Medications to reduce fibroids

#KnowledgeIsSuccess There are medications that slightly reduce the size of fibroids, but they do not disappear ♀️💊👵 🙅 and by inducing a temporary menopause, both the patient and the fibroid suffer changes that complicate fertility and surgery.

Dr. Arturo Valdés, a Creafam fertility expert, shares with us 3 cases of fibroids that were originally very similar, but due to external circumstances ended up in very different surgeries.

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In one of these three patients we had a very important detail. The patient was not anemic, however, when we started the surgery she had bled more or less 600 ml and she began to have a little signs of hemodynamic decompensation and we could not convince either the mother or the patient to accept the procedure. put on a globular package.

It is very important to remind them as I tell patients: The decision to perform surgery or an intervention is the doctor’s, the responsibility is also the doctor’s, but the postoperative period is also the doctor’s responsibility, but here the patient, that is, as I explained to the patients, well, maybe, if I don’t put the package in, the evolution will be more torpid, the patient will have dizziness, she will feel bad, she will not be able to do daily physical activities or even small ones such as bathing or changing and putting a globular package will always be for the benefit and the earlier and faster recovery of the patient also because there are more risks of infection or of the wound opening than It is called “Dehiscence” because if we have acute anemia, that is, due to bleeding, then the oxygenation of those tissues will not be adequate.

It is very important when you come and see your doctor or here at Creafam that you trust who your doctor is going to be, but most importantly, transfusing or placing a blood cell package will always have a medical justification but above all, an indication of health and well-being for the patient.

Fibroid surgery WITHOUT prior medication

Right now we are going to review three cases that are very similar, very similar in age, the first patient is a patient from Querétaro who is 32 years old… 30 years old and she came to us because she had three pregnancies but she had had an abortion and one Of the two full-term babies, she died in utero, so she practically only has one child born alive and began to have a tumor, which she already had before she became pregnant, but it was currently a large tumor of more or less 15 cm, half bilobed and that It was already causing a little bit of problems in terms of abdominal discomfort, with a distension, he was already touching it near the scar, when he peed it bothered him, he already had symptoms that we call urinary urgency, but he was also starting to have some problems. there in the menstrual cycles such as pain or dysmenorrhea.

Good afternoon, we are going to start again another myomectomy of a 30-year-old patient who wrote to us from Querétaro, San Juan del Río with a fibroid with large single intramural elements on the posterior surface, obviously it began to give her a lot of problems. urinary urgency, some bleeding, metrorrhagia, but as they had always told her that the uterus had to be removed, so we are going to start doing the infiltration, it is a fairly large fibroid, look, there we see it, this part over there is the fibroid, It’s very good, except that the incision is small as always to ensure a little aesthetics and recovery.

So let’s start infiltrating right now. Ready, we have removed the fibroid, look how beautiful it is, it has a little bit of a semi-cystic degeneration, it is soft, but it came out super well in a very small incision and down here are the pedicles, which is where we are going to start, obviously cauterizing to have much less bleeding, but it took 15 minutes of surgery and we practically removed this base and closed, that is, in half an hour I finished this large myomite but it is a unique fibroid, intramural pedunculated, so it has a very good characteristic and it performed very well for having a little bit of cystic degeneration, but as we said, we have to be very careful with fibroids, especially in their vascularity, but in this patient, as we are seeing her, I believe that in three months we can begin to investigate or see if there is going to be a pregnancy and not It was necessary to remove the uterus because she is only 30 years old. Ready, we finished the surgery, here is the fibroid, it was practically four fingers, a 6-7 cm incision.

We’re done, the patient, obviously tomorrow she goes to her house without any problem.

Fibroid surgery WITH prior medication

Second case, a patient from Coatzacoalcos Veracruz, 34 years old, with a fairly large fibroid of 10 or 12 cm. She has not had pregnancies but had a little bleeding, menstrual pain and also some urinary urgency. This patient came to us because she had already been given medication, in fact we mentioned it in the video, medication to reduce her size.

One was an injection that all doctors know is goserelin or soladex, what it does is block the action of a gland that is at the base of the skull called the pituitary gland, this gland is responsible for stimulating the ovary. through two hormones; Fsh and Lh and what these two hormones do is that there is an ovulatory cycle, when there is an ovulatory cycle, estrogens are formed and estrogens are what feed or what makes these fibroids grow, so when we give these injections we block to the pituitary gland, we practically cause a kind of temporary or temporary menopause in three or four months while the medication is being applied. This causes the fibroid to decrease because there is no longer any estrogenic hormone, but there are also some side effects that can present as if they were a climacteric or menopause patient, but the most important thing: It is not always the appropriate indication, that is, putting this type of medications in addition to assessing that we are going to have bone demineralization of the bones and more so in a young woman, since it has to be very well assessed by the doctor.

