GYNAE PRACTICE

Treatment of Uterine Fibroids
should be tailored to the-

  • Size and location of the tumors
  • The patient’s age
  • Symptoms
  • Desire to maintain fertility
  • Access to treatment the gynae experience

TREATMENT OPTIONS FOR UTERINE FIBROIDS

LIMITATION OF SURGICAL THERAPY

  • Hysterectomy
  • Myomectomy
  • Symptoms
  • Uterine-artery embolization (UAE)
  • Magnetic Resonance-guided Focused Ultrasound

HYSTERECTOMY

Morbidity
Risk of Surgical long-term complications
Complete loss of fertility

MYOMECTOMY

Fibroid
Recurrence
Potential Uterine
rupture
Pregnancy/
delivery

UTERINE-ARTERY EMBOLIZATION (UAE)

Fibroid Recurrence
Pain
Possibility of severe complication
Possibility of subsequent hysterectomy in 20% cases

MAGNETIC RESONANCE-GUIDED
FOCUSED ULTRASOUND

High costs
Needs interventional radiologist
No sufficient data for fertility & subsequent pregnancies

LIMITATION OF MEDICAL THERAPY (HORMONAL)

NSAIDs

Lack of supportive evidence from clinical trials

GI side effects & risk of gastric ulceration

Anti-fibrinolytics TNX

Can increase the size of myoma

TNX: Tranexamic acid

Androgens (Danazol)

Causes acne hirsutism, edema

Associated with liver toxicity

Adverse effects on lipid metabolism & weight gain

Aromatase Inhibitors (Al)

Causes Hypoestrogenic side effects

Insufficient evidence to support use of Al for Fibroid

GNRH Agonist Leuprolide Triptorelin

Causes hot flushes, vaginal dryness & decreased libido

Increase bone mass
loss; Increase risk of Osteoporosis

Progestins

Breakthrough bleeding

Can increase size
of myoma

Combined Oral Contraceptives (COC)

Breakthrough
bleeding

Not safe for long term use

Can increase size of myoma

CLINICAL TRIALS

CLINICAL EVIDENCE OF TRIPTERYGIUM WILFORDII

Clinical study on effect of Tripterygium Wilfordii Hook on Uterine Leiomyoma

TRIPTERYGIUM WILFORDII

  • STUDY DESIGN

    Randomized controlled Study

  • SUBJECT

    65 women with uterine fibroids

  • TREATMENT

    Tripterygium Wilfordii

  • DURATION

    6 months

  • OUTCOMES

    Decrease in volume of fibroids &
    Uterus, serum estradiol & progesterone

CONCLUSION

Tripterygium Wilfordii Hook may be an effective therapeutic agent for leiomyomas with fewer side effects. Tripterygium Wilfordi Hook treatment showed a reversibly inhibitory effect on the ovary. It may be one of the mechanisms of Tripterygium Wilfordii Hook in decreasing leiomyoma volume.

CLINICAL EVIDENCE OF (EGCG 45%)

Treatment of symptomatic uterine fibroids with EGCG 45% a pilot randomized

EPIGALLOCATECHIN GALLATE

  • OBJECTIVE

    To evaluate efficacy & safety of Epigallocatechin gallate [EGCG] on UF burden and quality of life in women with symptomatic UF

  • STUDY DESIGN

    Double-blinded placebo-controlled
    randomized study

  • SUBJECT

    11 patients received 800mg of brown rice
    this one with treatment placebo group

  • TREATMENT GROUP

    22 patients received 2 capsules of 400mg
    of green tea extract (45% EGCG)

  • PLACEBO GROUP

    11 patients received 800mg of brown rice

  • DURATION

    4 months

  • OUTCOMES

    Decrease in volume of fibroids, fibroid specific symptom severity, health related quality of life (HRQL), change in Hb

CONCLUSION

EGCG 45% shows promise as a safe and effective therapeutic agent for women with symptomatic UFs. Such a simple, inexpensive, and orally administered therapy can improve women’s health globally.

TESTIMONIALS

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