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Menstrual Health and Lifestyle Medicine
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Kranti Dasgupta, Madeline Hardacre, Michelle Tollefson
Uterine leiomyomata (fibroids), a frequent cause of heavy bleeding, are benign tumors arising from the smooth muscle of the uterus. Cumulative incidence of fibroids by age 50 is approximately 80% and 70% in black and white women, respectively.76 Risk factors include age, premenopausal state, hypertension, family history, time since last birth, food additives, and soymilk consumption,77 as well as estrogen and progesterone exposure.
Surgical Treatment of Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Ibrahim Alkatout, Liselotte Mettler
Myomectomy is a surgical treatment option for women who have not completed their family or who wish to retain their uterus for any other reasons. The enucleation of fibroids by any method is an effective therapy for bleeding disorders or displacement pressure in the pelvis. Nevertheless, the risk of recurrence remains after myomectomy. Furthermore, if any other pathologies might be causative or only co-causative for the symptoms (such as adenomyosis uteri), these problems will persist (Wallach and Vlahos 2004). Complications arising at myoma enucleations and pregnancy-related complications have been investigated extensively. All operating possibilities, especially laparoscopic versus laparotomic but recently also laparoscopic versus robotic-assisted myomectomy, have been evaluated. Uterine rupture or uterine dehiscence is rare and occurs in less than 1% of laparoscopic cases and even less seldom in robotic-assisted and laparotomic cases. Careful patient selection and secure preparation and suture techniques appear to be the most important variables for myomectomy in women of reproductive age (Kim et al. 2013; Lonnerfors and Persson 2011). Uteri with multiple fibroids have an increased number of uterine arterioles and venules. Therefore, myomectomy can lead to significant blood loss and corresponding arrangements should be made (Mettler et al. 2012b).
The Uterus
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Jure Knez, Veljko Vlaisavljević
Adenomyosis is a benign condition of the uterus characterized by the presence of endometrial glands and stroma within the myometrium. Historically, the diagnosis could only be made by histological examination, but today we can diagnose this condition reliably with ultrasound. The prevalence in the general population has been estimated to be around 20%, which makes it one of the most common acquired uterine abnormalities [5]. The prevalence increases with age and reaches a peak at 40–49 years of age. Clinically, adenomyosis is most often associated with heavy and prolonged periods and menstrual pain. Although the correlation with fertility problems is less clear, recent clinical studies show that especially severe forms of adenomyosis can have an influence on reproductive function in women [6].
A method to protect the endometrium for microwave ablation treating types 1-3 uterine fibroids: a preliminary comparative study
Published in International Journal of Hyperthermia, 2023
Hong-Hui Su, Dong-Ming Guo, Pei-Shan Chen, Meng-Hong Cai, Yu-Xia Zhai, Zhe Chen, Wei-Jian Luo, Zhi-hui Lin, Wen-Bin Zheng
Patients in the study group were treated with percutaneous intrauterine instillation of chilled saline to protect the endometrium. All patients took laxatives one day before surgery to empty the intestinal contents and emptied the bladder before puncture. Applying pressure to the abdominal wall during puncture can push the intestinal tracts and omentum aside. This helps to puncture the uterus, even the retroverted uterus. Additionally, the retroverted uterus can be punctured in the direction from the cervix to the fundus. Before the ablation started, an 18 gauge puncture needle was percutaneously penetrated into the uterine cavity under the guidance of ultrasound, and the outer end of the needle was supplied with chilled saline for instillation under continuous pressure to protect the endometrium throughout the operation (Figure 1). The instilled normal saline was discharged from the uterine cavity through the vagina. A funnel-shaped drainage bag was placed at the perineum to avoid spillage and drain the water into a bucket. The puncture needle was removed immediately after the operation.
Therapeutic dose and long-term efficacy of high-intensity focused ultrasound ablation for different types of uterine fibroids based on signal intensity on T2-weighted MR images
Published in International Journal of Hyperthermia, 2023
Yangyang Wang, Chunmei Gong, Min He, Zhenjiang Lin, Feng Xu, Song Peng, Lian Zhang
Conventional treatments for symptomatic uterine fibroids include medication, myomectomy and hysterectomy. Recently, uterine artery embolization (UAE) has become a routine treatment for uterine fibroids in developed countries. Medication can be used to effectively control fibroid-related symptoms, but symptoms can easily recur after medication withdrawal. In addition, serious side effects of some medications have limited their role in the management of uterine fibroids. Myomectomy is a standard treatment for patients with uterine fibroids who wish to retain their uterus, but the cumulative recurrence rates at 12 and 24 months after myomectomy were high [5]. Hysterectomy is a definitive treatment for uterine fibroids, but this operation is not suitable for patients who wish to remain fertile. UAE is less invasive than surgery and can be used to effectively control the symptoms caused by uterine fibroids, but its adverse effects on ovarian function, have limited the clinical application of this technique.
Temporary cervical sling and uterine twist before B-Lynch for massive uterine bleeding after delivery
Published in Journal of Obstetrics and Gynaecology, 2022
Basile Pache, Vincent Balaya, David Desseauve
After de-twisting the uterus but maintaining the cervical sling, the first step is to exit threads from the cavity on the posterior wall from the uterus at A and B (video). The two strands of the suture are looped over the fundus, like suspenders, and then re-entered into the uterine cavity anteriorly at C and D, on the upper edge of the hysterorrhaphy. It is then exited from the lower edge of the hysterorrhaphy at E and F, which are directly below C and D, respectively. The uterus is rolled from the fundus, emptied and very tightly maintained. The two strands are tied together, ending the original B-Lynch procedure. Tying the two suspenders together allows them not to slip when the uterus will contract. Additional rolling up carpeting knots can be performed to lower even more the uterine volume.