Will Sysron work best and help avoid fibroid removal surgery?

Hello,

Welcome to icliniq.com.

Let me start by putting forth a few basic facts about fibroid and their management. Many of which may be well known to you. Each point has a point in your history and direction. Fibroids are the most common uterine benign tumors. They usually never appear single. One of them dominates the rest, staying under the shadow of the main fibroid and increasing in size or coming into the limelight once the main fibroid is gone. They usually begin as intramural or mass within the myometrium. They are sensitive to estrogen, or the female hormone, throughout the reproductive period of a woman. As long as the ovaries keep producing the estrogen hormone, they grow. That means menopausal time is the final solution to the estrogen hormone. These fibroids grow towards the endometrial lining, gradually protruding into the uterine cavity, presenting as menorrhagia or excessive bleeding. If simulated, only an ulcer or swelling protruding into the oral cavity can disturb your chewing action, not one on the cheek or one that stays in the myometrium or intramural, causing excessive pain and bleeding, as the myometrium is irritated, leading to pain in periods, also the inability of the myometrium to contract well, causing poor control of bleeding. Or they start protruding out of the uterus or subserous, which causes pressure effects like on the bladder, surrounding muscles, nerves, lower abdominal discomfort or fullness, or no symptoms at all.

The only way to control fibroids is to stop the growth by blocking the blood flow or blocking the growth factor (an estrogen hormone). I feel (attachment removed to protect the patient's identity) there must be more fibroids. Subserous ones never present with bleeding, as explained above. If your complaints have been resolved for some time and the size of the myomas is marginally reduced, then a medical management line is the first choice. Had the bleeding not stopped with medicine, surgery would be the first choice to save you from all symptoms. Of course, you may feel that the work of the uterus is over. But that is the sign of womanhood. Also, removal of the uterus alone will compromise the vascularity of the ovaries. The aorta's ovarian artery branch has an anastomosis with the uterine artery, which may inadvertently be damaged. This can reduce the life of the remaining ovaries and cause menopausal symptoms to appear earlier. Even though you may enter menopause around 52-54 years of age, ovarian hormones persist until the 60s. Ulipristal (Fibristol) is useful but needs medication daily for many years and is costly. Norethisterone is progesterone, which helps only to control bleeding, but at the same time, it increases the endometrial lining thickness, so when you stop the pills, you will have a heavy withdrawal bleeding with clots and thick fleshy masses. I would suggest the following management:

1. If you are bleeding now, that course or Norethisterone (Aygestin) 5 mg will resolve immediately. You can supplement it with the Tranexamic acid (Cyklokapron) tablet.
2. Once you have that good withdrawal bleeding, have a proper 3D scan or better MRI pelvis to map out the exact fibroid location. There may be submucosal or intramural small ones near the submucosal plane.
3. Suppose submucosal or almost submucosal have hysteroscopic removal of myomas or polyp. This is much more specific and much effective than d&c. Even a complete endometrial resection or damage can be done with a hysteroscopic resectoscope. This is a short procedure as a daycare procedure under short general anesthesia.
4. If they are mainly intramural or not very close to the submucosal plane, have those two shots of Lupreolide acetate. This will completely thin out the endometrial lining to menopausal status. The fibroid shrinks off.
5. It is affordable, has no side effects, and does not affect any part other than the uterus.
6. Have an ultrasound scan after one year.
7. You may have slight brown discharge 3-4 times a year.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

Endometriosis, adenomyosis, or fibroids are all like siblings of the mother estrogen. All three grow only once the periods start, gradually increase over the years, and get suppressed when the period stops, during pregnancy, medication, or menopause. Fibroids are hypertrophy of the small muscle area, which are stretching and contracting points during periods. Endometriosis is a condition where bleeding during periods flows out of the uterus. A small part flows into the peritoneal cavity through tubes. This gets deposited on the ovaries and adnexa, like the bowel, bladder, and ovary, also into the deeper layers, deep into the pelvic floor muscles and ligaments. It is like getting beaten at the same place every month. Gradually, over months and years, the area is edematous, tender, and inflamed. The main symptom would be severe pain during periods, sex, examination, or on the pelvic scan, regardless of how you touch it. So bleeding may be higher, but it is not the main problem. As you can imagine, the area getting beaten will not bleed but will be tender. The solution is to stop beating or, in your case, stop periods. It will resolve.

During periods, a small part of adenomyosis also enters the muscle of the uterus or myometrium through tiny breaks in the lining. The main symptoms are pain and bleeding, bleeding because the myometrium cannot contract well to stop bleeding, and pain due to the inflammation of the uterine wall. More common at your age, especially if you have had two or more deliveries, even more if you have had a cesarean section, myomectomy, D and C, or any invasive surgery on the uterus. As MRI (magnetic resonance imaging) has confirmed that you have only one fibroid and its position is subserous, I am 100% sure that it's not the one causing bleeding. Mostly, the size of the uterus is larger. Normally, the length of the uterus is 2.7 inches. The uterus must be bulky.

Anyway, D and C are not going to reduce fibroids, as they are far away from the cavity. Adenomyosis will also be unaffected. Usually, these siblings appear in combination, one of them dominating. Hystero-laparoscopy can clear only fibroids projecting into the uterine cavity or close to the cavity. There is no question of endometriosis in the uterus; then it is called adenomyosis and will not be cleared by D&C or hysteroscopy. Hysteroscopy needs one day of rest due to general anesthesia. The next day you will be fine. If you want to confirm no more periods after hysteroscopy, the doctor can do a hysteroscopic endometrial ablation, cauterizing the entire lining, and the period will stop.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.