Gynecology case no 3.Fibroids

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Gynecology case no 3.Fibroids

What are Fibroids ?

Fibroids are abnormal growths that develop in or on the uterus.Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In most cases, they cause no signs or symptoms at all.The growths are typically benign, or noncancerous. The cause of fibroids is unknown.

Fibroids are also known by the following names:

uterine fibroids
fibromas
myomas
leiomyomas
uterine myomas

According to the Office on Women’s Health, Around 20%-80% of women have them by the age of 50 years old. However, most people don’t have any symptoms and may never know they have fibroids.

Types of fibroids:-

There are various types of fibroids. The types differ depending on their location in or on the uterus

Intramural fibroids: Intramural fibroids are the most common type. They appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your uterus.
Subserosal fibroids: Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your uterus appear bigger on one side.
Pedunculated fibroids: Subserosal fibroids can develop a stem, a slender base that supports the tumor. When they do, they’re known as Pedunculated fibroids.
Submucosal fibroids: These types of tumors develop in the myometrium, the middle muscle layer of your uterus. Submucosal tumors aren’t as common as other types.
Cervical fibroids: Cervical fibroids develop on the cervix which connects the uterus to the Vagina They’re also rare.

Fibroids symptoms:-

Your symptoms will depend on the number of tumors you have as well as their location and size. For instance, submucosal fibroids may cause heavy menstrual bleeding and trouble conceiving.

If your tumor is very small or you’re going through menopause, you may not have any symptoms. Fibroids may even shrink during menopause and after menopause. This is because your estrogen and progesterone levels drop during menopause. These hormones stimulate fibroid growth.

Symptoms of fibroids may include:-

heavy bleeding between or during your periods.
Menstrual clots.
Menstruation that lasts longer than usual.
increased menstrual cramping
pain in the pelvis or lower back
Pressure or fullness in your lower abdomen.
Swelling or enlargement of the abdomen.
Increased Urination.
Pain during intercourse.

Pain during sex.
Low back pain.
Constipuation or feeling pressure on your rectum.
Long-term (chronic) Vaginal discharge .
Inability to pee or completely empty your bladder.
Increased abdominal distention (enlargement), causing your abdomen to look pregnant. Excessive or painful bleeding during your period.

Bleeding between your periods.
A feeling of fullness in your lower belly (abdomen)/bloating.
Frequent urination (this can happen when a fibroid puts pressure on your bladder).

What are the complications of uterine fibroids?

Most uterine fibroids don’t cause serious complications. However, the most common complications of fibroids are:

Pain that becomes unmanageable.
Swelling of your abdomen or pelvic area.
Excessive bleeding.
Anemia.
Infertility (this is rare).

Causes of fibroids:-

It’s unclear why fibroids develop. A couple of different factors may influence their formation:

Hormones: The Overies produce estrogen and progesterone. These hormones cause the uterine lining to regenerate during each menstrual cycle and stimulate the growth of fibroids.
Family history: Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.

People are at greater risk of developing fibroids if they have one or more of the following risk factors:

a family history of fibroids
are 30 years old or Older.
a high body weight.

People who are African American are also at a higher risk of fibroids than people of other ethnicities.

Fibroids and pregnancy:-

Pregnancy increases your body’s production of estrogen and progesterone. Fibroids may develop and grow rapidly while you’re pregnant.

That said, people who are pregnant are still less likely to develop fibroids than people who aren’t pregnant. According to a 2020 study, fibroids affect 20% to 40% of all women and only 0.1% to 3.9% of pregnant women.

Do fibroids cause pain?

Fibroids are noncancerous tumors that grow on the walls or lining of the uterus. Many women will have uterine Fibroids at some point, but most women don’t know they have them since they typically don’t have symptoms.

