to look for other possible causes of your symptoms. Additional tests for specific symptoms, such as urinary or bowel problems, may be needed to diagnose the problem or develop a treatment plan.

Uterine Fibroids - Prevention

There is no known treatment that prevents uterine fibroids. But getting regular exercise may help. According to one study, the more exercise women have, the less likely they are to get uterine fibroids.10 Preventing fibroids from coming back after treatment It is common for fibroids to grow back after treatment. The only treatment that absolutely prevents regrowth of fibroids is removal of the entire uterus, calledhysterectomy. After hysterectomy, you cannot get pregnant. While many women report an improved quality of life after hysterectomy, there are also possible long-term side effects to consider. For more information, see the topic Hysterectomy.

Uterine Fibroids - Medications

Medicine can be used to help relieve uterine fibroid problems. The goals of medicine treatment are to: Relieve severe pain or other symptoms caused by fibroids. Correct anemia caused by heavy bleeding. Shrink fibroids before fibroid removal (myomectomy) or uterus removal (hysterectomy). Avoid hysterectomy. When treatment is stopped, symptoms usually return. Medication Choices The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods-they do not shrink fibroids: Nonsteroidal anti-inflammatory drug (NSAID) therapy relieves menstrual cramping and greatly reduces heavy menstrual bleeding for many women. But there are no studies that show that NSAIDs decrease fibroid pain or bleeding.4 Birth control hormones (pill, patch, or ring) reduce heavy menstrual periods and pain while preventing pregnancy. But they usually do not affect the size of uterine fibroids. An intrauterine device (IUD) that releases small amounts of a certain hormone (levonorgestrel) into the uterus may reduce heavy menstrual bleeding. A progestin shot (Depo-Provera) every 3 months may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may improve fibroids or may make them grow.5, 2 This might be different for each woman. Iron supplements, available without a prescription, are an important part of correcting anemia caused by fibroid blood loss.

Uterine Fibroids - References

Citations 1. Drinville JS, Memarzadeh S (2007). Benign disorders of the uterine corpus. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecologic, 10th ed., pp. 639-653. New York: McGraw-Hill. 2. Practice Committee of the American Society for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and reproductive function. Fertility and Sterility, 90(3): S125-S130. 3. Parker WH (2007). Etiology, symptomatology, and diagnosis of uterine myomas. Fertility and Sterility, 87(4): 725-736. 4. Lethaby A, Vollenhoven B (2009). Fibroids (uterine myomatosis, leiomyomas), search date November 2006. Online version of BMJ Clinical Evidence. Also available online: www.clinicalevidence.com. 5. American College of Obstetricians and Gynecologists (2006, reaffirmed 2008). Use of hormonal contraception in women with coexisting medical conditions. ACOG Practice Bulletin No. 73.Obstetrics and Gynecology, 107(6): 1453-1472.

Surgery Choices Surgical treatment options include: Myomectomy, or fibroid removal. This is the only fibroid treatment that may improve your chances of having a baby.2 It is known to help with a certain kind of fibroid called a submucosal fibroid. But it may not help with any other kind of fibroid.3 Hysterectomy, or uterus removal. This is only recommended for women who have no future pregnancy plans. Hysterectomy is the only fibroid treatment that prevents regrowth of fibroids. It improves quality of life for many women, but it can also have negative long-term effects, such as pelvic organ prolapse. For more information, see the topic Hysterectomy. Myomectomy or hysterectomy can be done through one or more small incisions using laparoscopy, through the vagina, or through a larger abdominal cut (incision). The method depends on your condition, including where, how big, and what type of fibroid is growing in the uterus and whether you hope to become pregnant. Uterine fibroids: Should I have surgery? Uterine fibroid embolization (UFE) (also called uterine artery embolization) is a nonsurgical option that shrinks or destroys a fibroid by cutting off its blood supply. For more information, see the Other Treatment section of this topic.

Uterine Fibroids
Uterine Fibroid Symptoms Most women with uterine fibroids have no symptoms. However, abnormal uterine bleeding is the most common symptom of a fibroid. If the tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause heavy periods, painful periods, prolonged periods or spotting between menses. Women with excessive bleeding due to fibroids may develop iron deficiency anemia. Uterine fibroids that are deteriorating can sometimes cause severe, localized pain. Fibroids can also cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. Large fibroids can cause:
pressure, pelvic pain, pressure on the bladder with frequent or even obstructed urination, and pressure on the rectum with pain during defecation.

What are uterine fibroids?

Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are many times denser than normal myometrium. Uterine fibroids are usually round or semi-round in shape. Uterine fibroids are often described based upon their location within the uterus. Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the organ). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle. Submucosal (submucous) fibroids are located inside the uterine cavity beneath the lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus.

