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How to treat recurrent uterine fibroids?

Q: I have been operated for uterus cysts both on the left and right side. I was given Decapeptyl Depot injection (total 3 nos) during and after one month of the operation. Since last week I am getting the pain again. The doctor has advised me to go for an ultrasound. The untrasound report showed 3 x 4 cm cysts again on the right side of the uterus. Doctor has advised me to continue with another 3 dozes of the above injection to suppress the growth of the cysts. Doctor has advised me to go for an operation after 45 years of age. What is your opinion on this? Kindly give me the pros and cons on this.

A:I think you mean a uterine fibroid when you mention uterine cyst. A fibroid (or a leiomyoma) is the most common non-cancerous tumour of the uterus, which arises due to overgrowth of smooth muscle and connective tissue in the uterus. The hormone estrogen promotes its growth and thus it tends to shrink following menopause. It may be single or multiple and rarely turns into cancer. The most common warning sign is a rapidly growing tumour that requires surgery. More than 90% of these tumours arise within the uterine wall (intramural) while only a few are on the outer surface (sub-serosal) or in the inner lining (submucosal, or subendometrial). Most patients are asymptomatic and only 10-20% of women require treatment. The symptoms depend on its location, size, & number and include: bleeding (increased amount & duration of flow), pain, pressure (urinary frequency, urgency, and/or incontinence result from pressure on the bladder or constipation or difficult defecation etc. due to pressure on the colon). The treatment depends on the symptoms, the size and location of fibroids, patient age (child-bearing or peri-menopausal), desire to have children and general health. If the patient is asymptomatic and if the fibroid is not growing rapidly, no treatment may be needed and twice-yearly examinations may suffice. Abnormal vaginal bleeding may require scraping of the uterine cavity in a procedure known as a dilatation & curettage (D & C). If no cancer is found, this bleeding can often be controlled by hormonal medications. Surgical options have both risks and benefits. Myomectomy is the surgical removal of only the fibroid(s) leaving the uterus intact enabling future pregnancy. This may be done via a hysteroscope, laparoscope, or an open procedure depending on the size and location of the fibroid. The procedure is less likely to injure the bowel, bladder, or ureter than hysterectomy. In contrast, hysterectomy is the surgical removal of the uterus, is the most commonly performed procedure in the treatment of fibroids and is considered a cure. Depending on the size of the fibroid, hysterectomy can be performed through the vagina or abdomen. A relatively newer technique is uterine artery embolisation in which the arterial blood supply to the fibroid is impeded. This procedure is done by inserting a small tube called catheter into an artery of the leg, tracing the blood supply to the uterus and then blocking the artery. This may be indicated in cases where other methods have failed or the patient is unwilling or unsuited for surgery. You need to discuss these issues with your doctor and then decide what is best suited.

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