Experts say no best treatment for uterine fibroid

Fertility experts have said that there is no best medical treatment that completely eliminates uterine fibroids, suggesting that non-invasive technologies can improve treatment.

The experts spoke recently during a virtual event on uterine fibroids organised by the Society of Gynaecology & Obstetrics of Nigeria ESGE Working Group on Non-Surgical Ablative Therapy of Benign Uterine Disease International Society of Minimally and Virtual Surgery themed ‘Non- surgical Treatments of Uterine Disorders.’

The treatment of fibroid has transcended from very invasive, to minimal invasive, the experts say, while explaining that fibroids are only needed to be treated when causing problems or impacting fertility.

Speaking on uterine fibroids and interventional radiology management, Hammed Ninalowo, consultant vascular and interventional radiologist, founder, and CEO, IRDOCNIGERIA, said there are lots of women with fibroids that do not require treatment.

According to him, only twenty percent of women fibroids require treatment.

He said that fibroids do not disappear on their own, however, one may only need to treat them if they are causing problems.

“Up to 60 to 80 percent of women have uterine fibroids by the age of 50 and many are unaware of them until they cause problems or show up on imaging or during a physical exam.

“Black women are more likely to develop fibroids and family history of fibroids can also increase your risk,” he said.

Ninalowo explained that current local available treatments for fibroids include hormonal therapy, myomectomy, laparoscopic, hysterectomy, uterine fibroid embolization, and High-Intensity Focused Ultrasound (HIFU) is also now locally available.

He further explained that the minimally invasive option targets all fibroids in the uterus, and is effective for women with only a few fibroids as well as those who have many fibroids adding that the procedure has proven effective in over 30 years.

However, he advised that before any procedure every patient is examined differently and counseled appropriately based on their situation in collaboration with infertility specialty and gynecology to offer the treatment option that best suits each patient.

Speaking on drug treatment for fibroids and Adenomyosis, Christopher Aimakhu, consultant Obstetrician and Gynaecologist, College of Medicine, University College Hospital UCH, Ibadan said that it is unclear exactly why fibroids form, but seem to develop when estrogen levels are higher.

Aimakhu said that although attempts at finding a nonsurgical cure date back centuries, he explained that it is only around the middle of the last century that serious attempts at a medical treatment were carried out.

“Currently, GnRH agonists and SPRMs are the most effective medical therapies with the most evidence to support the reduction of fibroids volume and symptomatic improvement in menstrual bleeding.

“Initially, both progestins and estrogens- progestin combinations have been utilized, although proof of their usefulness is lacking,” he explained.

The consultant Obstetrician and Gynaecologist said that most women with uterine fibroids either remain asymptomatic or develop symptoms gradually over time.

“No medical treatment completely eliminates fibroids. Medical treatment of uterine fibroids may provide symptoms relief of the uterine fibroid-related symptoms along with the opportunity to maintain fertility,” said Aimakhu.

Hugo Verhoeven also spoke on Non- surgical Ablative therapy for Benign diseases of the uterine wall said that Uterine fibroids are the major indication for High-Intensity Focused Ultrasound (HIFU), noting that a worldwide registry of over 137,766 HIFU treatment of benign uterine disease cases.

According to him, HIFU treatment does not increase the complication rate during pregnancy and delivery, especially no increase in the incidence of uterine rupture. HIFU is a safe treatment option for infertility patients.

“Focused ultrasound is approved in Canada, China, Europe, India, Africa, the Middle East, Africa, Oceania, Russia, South America and Taiwan’’ added Nuria Pons Serra.

The event was moderated by Abayomi Ajayi, managing director, Nordica Fertility Centre mentioned that HIFU is also available in Nigeria.