For some women, the pain from fibroids can be severe. Apart from heavy menstrual bleeding and Prolong periods fibroids can cause:

dull, chronic pelvic pain and pressure
lower back pain
abdominal swelling and bloating
pain with periods or sex

They can even make you feel like you need to urinate frequently

The pain may come and go or occur only during sex or menstruation. It may be sharp or a dull ache. Symptoms can also vary depending on the location, size, and number of fibroids you have.

The symptoms of fibroids may be similar to other pelvic disorders, such as:

Endometriosis
Adenomyosis
Pelvic infection

Where do fibroids grow?

Fibroids can grow as a single nodule (one growth) or in a cluster. Clusters of fibroids can range in size from 1 millimeter to more than 20 centimeters (8 inches) in diameter or even larger. For comparison, fibroids can be as small as a seed or get as large as a watermelon. These growths can develop within the wall of your uterus, inside the main cavity of your uterus or on the outer surface of your uterus.

What causes fibroid back pain?

The pain associated with fibroids occurs when they push and press on surrounding tissues. The larger the fibroid, the more likely it is to come into contact with the muscles and nerves of the lower back. This can lead to pain and discomfort that prevents women from enjoying everyday activities.

Additional symptoms can arise from the pressure of fibroids on surrounding organs. For example, if fibroids press on the bladder, a woman may experience urinary frequency and urgency. Additionally, if the tumors press on the rectum, a woman may have difficulty with bowel movements. Heavy bleeding and pain during intercourse may also occur.

How to find relief from back pain?

Some fibroid pain relief is possible through several at-home solutions:

Take over-the-counter pain medication: Drugs like ibuprofen or acetaminophen can reduce inflammation and alleviate pain. Speak with a healthcare provider before making changes to your medication.
Tablet 1:sulidac 200mg AS A Sulindac Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs) if persistence pain then apply if not existence the pain no need.

Apply heat: A heating pad may soothe muscle tension and ease the pain. Use on the lower back for 15 – 20 minutes at a time.
Engage in regular exercise: It may be difficult to find the motivation to work out when in pain, but moderate activity has been known to reduce discomfort. Exercise releases endorphins that block pain signals from reaching the brain.
Practice relaxation techniques: Try deep breathing or visualization to help your body relax and manage discomfort.

Fibroids diagnosis:-

For a proper diagnosis, you’ll need to see a gynecologist for a pelvic exam. During this exam, they’ll check the condition, size, and shape of your uterus.You may also need imaging tests.An Ultrasound uses high-frequency sound waves to produce images of your uterus on a screen. This will allow a doctor or healthcare professional to see the internal structures of your uterus as well as any fibroids.A Transvaginal Ultrasound in which an ultrasound wand is inserted into the vagina, may provide clearer images because it’s closer to the uterus during the procedure.A Pelvic MRI is an in-depth test that produces images of your uterus, ovaries, and other pelvic organs.

Ultrasonography : This noninvasive imaging test creates a picture of your internal organs with sound waves.
MRI: This test creates detailed images of your internal organs by using magnets and radio waves.
CT: A CT scan uses X-ray images to make a detailed image of your internal organs from several angles.
Hysteroscopy:- During a hysteroscopy, your provider will use a device called a scope (a thin, flexible tube with a camera on the end) to look at fibroids inside your uterus. The scope is passed through your vagina and cervix and then moved into your uterus.
Hysterosalpingography: This is a detailed X-ray where your provider injects contrast material and then takes X-rays of your uterus.
Sonohysterography: In this imaging test, your provider places a small catheter in your vagina and then injects saline into your uterus. This extra fluid helps to create a clearer image of your uterus than you would see during a standard ultrasound.
Laparoscopy: During this test, your provider will make a small cut (incision) in your lower abdomen. A thin and flexible tube with a camera on the end will be inserted to look closely at your internal organs.

Medications management:-

Medications to regulate your hormone levels may be prescribed to shrink the fibroids.

Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide acetate (Lupron Depot), will cause your estrogen and progesterone levels to drop. This will eventually stop menstruation and shrink your fibroids.