Medical treatments
Non-surgical techniques are usually hormonal in nature and include the use of drugs that turn off the production of estrogen from the ovaries (GnRH analogs). These medications are given for three to six months and induce a hypoestrogenic (low estrogen) state. When successful, they can shrink the fibroids by as much as 50%. Side effects of these drugs are similar to the symptoms of the perimenopause and can include hot flashes, sleep disturbance, vaginal dryness, and mood changes. Bone loss leading toosteoporosis after long-term (12+ months) use is the most serious complication. These drugs may also be used as preoperative treatment prior to undergoing surgical treatment of leiomyoma. Mifepristone (RU-486) is an antiprogestin drug that can shrink fibroids to an extent comparable to treatment with the GnRH analogs. This drug, sometimes known as the "morning-after pill" is also used to terminate early pregnancy. Treatment with mifepristone also reduced the bleeding associated with fibroids, but this treatment can be associated with adverse side effects such as overgrowth (hyperplasia) of the endometrium (uterine lining). Mifepristone is not approved by the US Food and Drug Administration (FDA) for the treatment of uterine leiomyomas, and the required dosages (different from those used for termination of early pregnancy) have not been determined. Danazol (Danocrine) is an androgenic steroid hormone that has been used to reduce bleeding in women with fibroids, since this drug causes menstruation to cease. However, danazol does not appear to shrink the size of fibroids. Danazol is also associated with significant side effects, includingweight gain, muscle cramps, decreased breast size, acne, hirsutism (inappropriate hair growth), oily skin, mood changes, depression, decreased high density lipoprotein (HDL or 'good cholesterol') levels, and increased liver enzyme levels. The administration of raloxifene (Evista) (a drug used to prevent and treat osteoporosis in postmenopausal women) has been shown to decrease the size of fibroids in postmenopausal women, but results with this therapy in premenopausal women have been conflicting. Low dose formulations of oral contraceptives are also sometimes given to treat the abnormal bleeding associated with fibroids, but these do not shrink the fibroids themselves. Use of oral contraceptive pills has been associated with a decreased risk of developing fibroids, so some women may benefit from their use for this purpose.

What are the risks of uterine fibroids during pregnancy?

Uterine fibroids are identified in about 10% of pregnant women. Some studies have shown an increased risk of pregnancy complications in the presence of fibroids, such as first trimester bleeding, breech presentation,placental abruption, and problems during labor. Fibroids have also been associated with an increased risk of cesarean delivery. The size of the fibroid and its precise location within the uterus are likely to be important factors in determining whether a fibroid causes obstetric complications.

What Is Adenomyosis?
Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot. Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman's quality of life.
Recommended Related to Women
Vulvovaginitis Important It is possible that the main title of the report Vulvovaginitis is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Read the Vulvovaginitis article > >

What Are the Symptoms of Adenomyosis? While some women diagnosed with adenomyosis may have no symptoms, the disease can cause:

Heavy, prolonged menstrual bleeding Severe menstrual cramps Abdominal pressure and bloating

Who Gets Adenomyosis? Adenomyosis is a common condition. It is most often diagnosed in middle-aged women and women who have had children. Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis. Though the cause of adenomyosis isn't known, studies have suggested that various hormones -- including estrogen, progesterone, prolactin, and follicle stimulating hormone -- may trigger the condition. Diagnosing Adenomyosis Until recently, the only definitive way to diagnose adenomyosis was to perform ahysterectomy and examine the uterine tissue under a microscope. However, imaging technology has made it possible for doctors to recognize adenomyosis without surgery. Using MRI or transvaginal ultrasound, doctors can see characteristics of the disease in the uterus.

If a doctor suspects adenomyosis, the first step is a physical exam. A pelvic exam may reveal an enlarged and tender uterus. An ultrasound can allow a doctor to see the uterus, its lining, and its muscular wall. Though ultrasound cannot definitively diagnose adenomyosis, it can help to rule out other conditions with similar symptoms. Another technique sometimes used to help evaluate the symptoms associated with adenomyosis is sonohysterography. In sonohysterography, saline solution is injected through a tiny tube into the uterus before an ultrasound is given. MRI -- magnetic resonance imaging -- can be used to confirm a diagnosis of adenomyosis in women with abnormal uterine bleeding. Because the symptoms are so similar, adenomyosis is often misdiagnosed asuterine fibroids. However, the two conditions are not the same. While fibroids are masses of tissue attached to the uterine wall, adenomyosis is a growth within the uterine wall. An accurate diagnosis is key in choosing the right treatment. How Is Adenomyosis Treated? Treatment for adenomyosis depends in part on your symptoms, their severity, and whether you have completed childbearing. Mild symptoms may be treated with over-the-counter pain medications and the use of a heating pad to ease cramps. Anti-inflammatory medications. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild pain associated with adenomyosis. NSAIDs are usually started one to two days before the beginning of your period and continued through the first few of days of your period.

