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Uterine Fibroid

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Uterine Fibroid is benign tumor commonly called myoma that is easy to find in over 20-40 % of fertile women. There are usually no symptoms being presented so many times it is found while giving medical examination or due to promotion of foreign substance from underbelly. It’s because people usually can not notice the problem since most of Uterine Fibroid exhibits no symptoms or unclear symptoms like uncomfortable pelvis, pressure, dyspareunia, lumbago and urinary disturbance. Uterine fibroid existence and sizes can be confirmed easily with simple ultrasound exam. It is unusual for uterine fibroid to grow as cancer but however 0.1~0.4% of uterine fibroid turns into cancer and sometimes it creates 2nd degeneration and cause great pelvis pain. Unless the size of uterine fibroid is too big or cause special symptoms, it is not must to treat.
The reason of uterine fibroid creation and growth is unclear but it is inferred that female hormone, estrogen act greatly and Uterine myoma is generally classified into 3 types based on where the myoma is developed within the uterus.

1. Submucosal myoma - This type develops in the substratum endometrium, with the worst prognosis and many complications. Even a small size can bring bleeding and causes abortion and infertility. The rate of changing to a sarcoma is large and easily becomes an infection, suppuration, and necrosis.
Incidence rate : about 5%
2. Intramural myoma - Developing deeply within the myometrium, this myoma causes the uterus size to increase. The area of the endometrium increases which causes the amount of menstruation to increase, but the patient cannot feel any other symptoms.
Incidence rate : about 80%
3. Subserosal myoma - This develops in the most outer layer of the uterus. The myoma itself does not have any subjective symptoms, but suppresses other surrounding organs and causes many kinds of symptoms.
Incidence rate : about 15%

As the uterine myoma increases, it suppresses many surrounding organs within the body and blocks the contraction and relaxation of the uterus which causes many symptoms. The representative symptoms are abnormal metrorrhagia, pelycalgia, menstrual cramps, dyspareunia, urinary frequency, etc. The possibility of early labor increases in the case of infertility, early abortion and pregnancy, and that of puerperium bleeding increases since the uterus does not contract well after giving birth.

1. Menorrhagia
As the most common symptom of uterine myoma, the amount of menstruation increases and presents the main reason for treatment or surgery. This naturally causes anemia and chronic fatigue, which is a syndrome of continuous tiredness. The menstruation period may increase or it happens abnormally not during the period.

2. Pelycalgia
It is classified into chronic pelycalgia and acute pelycalgia. Chronic pelycalgia occurs in a form of menstrual cramps, dyspareunia, pelvic compression, and acute pelycalgia may occur with necrosis or denaturation of the myoma. Pelycalgia shows severe difference between individuals, and has various cases from slight levels to unbearable severe pain.

3. Urinary frequency or micturition disorder
This occurs if the uterine myoma develops from the anterior direction of the uterus wall and suppresses the urinary bladder or ureter.

4. Constipation or defecation pain
This occurs if the uterine myoma develops from the posterior direction of the uterus wall and suppresses the rectum.

5. Digestion disorder or ileus
This occurs when the uterine myoma suppresses the intestines.

6. Infertility
The myoma causes infertility and abortion depending on its location.
About 3 methods are presented for treating uterine myoma- hormone therapy, extirpation, (hysterectomy, myomectomy) and radiofrequency myolysis. Extirpation is divided into laparotomy and endoscopic operation. Endoscopic operation is parted into colpolaparotomy and laparoscopy. As the most recently developed method, RF Myolysis is the most supported by uterine myoma patients and OBGYN doctors. The treatment mechanism is to insert a thin RF electrode into the myoma or adenomyoma and create radiofrequency by RF generator. Then the ions in the organs will vibrate, creating heat and protein degeneration. The tissue which protein was degenerated dies, changes into collagen, and is absorbed slowly into normal organs. Therefore, the myoma size begins to reduce. Not only the tissue is degenerated, but also many blood vessels and other factors related to the growth of the myoma that nutrients it also dies, reducing the myoma and preventing reproduction and redevelopment. This lowers the recurrence rate significantly. Also, factors causing bleeding and pain are also eliminated. At present, many university and specialized hospitals are using this method, and many studies are being presented on positive, epochal treatment effects. Since its priorities are to preserve the uterus while showing fast improvements of several symptoms caused by uterine myoma or uterine adenomyoma, young women, those who want to preserve the uterus although they do not have further plans of pregnancy, and women in their 40s close to menopause with severe symptoms due to the myoma should actively consider this method.

Advantages of RF Myolysis are as follow;
1. Preserve uterus with minimal damage.
2. Conscious sedation can be used which excludes the risk of general anesthesia.
3. The procedure time is short, and the patient can admitted and departed on that day since there are not any sequelas.
4. Symptoms such as excessive bleeding or pain are quickly improved.
5. No pain due to procedure or bleeding and leaves no scars or wound.
6. The redevelopment and recurrence are blocked by eliminating the growth factor of the myoma.
7. In cases of uterine adenomyoma, preservation treatment without removing the uterus is possible.
8. Re-operation is simple, in case symptom improvement effects are under expects.