GnRH antagonist also help to shrink fibroids. These medications work by stopping your body from producing follicle-stimulating hormone and luteinizing hormone. Examples include:

cetrorelix acetate (Cetrotide), an injectable drug
injection1:-Cetrolix sc injection 250mcg/vial (AS A Cetrorelix Acetate Drugs affecting (inhibiting) gonadotrophin)
Indications of Cetrolix Sc Injection(AS A Cetrorelix Acetate Drugs affecting (inhibiting) gonadotrophin):-

Cetrolix is indicated for the treatment of infertility in females. It restricts eggs to release directly and prevents premature ovulation. In Female infertility, Cetrolix prevents release of premature eggs during a process called ovulation in females. This helps in normal development of an egg in a woman’s ovary (female reproductive organ), and stimulates the release of a healthy, matured egg. This helps to treat infertility in women and increases the chance of a successful pregnancy.

Side Effects Of Cetrolix Sc Injections (AS A Cetrorelix Acetate Drugs affecting (inhibiting) gonadotrophin):-

The most commonly reported adverse effects are local injection site reactions such as erythema, swelling and pruritus that are usually transient in nature and mild in intensity. Mild to moderate ovarian hyperstimulation syndrome (OHSS) (WHO grade I or II) have been commonly reported and should be considered as an intrinsic risk of the stimulation procedure.

ganirelix acetate (Fyremadel), an injectable drug
elagolix, which is present in the oral drug
Tablet 2:-Endolix 200mg As a Elagolix sodium (AS A Gonadotropin-releasing hormone (GnRH) antagonist)
Indications Of Endolix tablet (Elagolix sodium (AS A Gonadotropin-releasing hormone (GnRH) antagonist)

Endolix is indicated for the management of moderate to severe pain associated with endometriosis.

Side Effects of Endolix tablet (Elagolix sodium (AS A Gonadotropin-releasing hormone (GnRH) antagonist):-

Common: The most common side effects include hot flushes, night sweats, headache, nausea, amenorrhea, , arthralgia, mood changes & bone loss. Rare: Insomnia, anxiety & elevated hepatic transaminase.

elagolix/estradiol/norethindrone acetate (Oriahnn)

Other options that can help control bleeding and pain but won’t shrink or eliminate fibroids include:

Over the counter anti inflammatory pain relievers such as ibuprofen (Advil, Motrin) and Naproxen (Aleve, Anaprox DS)
Tablet:-Lindac 200mg 1+0+1 for 3 day AS A Sulindac Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs) if persistence pain then apply if not existence the pain no need.

Indications of Lindac tablet (AS A Sulindac Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Lindac is indicated for the symptomatic treatment of-

Rheumatoid arthritis
Osteoarthritis
Ankylosing spondylitis
Periarticular inflammatory disorders
Acute painful shoulder
Acute gouty arthritis
Diabetic neuropathy
Diabetic retinopathy

Side Effects of Lindac tablet (AS A Sulindac Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Gastrointestinal side effects are the most common and consist of abdominal pain, nausea and constipation. Gastrointestinal ulceration and bleeding may also occur. The most frequently reported central nervous system side effects are drowsiness, dizziness, headache and nervousness. Other adverse effects include depression, tinnitus, confusion, light-headedness, insomnia, psychiatric disturbances, syncope, convulsions, coma, peripheral neuropathy, blurred vision and other ocular effects, oedema and mass gain, hypertension, hematuria, skin rashes, pruritus, urticaria, stomatitis, alopecia and hypersensitivity reactions. A hypersensitivity syndrome consisting of fever and chills, skin rashes or other cutaneous manifestations, hepatotoxicity, renal toxicity (including renal failure), leukopenia, thrombocytopenia, eosinophilia, inflammed glands or lymph nodes, and arthralgia have been reported. Leucopenia, purpura, thrombocytopenia, aplastic anaemia, haemolytic anaemia, agranulocytosis, epitaxis, hyperglycaemia, hyperkalaemia and vaginal bleeding have been reported. There have also been reports of hepatitis and jaundice or renal failure.

