Uterine fibroids mostly occur in the late middle age, and about 20% to 25% of women suffer from uterine fibroids before entering menopause. What should we do if uterine fibroids occur near menopause? This depends on the growth location, size, severity of symptoms, and presence of complications of the fibroids, which need to be considered comprehensively. Generally speaking, the following treatment methods can be adopted.
1. Observation and Follow-Up
For perimenopausal women approaching menopause, if the fibroids grow slowly, the uterus is smaller than the size of a 3-month pregnancy, and there is no menorrhagia or compression symptoms, no treatment is needed. Only re-examination is required every 3 to 6 months, expecting the uterine fibroids to shrink after menopause. After menopause, with the decrease in estrogen secretion, uterine fibroids will gradually shrink without the stimulation of estrogen. However, women with uterine fibroids often have a delayed menopause. If the fibroids continue to grow or other symptoms appear during the observation period, surgery must still be considered.
2. Western Medicine Treatment
Western medicine treatment has a certain effect on improving patients' symptoms. For patients with more menstrual flow but small fibroids, who have excluded endometrial lesions, estrogen treatment can be used. Androgens can promote the contraction of the uterine myometrium and vascular smooth muscle in the myometrium, and antagonize estrogen to atrophy the endometrium, thereby reducing the amount of bleeding. Commonly used androgens include methyltestosterone, taken orally 1 to 2 times a day, 5mg each time; testosterone propionate, intramuscularly injected 2 to 3 times a week, 25mg each time. However, the monthly dosage of androgens should not exceed 250mg to avoid virilization. Other hemostatic agents such as Yunnan Baiyao, etamsylate, 6-aminocaproic acid, and vitamin K also have a certain effect on reducing bleeding.
3. Traditional Chinese Medicine (TCM) Treatment
The effect of TCM in treating uterine fibroids is satisfactory, especially for symptoms such as menorrhagia and abdominal pain caused by uterine fibroids. In clinical practice, we treated more than 60 cases of uterine fibroids with self-formulated Xiaozheng Pills. Most patients had significant improvement in clinical symptoms after 3 months of medication, and nearly half of the patients had a significant reduction in fibroid volume. Prescription: Astragalus membranaceus 60g, Codonopsis pilosula 50g, Carapax et Plastrum Testudinis 80g, Prunella vulgaris 45g, Scrophularia ningpoensis 30g, Rhizoma Pleionis, Fritillaria thunbergii, and Squama Manis each 12g, Hirudo 10g, Pyrola calliantha 45g, Akebia quinata 30g, Ramulus Cinnamomi 12g, Poria cocos 15g, Panax notoginseng 10g, Dracaena draco 6g. Grind all into fine powder and make into bean-sized water pills, 9g each time, twice a day. Discontinue medication during menstruation, and one month is a course of treatment.
4. High-Intensity Focused Ultrasound (HIFU) Ablation (Key Introduction)
As a minimally invasive and non-surgical treatment method, high-intensity focused ultrasound (HIFU) ablation has become an important treatment option for perimenopausal uterine fibroids, especially suitable for patients who are unwilling to undergo traditional surgery or have poor physical condition and cannot tolerate surgery.
HIFU ablation works by focusing high-intensity ultrasound waves on the fibroid tissue through the skin and abdominal wall. The ultrasound energy is concentrated in a small area, generating high temperature (above 60℃) in the target area, which can quickly cause coagulative necrosis of fibroid cells, making the fibroids gradually shrink, soften and even disappear. This method does not require surgical incisions, has no bleeding during the operation, and the patient can recover quickly, usually being discharged from the hospital within 1 to 2 days after the operation.
For perimenopausal women, HIFU ablation has obvious advantages: it can effectively relieve symptoms such as menorrhagia and pelvic compression caused by fibroids, avoid the trauma and risks brought by traditional surgery, and retain the integrity of the uterus. It is especially suitable for patients with small to medium-sized fibroids, or those who have contraindications to surgery due to hypertension, diabetes and other comorbidities. However, it should be noted that HIFU ablation is not suitable for all patients. For example, patients with very large fibroids (more than 10cm in diameter) or fibroids with malignant transformation may still need surgical treatment. Before treatment, a comprehensive examination must be carried out to evaluate the size, location and nature of the fibroids to determine whether HIFU ablation is suitable.
5. Surgical Treatment
Surgical treatment should be performed if any of the following conditions exist:
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① Large fibroids: The uterus is larger than the size of a 12-week pregnancy. Even if these patients have no symptoms, surgical resection should be performed.
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② Anemia caused by excessive menstrual flow, which is ineffective after conservative treatment.
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③ Tumor compression of the bladder or rectum, resulting in frequent micturition, dysuria, constipation, or pelvic pain.
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④ Fibroids growing in the cervix, broad ligament, or submucosal fibroids.
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⑤ Fibroids growing rapidly in a short period of time.
The method of surgical treatment varies from person to person. For submucosal fibroids protruding into the vagina, the fibroids can be removed through the vagina. In recent years, with the development of hysteroscopic surgery technology, submucosal fibroids not protruding into the vagina can also be removed under hysteroscopic vision. For intramural fibroids with excessive menstrual flow, endometrial curettage can also be performed to cause artificial amenorrhea, so as to achieve the therapeutic purpose. For other types of fibroids, the most commonly used surgery is total hysterectomy, including the uterine body and cervix. However, if the patient's general condition is poor or technical conditions are limited, subtotal hysterectomy with preservation of the cervix can also be performed. Whether to retain the ovaries during the operation depends on the patient's age. For patients who have entered menopause or are over 50 years old, bilateral ovaries are generally removed. Hysterectomy is not technically difficult, the surgical scope is not too large, it is safe in most cases, there are few postoperative complications, and the patient recovers quickly. Therefore, patients do not need to worry too much about this operation. Since perimenopausal women have no fertility needs, open myomectomy is generally not considered.