The new drug will avoid surgery

Proven content

This is a breakthrough in treatment – says prof. Grzegorz Jakiel. In May, pharmacies will find a new drug for uterine fibroids, thanks to which it will be possible to avoid surgery.

– You have two children and are over 40 years old. Why your uterus? – this question has been heard by many women diagnosed with fibroids. Prof. Grzegorz Jakiel, head of the XNUMXst Obstetrics and Gynecology Clinic of the Medical Center of Postgraduate Education in Warsaw, says that many gynecologists offer uterine excision to all myoma patients. They treat the will to preserve this organ as a woman’s whim. – Meanwhile, for many women the loss of the uterus is a huge emotional problem – adds prof. Jakiel. Gynecologist Dr. Jacek Tulimowski talks about the empty doll syndrome. – Women find that after hysterectomy they lose their attractiveness. Anyway, many men, who do not know the anatomy of the female body, think that their partner is incapable of sexual contact after such surgery, she adds. – Therefore, treatment should always be adjusted to the patient’s needs – believes prof. Jakiel.

The incidence of fibroids

Uterine fibroids, which are benign tumors of the reproductive organs, are the most common disease in women. They can appear in women of any age without any symptoms. The diagnosis is made possible by an ultrasound examination. Myomas occur singly or in groups. They can be the size of a cherry stone, but also a pool ball, or even a football. The largest of the fibroids removed so far weighed as much as 64 kilograms. It is estimated that one in four of Polish women aged 30 to 40 has fibroids. This percentage increases with age and 50% of them suffer from this ailment after the age of 40. The causes of fibroids are unknown. It is known that they appear more often in women who are obese and have not had children.

The effects of uterine myoma

Growing myoma can cause heavy periods, intermenstrual bleeding and pain. Too much bleeding leads to anemia. – It happened that patients with hemoglobin at the level of 5% (the norm is 12%) came to me, which means that they had only 1/3 of the amount of blood needed. Interestingly, they came on their own feet – says prof. Grzegorz Jakiel. Prolonged periods and bleeding between them cause intramural fibroids – developing in the uterine wall and submucosal fibroids – to form under the mucosa and grow towards the uterine cavity. During menstruation, the epidermis peels off and bleeding from the uncovered vessels. In healthy women, the muscles of the uterus constrict the vessels and bleeding stops. A fibroid located in the wall of the uterus disrupts the work of the muscles. Whereas tumors subsistence, which grow outside the uterus cause a feeling of fullness in the lower abdomen, an increased urge to urinate, urinary incontinence or difficulty emptying the bladder. They can also compress the intestine, causing constipation.

Surgical removal of fibroids

– American doctors prefer radical solutions and that is why as many as 60% of women aged 60 do not have a uterus. In Poland, many gynecologists are also supporters of such methods. Meanwhile, the diagnosis of a myoma does not require surgery – says prof. Jakiel. He explains that if the tumor does not show any symptoms, it should be monitored every six months in a vaginal ultrasound. If, on the other hand, it causes excessively heavy periods, post-menstrual bleeding or pain, different treatments should be considered. The professor also emphasizes that women who want to get pregnant should try to do so. If it fails, then you should decide to have the myoma removed, because the risk of pregnancy with a plate-sized myoma is less than the risk of damaging the uterus during its removal.

Hysteroscopy and laparoscopy

If the myoma is less than 5 cm in diameter, it can be removed using a hysteroscope, i.e. by inserting a speculum with a camera and surgical instruments through the vagina into the uterine cavity. If it is larger, laparoscopy may be necessary, which is the insertion of a camera and instruments through minimal incisions over the symphysis pubis. Sometimes it is necessary to have a classic operation by dissecting the abdomen. Laparoscopy usually takes longer than classic surgery, around 2 hours. The patient, however, can go home the next day, while after a normal cut, she recovers for a much longer time. All these procedures, however, are associated with numerous complications that can occur after surgical operations. They also do not solve the problem definitively, because new tumors may appear in the place of the removed tumors.

Embolization of fibroids

Another way to get rid of fibroids is to cut off the blood vessels that feed it. Blood vessels can be closed with a laparoscope. – This method requires very high precision from the surgeon. Not every doctor can use it – says prof. Jakiel. The so-called embolization. A catheter is inserted through the inguinal artery into the vessels supplying blood to the myoma, and then plugged with a special material. The procedure is performed under local anesthesia, which means that the patient does not fall asleep. Unfortunately, this method is not suitable for the removal of subserial fibroids. In addition, the Canadian Gynecological Society noted that this method may cause fertility problems.

Read more: Removal of the feminine

Artificially inducing menopause

The search for a non-surgical method of treating myomas began with administering progesterone to patients. Unfortunately, it turned out to be ineffective – the changes continued to grow. Another idea was to block the pituitary gland to stop hormone production. The patients were put into acute menopause and the myoma, cut off from hormonal activity, stopped growing. However, the patients began to develop osteoporosis, urogenital atrophy. Their skin was aging faster. They had all the symptoms of menopause. Due to the troublesome side effects, the method did not catch on. – After this therapy, the myomas were smaller, but more difficult to remove – says prof. Jakiel. – The tumor looks like a white billiard ball and is therefore easy for a surgeon to excise. After this therapy, the myoma lost its structure and it had to be torn out in pieces – explains Prof. Jakiel.

Hormone therapy in the treatment of tumors

– Now a drug has appeared that opens up new possibilities for hormonal effects on fibroids. Contrary to previous treatment attempts, it does not disturb the body. The new concept assumes a selective action. Blocking the pituitary gland was like shutting down a power plant, making all the street lamps in the city go out one by one. The new drug only turns off the light of myoma – explains Dr. Tulimowski. The prestigious New England Journal of Medicine has already published an article describing the effects of treatment with the new preparation. The treatment lasts for 3 months, then the tablets are discontinued. Bleeding problems disappear after just 7 days. The patient has no menstruation within 3 months. It comes back 4 weeks after its completion. The tumor shrinks by up to 50% of its weight. The problem is that there are no long-term studies yet. It is certain that the effect of the therapy lasts up to 30 weeks after its completion. – This is good news anyway, because the patient can improve her hemoglobin and thus avoid blood transfusions, which will also have a beneficial effect on the course of any subsequent surgery. The treatment also allows you to postpone the date of the procedure, says Dr. Tulimowski. – If the tumor is small and the patient survives thanks to the menopause treatment, she will not have to think about surgery at all – adds prof. Jakiel. The new drug will appear in Germany and Great Britain in April. In Poland at the beginning of May. The cost of monthly therapy is to vary between PLN 500 and PLN 1000. The manufacturer of the drug will try to be entered on the reimbursement list.

Vaginal ultrasound once a year

Sometimes the tumor may turn out to be a malignant sarcoma tumor. They are rare, accounting for 0,2% to 0,3% of fibroids. Unfortunately, it is extremely resistant to chemotherapy and radiation therapy, and the best treatment is to remove it at an early stage. The problem is that there are currently no diagnostic tools to distinguish sarcoma from myoma. The only differentiating criterion is growth slack. If the myoma grows by at least 50% within six months, we may suspect that it is a sarcoma. Therefore, doctors recommend that all women have a vaginal ultrasound scan once a year, and those who are diagnosed with fibroids every six months.

Also read: Myomas – the most common benign tumors of the uterus