Biarth control pills
an intrauterine device(IUD). that releases the hormone progestin

Noninvasive or minimally invasive procedures:–

Forced ultrasound surgery is a newer and completely noninvasive surgical procedure. You lie down inside a special MRI machine that allows a doctor to visualize the inside of your uterus. High-energy, high-frequency sound waves are directed at the fibroids to ablate, or destroy, them.

Myolysis procedures (such as Acessa) shrink fibroids using heat sources, such as an electric current or laser, while cryomyolysis freezes the fibroids. During endometrial ablation, a healthcare professional inserts a special instrument into your uterus to destroy the uterine lining using heat, an electric current, hot water, or extreme cold.

Another nonsurgical option is uterine fibroids embolization. In this procedure, small particles are injected into the uterus to cut off the fibroids’ blood supply.

Fibroid surgery

There are several factors to consider when talking about the different types of surgery for fibroid removal. Not only can the size, location and number of fibroids influence the type of surgery, but your wishes for future pregnancies can also be an important factor when developing a treatment plan. Some surgical options preserve your uterus and allow you to become pregnant in the future, while other options can either damage or remove your uterus.

Myomectomy is a procedure that allows your provider to remove the fibroids. There are several types of myomectomy. The type of procedure that may work best for you will depend on where your fibroids are located, how big they are and how many you have. The types of myomectomy procedures to remove fibroids can include:

Hysteroscopy: Your provider inserts a scope (a thin, flexible, tube-like tool) through your vagina and cervix and into your uterus. Your provider uses the scope to cut away and remove the fibroids.
Laparoscopy: In this procedure, your provider will use a scope to remove the fibroids. Unlike hysteroscopy, this procedure involves placing a few small incisions in your abdomen. This is how the scope will enter and exit your body.
Laparotomy: During this procedure, your provider makes one larger incision in your abdomen and removes the fibroids through this one cut.

If you aren’t planning future pregnancies, there are additional options your healthcare provider may recommend. These options can be very effective, but they typically prevent future pregnancies. These can include:

Hysterectomy: Your provider removes your uterus during a hysterectomy. A hysterectomy is the only way to cure fibroids. By removing your uterus completely, the fibroids can’t come back and your symptoms should go away. If your ovaries are left in place, you won’t go into menopause after a hysterectomy. This procedure might be recommended if you’re experiencing very heavy bleeding from your fibroids or if you have large fibroids. Minimally invasive hysterectomies include vaginal, laparoscopic or robotic methods.
Uterine fibroid Embolization: An interventional radiologist performs this procedure with the help of your gynecologist. They put a small catheter in your uterine artery or radial artery and inject small particles, which then block the flow of blood from the artery to the fibroids. Loss of blood flow shrinks the fibroids and improves your symptoms. This procedure may not be right for everyone.
Radiofrequency Ablation(RFA): This is a safe and effective treatment that uses microwave (RF) energy to treat uterine fibroids. It’s recommended for people who haven’t reached menopause. It treats smaller fibroids.

জরায়ু ফাইব্রয়েড কি?

জরায়ুর ফাইব্রয়েডগুলি সৌম্য, বা ক্যান্সারহীন, তন্তুযুক্ত বৃদ্ধি যা জরায়ুতে তৈরি হয়। তারা খুব সাধারণ. এগুলি জরায়ুর বাইরের দিকে (যাকে সাবসারোসাল ফাইব্রয়েড বলা হয়), জরায়ুর পেশীর ভিতরে (যাকে ইন্ট্রামুরাল ফাইব্রয়েড বলা হয়) বা জরায়ু গহ্বরে (যাকে সাবমিউকোসাল ফাইব্রয়েড বলা হয়) বৃদ্ধি পেতে পারে।

ফাইব্রয়েডের কারণ কী?

