Update treatment of Uterine Fibroids

Uterine fibroid is a benign non-cancerous tumor that originates from the smooth muscle layer and connective tissue of the uterus. Fibroids are the most common benign tumours in females. About 20-40% of women in child-bearing age having uterine leiomyoma of varying size, more common in black women, over white women. Fibroid depends on estrogen-progesterone to grow, therefore relevant only during reproductive years and suspected to shrink after menopause. Leiomyomas grossly appear as round, well circumscribed solid nodules that are white showing whorled appearance on histological section. Ultrasound is used as standard tool to evaluate the uterus for fibroid. MRI is used to define the size and location of the fibroids within the uterus. Magnetic resonance-guided focused ultrasound is non-imaging instrumentation that uses High Intensity Focused US (HIFU) waves to ablate time in combination with MIR which guides monitors the treatment. This technique was approved by FDA at 2004. Uterine artery embolization using interventional radiology techniques to occludes both uterine arteries, reduces the blood supply to fibroids. Small catheter is inserted into the femoral artery at level of groin under local anesthesia under imaging guidance and injecting small particles that will block the blood supply to fibroids. Uterine artery ligation is laparoscopic occlusion of uterine arteries to limit blood supply to the uterus. Radiofrequency ablation is the newest minimally invasive treatment to shrink the fibroids by inserting a needle like device into the fibroid through the abdomen and heat with radiofrequency electrical energy to cause necrosis of the cells. Histeroscopic myomectomy using resectoscope and endoscopic instrument and high frequency electrical energy to cut the tissue and can be done as an outpatient procedure under local or general anesthesia. Laparoscopic myomectromy requires small incision near the wall. Laparotomic myomectomy is the most invasive surgical procedure and any further births will be conducted by caesarean section. Hysterectomy is the classical method of treatment of fibroids. Endometrial ablation is used if fibroids are only within the uterus and small (intramural). Malignancy is about one out of 1000 lesions become malignant typically as leiomyosarcoma. Growth of lesion after menopause is a sign of malignant transformation.Objectives: The aim of this work is to evaluate the recent modalities in the management of uterine fibroids.