I always tell them: Let’s see, if it is a patient in the final stages of her reproductive life, 47, 48 years old, who has a relatively large fibroid, has a little bleeding but no longer wants to have surgery, maybe it would be worth putting her in because she is already in the final stage of her reproductive life and also in the perimenopausal stage, but in a young woman it is not always the best indication to apply soladex, and later on this patient also received the esmya that we have already talked about, which is ulipristal acetate. What it does is an antiprostaglandin progesterone and it also inhibits the receptors at the level of the fibroid so that its size decreases.

In total, the patient applied 3 sessions of soladex, 3 sessions of esmya, she did not decrease greatly and ended up having surgery. Why did she mention it? Because many times when the medication is given, the circumference of the fibroid loses that differentiation of its capsule with the muscle and then sometimes it is more difficult to dissect that tumor, you will see it in the video because there is no capsule that delimits us and then We can take a little muscle tissue and sometimes it also bleeds more, in addition to the surgery being more laborious and taking longer.

Look, we already infiltrated it, it has too thick muscles, look at this here, all of that is muscle, but it is a fibroid that is bilobed towards the lateral sides of the abdomen, on the posterior side it has another smaller one. Obviously the incision is very small so we are going to have to do a digital dissection and then morcellate little by little but we will show it to you as the surgery progresses. Ready, look we still need about 60% or 70% of myoma. We have morcellated very little, more or less a 5 cm fibroid. But right now what we are doing is removing the blood vessels that cover the fibroid and the capsule, because here there is a half-degenerated area, not well delimited by the number of fibroids that fused to make the fibroids, as we said, it was bilobed, so we are Being very careful, due to the bleeding, right now we are going to remove this large piece and it will even allow us to see if we can remove part of the sample.

Ready, we’re done, but we wanted to show you a little so that you can see how well the tomography helps us, see the size of the tumor. The previous size is half bilobed, which are these white spaces that you see here, here you can see it much better. If we have imagination, this would be a fibroid, this is another one, and further up we see this entire tumor, see how it looks in the contrast, very well, then the uterus was behind, behind this fibroid, all this fibroid did was more towards the bladder and compress a little.

We finished, this patient preserved her uterus.

About using blood or packed cells

Remember, we have always talked and it appears in our slogan, that a doctor is as good as his patients. Why is this? We must remember that both the patient and the doctor must be well informed and the surgery that is going to be performed carries or has some risks, it has some indications both medical and surgical, but also this patient who did not want to receive blood is very important to know. Since the health implications or post-surgery complications of not putting in a packed cell are also important, so please let the doctor do the surgery but also let the doctor decide what medication or What treatment is the most appropriate intraoperatively and postoperatively.

Today, I just returned from another patient who will appear in a subsequent video with a similarly degenerated cystic tumor, somewhat irregular on ultrasound, in fact we didn’t like it at all, at 41 years old, she already has three babies; two births and a cesarean section, her three children are alive, she did not want to remove the uterus due to some cultural and personal implications that we will discuss later with our psychologist, so she wanted to preserve the uterus and the surgery went very well, I had to put 3 packages on her globular so that the differentiation between these 3 can be seen before. This patient had a hemoglobin level of 6.5, so we cannot do surgery even if she is bleeding in a patient who is hemodynamically decompensated. We gave her two blood cells yesterday to raise that hemoglobin so that the tissues would be better irrigated and obviously prevent the risk. of transoperative bleeding and during the transoperative period we placed a third globular package.

With what purpose? Since this patient is six and a half with the two packages, she is going to be eight and a half, she only bled us 300 ml. We replace that bleeding and increase it, it will work out better with a hemoglobin of 9 or 9.5, the advantage of this patient who, since she had already had a very long period of chronic anemia, her body is used to compensating, but it is still risky and dangerous, so the idea is that you come out better than you entered the surgery and that’s why I tell patients “Knowing is power.” Document yourselves, investigate, write to us, the truth is that we are having a very good response both in videoconferences and in person, yesterday I had a patient from Ensenada who decided to come for the first consultation and it gives us great satisfaction to know that patients are becoming more informed, they are looking for the best option and without a doubt at Creafam Puebla they have one of the best options for fibroid surgery.

“If she is a patient in the final stages of her reproductive life, 47, 48 years old, who has a relatively large fibroid, has some bleeding but no longer wants to have surgery, maybe it would be worth putting her in because she is already in the final stage of her life. reproductive and also the perimenopausal stage, but in a young woman it is not always the best indication to apply soladex”

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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