Patient's question:
Detailed medical condition and consultation purpose: On November 28, 2005, two fibroids were detected, approximately 1.5 cm in size. I would like to ask if there are any methods to control or eliminate them? Please reply as soon as possible. Thank you.Onset and duration of the current illness:
Current general condition:
Medical history: Ultrasound showed two small fibroids, one about 1.5 cm in size.
Previous diagnoses and treatment history and outcomes:
Auxiliary tests:
Other: First follow-up question: I am not menstruating now, possibly pregnant. Please advise.
Doctor's answer:
Treatment for uterine fibroids should be comprehensively considered based on the patient's age, symptoms, size of the fibroids, fertility status, and overall health condition before making a decision. Generally, the following different treatment measures are adopted.(1) Follow-up observation
For patients with small fibroids, no obvious symptoms, or those nearing menopause with a small uterus, normal menstruation, and no pressure symptoms, temporary observation can be performed. It is recommended to have a follow-up examination every 3 months. Typically, fibroids can gradually shrink after menopause. If the fibroids enlarge or symptoms become significant during the follow-up period, surgical treatment should be considered.
(2) Medication treatment
For patients with heavy menstrual bleeding and an enlarged uterus, and after diagnostic curettage to rule out endometrial cancer, androgen therapy can be used. Androgens counteract estrogen, promote endometrial atrophy, cause contraction of the myometrium and vascular smooth muscle, and reduce bleeding volume. Commonly used medications include methyltestosterone 10mg, taken sublingually or orally once daily starting from the 5th day of the menstrual period, with a monthly dose of 20 days, not exceeding 300mg in total per month; or testosterone propionate 25mg, administered intramuscularly twice weekly, or 25mg daily during the menstrual period for 3–5 days, but the monthly total should not exceed 300mg to avoid masculinization.
(3) Surgical treatment
Surgical treatment should be considered for patients who do not respond to long-term conservative treatment, have significant symptoms, large fibroids, anemia, or rapid growth.
1. Myomectomy
Suitable for young patients who wish to preserve fertility. Regardless of whether the fibroids are subserosal, intramural, or submucosal, they can be removed laparoscopically while preserving the uterus. For pedunculated submucosal fibroids that have prolapsed into the vagina, the pedicle can be cut through the vagina, the stump ligated, or the residual pedicle can be clamped with a long curved hemostat and removed after 24 hours.
2. Hysterectomy
For older patients with significant symptoms and no desire for further fertility, a total or subtotal hysterectomy, or a vaginal hysterectomy, should be performed. If the patient is around 50 years old, one normal ovary can be preserved to maintain endocrine function.