Therapeutical approach to uterine fibroids in women in perimenopause

Abstract

Cilj ovog rada je prikazati pristupe u liječenju leiomioma u žena u perimenopauzi. Leiomiomi su benigni monoklonalni tumori nastali iz glatke mišićne stanice miometrija. Spadaju u najčešće tvorbe u maloj zdjelici, te su uzrok 1/3 operativnih zahvata kojima se odstranjuje maternica. Nastaju zbog kompleksne interakcije genetskih predisponirajućih čimbenika, steroidnih hormona jajnika i čimbenika okoliša. S obzirom da su miomi hormon ovisni tumori rijetko se javljaju prije puberteta, s nastupom menopauze regradiraju te mogu rasti tijekom uzimanja hormonskog nadomjesnog liječenja ili u trudnoći. Miome bez simptoma nije potrebno operirati. Liječenje simptomatskih mioma može biti konzervativno i kirurško. Konzervativno liječenje uključuje medikamentozno liječenje te embolizaciju materničnih krvnih žila. Kirurške mogućnosti liječenja trenutno uključuju abdominalnu miomektomiju, laparoskopsku miomektomiju, histeroskopsku miomektomiju, ablaciju endometrija i abdominalnu, vaginalnu ili laparoskopsku histerektomiju. Izbor liječenja je individualan jer ovisi o simptomima bolesti, narušenosti kvalitete života pacijentice te katkad terapijskom izboru same pacijetnice. Perimenopauza ili tranzicijski period je period u životu žene u kojem se postepeno gasi lučenje steroidnih hormona jajnika. Zbog učestalih anovulacija predominiraju simptomi estrogenskog suviška, a potom estrogenskog manjka klinički najčešće manifestirani nepravilnim krvarenjem iz maternice. Kod žena u perimenopauzi sa miomima češto postoje neopravdani pristupi u vidu ili zanemarivanja tegoba očekujući da će miomi nakon menopauze regredirati ili preagresivnog pristupa u vidu histerektomije. Današnje žene ne gledaju na uterus samo kao na organ koji omogućava rađanje, stoga je u terapijskom smislu potrebno razmatrati manje invazivne kirurške pristupe, ali i korištenje medikamentoznog liječenja koje će mnogim ženama sa miomima omogućiti prijelaz prema menopauzi bez simptoma uzrokovanih miomima uz održanu kvalitetu života.The aim of this paper is to present different approaches in the treatment of leiomyomas in women in perimenopause. Leiomyomas are benign monoclonal tumors arising from the smooth muscle cells of myometrium. They are the most common pelvic tumors and the reason for one third of all hysterectomies. They appear due to complex interactions of predisposing genetic factors, ovarian steroid hormones and environmental factors. Usually, they cause no symptoms, rarely occur before puberty, and regress after menopause due to reduced secretion of ovarian hormones. Fibroids are estrogen dependent and can grow while taking hormone replacement therapy (HRT) or during pregnancy. There is no need for the treatment of asymptomatic fibroids. Treatment of symptomatic fibroids may be conservative and surgical. Conservative treatments include the use of medication and embolization of uterine blood vessels. Surgical treatment options include abdominal myomectomy, laparoscopic myomectomy, hysteroscopic myomectomy, endometrial ablation and abdominal, vaginal or laparoscopic hysterectomy. The choice of treatment is individual as it depends on the clinical symptoms, the influence on quality of life and the patient’s choice. Perimenopause or the transitional period is the period in a woman's life in which the secretion of ovarian steroid hormones gradually extinguishes. Because of frequent anovulation symptoms of excess estrogen, followed by estrogen deficiency is frequently clinically manifested by abnormal uterine bleeding. In perimenopausal women with fibroids the therapeutic approach is often unjustified by neglecting complaints while expecting myomas to regress after menopause or on the other side using aggressive approach such as a hysterectomy. Modern women do not view the uterus as the organ which the only function is pregnancy, therefore the therapeutic approach should include less invasive surgical approaches, but also the use of medical treatment that can be offered to many women during the transition to menopause reducing the symptoms and sustaining the quality of life