The Uterus : Myometrium & Endometrium

The Uterus is uniquely feminine, it's why only women can have babies. The uterus can be diagnosed for fertility using advanced medical technologies. For most women, the uterus is simply the site of a lot of female problems. Not only does it cause many menstrual miseries; it also used to be believed in the past that a "wandering uterus" caused hysteria.

However, the uterus is a remarkable organ, which deserves a lot more respect. The uterine lining - the endometrium, is a remarkable tissue which grows and regenerates every month ! Basic scientists are learning a lot more about the marvels of cell proliferation and how it is regulated by studying the endometrium. More importantly, the uterus is what really makes a woman a woman. By giving a man female hormones, we can feminise him ; we can give him artificial breasts; and by surgery, we can create an artificial vagina; but the uterus is unique to women, which is why only women can have babies ! The uterus has 2 basic parts. One is the muscle, also called the myometrium. This is the wall of the uterus; and is where fibroids grow. The more important part is the endometrium. This is the inner lining of the uterus. It is this lining which is shed during the menstrual period; and it is in this lining that the embryo implants. For most women, the uterus is rarely a cause of infertility, because it is remarkably resilient. However, in some women, it does affect fertility, and this can be a very frustrating problem. The uterus can be studied by means of: 1. 2. vaginal ultrasound scanning, to check for the uterine lining thickness and texture and a HSG ( hysterosalpingogram, an X-ray of the uterus and tubes, which is done on Day 5-7 of the cycle.

The gold standard to evaluate the uterine cavity is a hysteroscopy. Related Searches: Infertility Uterus, Infertility Myometrium, Infertility Endometrium,Vaginal Ultrasound Scanning, HSG Infertility, Infertility Hysterosalpingogram,

Science News
Blog Cite Save Email Print Share

Recurrent Miscarriage Raises Heart Attack Risk Fivefold in Later Life, Study Finds
ScienceDaily (Dec. 1, 2010) Recurrent miscarriage increases a woman's chance of having a heart attack fivefold in later life, indicates research published online in the journal Heart.
See Also: Health & Medicine

Heart Disease Pregnancy and Childbirth Cholesterol Stroke Prevention Vioxx Diseases and Conditions

Reference

Miscarriage Stillbirth Fertility Gynecologic hemorrhage

Research indicates that miscarriage is one of the commonest complications of pregnancy, occurring in up to one in five pregnancies. The authors base their findings on more than 11,500 women who were taking part in the Heidelberg arm of EPIC, a large European study that is tracking the impact of diet and lifestyle on disease, particularly cancer. All the women had been pregnant at least once, and the authors were particularly interested in those whose pregnancies had ended prematurely, either as a result of miscarriage or abortion, or whose babies had been stillborn. Among the entire group, almost one in four (25%) had had at least one detectable miscarriage, while almost one in five (18%) had had at least one abortion. A further 2% had experienced a stillbirth. Of those 2876 women who had miscarried, 69 had done so more than three times. These women tended to weigh more; those who had experienced a stillbirth were less physically active and higher rates of diabetes and high blood pressure, all of which are independent risk factors for heart attack and stroke. Over a period of around 10 years, 82 women had a heart attack and 112 had a stroke.

No significant association was found between any of the types of pregnancy loss and an increased risk of stroke. But strong patterns emerged for stillbirth and miscarriage. But having at least one stillbirth increased the risk of a heart attack by 3.5 times. But those women who had had more than three miscarriages were nine times as likely to have a heart attack. The magnitude of the risk fell after adjusting for influential factors, such as weight, smoking, and alcohol consumption but it was still high, being five times as great. Each miscarriage increased heart attack risk by 40% and those women who miscarried more than twice were more than four times as likely to have a heart attack. "These results suggest that women who experienced spontaneous pregnancy loss are at a substantially higher risk of [heart attack] later in life," comment the authors. "Recurrent miscarriage and stillbirth are strong gender predictors for [this] and thus should be considered as important indicators for monitoring cardiovascular risk factors and preventive measures," they add.

Journal Reference: 1. Elham Kharazmi, Laure Dossus, Sabine Rohrmann, Rudolf Kaaks. Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study (EPICHeidelberg). Heart, 2010; DOI:10.1136/hrt.2010.202226

Science Reference Miscarriage

Miscarriage or spontaneous abortion is the natural or accidental termination of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined at a gestation of prior to 20 weeks.
STILL BIRTHA

stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body..