অবশ্যই একটি জেনেটিক উপাদান আছে, কিন্তু আমরা এমন কোনো জীবনধারার কারণ খুঁজে পাইনি যা জরায়ু ফাইব্রয়েড সৃষ্টি করে।

ফাইব্রয়েডের লক্ষণগুলি কী কী?

কিছু মহিলার ফাইব্রয়েডের কোনও লক্ষণ নেই এবং এমনকি তারা জানেন না যে তাদের আছে। অন্যান্য মহিলাদের গুরুতর লক্ষণ আছে। লক্ষণগুলির মধ্যে খুব ভারী মাসিক চক্র অন্তর্ভুক্ত থাকতে পারে। কিছু মহিলার এত বেশি রক্তপাত হয় যে তারা animic হয়ে যায় —এটি হলমার্কের লক্ষণ। ফাইব্রয়েডগুলি যা গুরুতর রক্তপাত ঘটায় সেগুলি সাধারণত জরায়ু গহ্বরের কাছাকাছি থাকে।

কিছু মহিলার খুব বড় ফাইব্রয়েড থাকতে পারে যার কারণে জরায়ু তার স্বাভাবিক আকারের 10 গুণ বেশি হয়। এর ফলে আমরা যাকে বলি “বাল্ক লক্ষণ”। উদাহরণস্বরূপ, একজন মহিলা অনুভব করতে পারেন যে তার জরায়ু খুব বড় হয়েছে, যেমন সে গর্ভবতী। কোষ্ঠকাঠিন্য বা বর্ধিত প্রস্রাবের মতো এর বাল্ক আকারের কারণে তার সম্পর্কিত উপসর্গ থাকতে পারে।

অন্যান্য সমস্যা এই উপসর্গ হতে পারে?

যদি একজন মহিলা তার ডাক্তারকে দেখান কারণ তার রক্তক্ষরণ বা ভারী মাসিক চক্র হচ্ছে, তাহলে ডাক্তার সম্ভবত জরায়ু ফাইব্রয়েড পরীক্ষা করবেন, তবে এই লক্ষণগুলি জরায়ু পলিপ, অকার্যকর জরায়ু রক্তপাত বা হরমোনের ভারসাম্যহীনতার কারণে রক্তপাতের মতো বিষয়গুলির কারণেও হতে পারে। .

কিভাবে ফাইব্রয়েড নির্ণয় করা হয়?

ফাইব্রয়েডগুলি সাধারণত আল্ট্রাসাউন্ড দ্বারা নির্ণয় করা হয়। এটি সত্যিই জরায়ু দেখার সবচেয়ে সহজ উপায়, এবং ফাইব্রয়েডগুলি সাধারণত খুব সহজেই দেখা যায়। প্রথম ধাপটি হতে পারে আপনার ডাক্তারের পরীক্ষা, যেখানে তিনি বর্ধিত জরায়ু অনুভব করবেন এবং ফাইব্রয়েডের সন্দেহ করবেন। ছোট ফাইব্রয়েডগুলির জন্য, তাদের নির্ণয়ের একমাত্র উপায় প্রায়শই আল্ট্রাসাউন্ড। কিছু ডাক্তার ফাইব্রয়েডগুলি ঠিক কোথায় তা দেখার উপায় হিসাবে পেলভিসের এমআরআই করা বেছে নিতে পারেন।

কিভাবে fibroids চিকিত্সা করা হয়?

