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Uterine fibroids with profuse bleeding: is the only solution to remove the uterus?

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Uterine fibroids are benign tumors rich in extracellular matrix and that derive from myocytes, which are present in the myometrium. These fibroids originate from smooth muscle cells found in the wall of the uterus. In most cases they are usually multiple, but they can also present in a single way.

It has to be said that They are very common. In fact, more than half of women have uterine fibroids, although In the vast majority of cases there are no symptoms. However, in the cases that do occur, these tend to be very variable, depending on the location, size and direction of growth of the tumor.

The The most important symptoms are menstrual bleeding disorders and pelvic pain.feeling of pressure in the stomach, frequent urination and constipation with manifestations of compression.

He fibroid treatment It depends on the therapeutic approach the specialist opts for depending on the evolution of the uterine fibroids. To treat symptoms, the following options are usually used:

Contraceptives that help control heavy menstrual periods.

Uterine devices (IUD) that secrete hormones called progestins and that in some cases contribute to reducing heavy bleeding.

– The iron supplements They are important in the event that the patient may suffer or already suffers from anemia due to excessive bleeding.

SPRMS (selective progesterone receptor modulators): is a recent form of treatment that blocks progesterone receptors at the fibroid level. It reduces the volume of fibroids and also excessive bleeding. Its repeated intermittent use has recently been approved.

GnRH analogues: They act by blocking the synthesis of female hormones (estradiol and progesterone). They control bleeding and reduce the volume of the fibroid, although their use is limited in time due to the side effects they present.

However, There may come a time when bleeding is not reduced despite receiving these therapeutic options.What can be done in these cases? Until not long ago, the most widespread option was to practice a hysterectomy (complete or partial removal of the uterus) to the patient.

The problem with this intervention is that It is a major surgeryhighly invasive, with risk of hemorrhage and a complicated postoperative process.

In our case, we provide a technique that until now had not been performed in Gipuzkoa to treat a fibroid. Uterine fibroid embolization is a technique that has been performed for years in other countries and in less than five hours the patient can be home, without any pain and in less than a week return to health to her usual routine, that is, it is an outpatient technique that allows the patient to immediately return to her life, has very few complications and is very effective.

The procedure consists of suppressing blood flow to fibroids. It proceeds by introducing (with the patient sedated, it does not require general anesthesia, also avoiding the risks involved) a catheter through the femoral artery to reach the uterine artery and then small particles of plastic or gelatin will be injected through from the catheter into the blood vessels that supply blood to the fibroids.

These particles will block blood flow to the tiny arteries that supply blood to the fibroids. As soon as you remove the blood supply to that tumor, the tumor decreases in size and the patient stops bleeding.. Therefore, it is about interrupting the flow so that the tumor suffers ischemia and little by little decreases in size, no longer bleeds, no longer compresses neighboring structures and does not cause symptoms. Furthermore, it is important to highlight that Six months after embolization the uterus remains viable for future pregnancies.

*Francisco Loyola and Iñaki Prieto are interventional radiologists at Policlínica Gipuzkoa.

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