The medical treatments currently approved include releasing intrauterine progestogens to reduce the uterine bleeding, GnRH analogues, and, more recently, selective modulators of the receptors of progesterone to control uterine hemorrhage and reduce the volume of the fibroid.
The fibroids are benign tumors originating from the uterine muscle fibres. They may be isolated or multiple and may develop towards the inside, and then flowing into the cavità of the uterus or to the outside, going in the cavità abdominal. Can be identified in up to 70% of the women, in spite of most of them is not produce symptoms clinically significant. In fact, their symptomatology is variable and può also does not occur at all.
Generally, the symptoms are directly is related to the location of the fibroid and its size. For example, a fibroid that extends into the cavità uterine può cause minor bleeding and irregular until the real episodes of hemorrhage. A fibroma that results in the cavità abdominal ,instead, può cause problems if it is of such a size as to compress the bladder or the bowel, or if it reaches a size that can mimic a gravid uterus. Moreover, in some cases, it can cause dyspareunia (pain during intercourse), and interfere with normal reproduction.
The risk factors for the emergence and growth of fibroids are linked to reproductive factors, for example prolonged exposure to the steroid hormones (started early, menopause, the late -, oligo-ovulation), but also by ethnicity and hereditary factors.
Normally, fibroids do not need to be treated unless:
their growth is not too rapid, so as to arouse the suspicion of a mutation malignant;
- have the symptoms associated with it;
- the size or the number of them alter the cavità of the uterus to such an extent as to reduce the functionalityà of the surrounding organs and the probability; of reproductive success.
In these cases, the surgical removal (ofhysterectomy or myomectomy) is the recommended action.
in Addition to the action surgical there are also therapies destructive that involve the use of ultrasound, radiofrequency ablation, endometrial ablation, uterine artery embolization, and medical therapies that may improve the seriousnessà of the symptoms and, consequently, the qualityà of life itself.
In the african american population, the fibroids tend to occur at a young age, but in the other races usually develop in the last period of the reproductive years. In the latter group, the fibroids will be reduced once the woman entrerà in menopause thereforeò not all require surgical intervention; if the menopause is close enough, you canò to remove the surgical therapy through a few months of medical therapy.
The medical therapies today include progestins, selective modulators of estrogen receptor (SERM), aromatase inhibitors, analogs of gonadotrophin-releasing hormone (GnRh) and selective modulators of the receptors of progesterone (SPRMs):
- The progestin ( via oral, intramuscular or intrauterine) can control the bleeding by reducing the endometrial hyperplasia, but their use is not will reduceà the size of the fibroid, on the contrary, could induce growth.
- The SERMS will cause an effect of the agonist or antagonist of estrogen depending on the tissue. Raloxifene (EVISTA®) has effects uterine antiestrogenici and slows down cell proliferation. The studies have reported conflicting results regarding their efficacy in the treatment of fibroids.
- the aromatase inhibitors prevent the conversion of androgens into estrogen and, therefore, is expected to lower estradiol levels; but in women who have regular menstrual cycle, induce development multifollicolare and, in general, lead to relatively high concentrations of estradiol. Locally inside the uterus/fibroids, their effect può lead to a reduction of the synthesis of estradiol and, therefore, may cause regression of the tumor. Need more clinical information with regard to their effects before we can draw definitive conclusions.
- the GnRH analogues are effective in the reduction of the size of the tumor. They are also associated with a significant reduction of bleeding; in fact a prolonged use induces amenorrhea. It is così to create a situation of hypoestrogenism, that forò could cause unwanted side effects. Unfortunately, their effect is temporary becauseé for a time suspended the treatment, the fibroids return to their original size. GnRH analogues can be combined with the “add-back therapy”, which provides for the combined use of progestin, estrogen, SERM) in order to minimize the side effects.
- selective modulators of the receptors of progesterone (SPRMs) are the choices of medical treatment in the più recent. Has been shown to induce a decrease of up to 57% of the volume of the fibroid, and this effect has been maintained for at least 6 months following the treatment. Their use is not associated with the side effects of hypoestrogenism, but studies that assess the impact of long-term use are still ongoing.
further studies Are underway to evaluation for herbal therapies supplementation vitamin D as the choices of care for the treatment of fibroids.
Fonte: Fibroid Growth and Medical Options for Treatment, Chabbert-Buffet N, Esber N, Bouchard P. Fertil Steril. 2014;102:630-639 – Traduzione di Flavia Splendore
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