এটি লক্ষণ এবং আকারের উপর নির্ভর করে। উদাহরণস্বরূপ, যদি একজন মহিলার জরায়ু গহ্বরের ভিতরে ফাইব্রয়েড থাকে, আমরা একটি হিস্টেরোস্কোপিক মায়োমেকটমি করতে পারি, যেখানে আমরা একটি ক্যামেরা দিয়ে জরায়ুর ভিতরে দেখি। একই সময়ে, ফাইব্রয়েডগুলি যদি জরায়ু গহ্বরের ঠিক ভিতরে থাকে তবে আমরা একটি অস্ত্রোপচার পদ্ধতি করতে পারি।

যদি একজন মহিলার গুরুতর উপসর্গ থাকে, এবং যদি ফাইব্রয়েডগুলি পেশীতে বা জরায়ুর বাইরে থাকে, তাহলে অস্ত্রোপচার সেরা বিকল্প হতে পারে। সেই ক্ষেত্রে,ROBOTIC and Laporoscopic বেশি সাধারণ। এটি একটি ন্যূনতম আক্রমণাত্মক পদ্ধতি যা পেটে চার থেকে পাঁচটি ছোট ছেদ তৈরি করে। তারপরে আমরা এই খুব ছোট খোলার মাধ্যমে ফাইব্রয়েডগুলি অপসারণ করতে রোবোটিক অস্ত্রের সাথে সংযুক্ত ছোট যন্ত্র ব্যবহার করি।

গুরুতর ক্ষেত্রে, একজন মহিলার একটি খোলা মায়োমেকটমি হবে, যাকে পেটের মায়োমেকটমিও বলা হয়। এই অস্ত্রোপচারের জন্য বিকিনি এলাকায় একটি ছেদ বা পেট বরাবর একটি উল্লম্ব ছেদ প্রয়োজন। আমরা তারপর এই ছেদ মাধ্যমে fibroids অপসারণ.

জরায়ু ফাইব্রয়েডের কিছু ননসার্জিক্যাল ব্যবস্থাপনায় ওষুধ অন্তর্ভুক্ত থাকতে পারে যা তাদের বৃদ্ধি দমন করতে সাহায্য করতে পারে, যেমন জন্মনিয়ন্ত্রণ বড়ি। লিউপ্রোলাইড অ্যাসিটেট নামে একটি ওষুধও রয়েছে, যা তাদের সঙ্কুচিত করতে সাহায্য করতে পারে।

কিভাবে ফাইব্রয়েড উর্বরতা এবং গর্ভাবস্থাকে প্রভাবিত করতে পারে?

উর্বরতার উপর তাদের প্রভাব নির্ভর করে ফাইব্রয়েডের অবস্থান এবং আকারের উপর, সেইসাথে একজন মহিলার কী ধরনের উপসর্গ থাকে তার উপর। জরায়ু গহ্বরের অভ্যন্তরে থাকা ফাইব্রয়েডগুলি একটি ভ্রূণকে রোপন করা থেকে আটকাতে পারে, যা এটিকে ভ্রূণে বাড়তে বাধা দেয়। জরায়ুর পেশীতে থাকা বড় ফাইব্রয়েড-প্রায় চার সেন্টিমিটার বা তার বেশি-ও ইমপ্লান্টেশনকে প্রভাবিত করতে পারে। জরায়ুর পেশীর ভিতরে থাকা ফাইব্রয়েড ফ্যালোপিয়ান টিউবকে ব্লক করতে পারে, যা বন্ধ্যাত্বের কারণ হতে পারে।

কখনও কখনও ফাইব্রয়েড শিশুর প্রসবের পদ্ধতিকে প্রভাবিত করতে পারে। উদাহরণস্বরূপ, যদি একজন মহিলার জরায়ুর নীচের অংশে একটি ফাইব্রয়েড থাকে, তাহলে এটি জরায়ুর সম্পূর্ণরূপে খোলার জন্য এটি কঠিন করে তুলতে পারে, যা একটি সি-সেকশনকে কঠিন করে তুলতে পারে।

প্রতিটি মহিলা এবং তার প্রসূতি বিশেষজ্ঞের জন্য প্রসবের জন্য একটি গেম প্ল্যান থাকা সত্যিই গুরুত্বপূর্ণ।

Raiyyan Tahsan date:05-11-24 time:09.20pm

Raiyyan Tahsan

Raiyyan Tahsan