Nőgyógyászati, Szülészeti és Ultrahang Magánrendelő Debrecen - Dr. Zatik János

 
  Dr. Zatik János szülész-nőgyógyász Debrecen Szent Anna nőgyógyászati magánrendelő Debrecen    
   
 
 
 
 







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Dr. Zatik János
szülész-nőgyógyász szakorvos
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Tevékenység

A magán nőgyógyászati praxis tevékenységi köre a nőgyógyászat, terhesgondozás valamennyi területére kiterjed. Az Ultrahang vizsgálat felár nélkül az alapszolgáltatásaink közé tartozik.

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Cím

Szent Anna Nőgyógyászati, Szülészeti és Ultrahang Magánrendelő
Debrecen
Szent Anna utca 48. sz.

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Kedd, csütörtök, péntek
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8:00 és 13:00 óra között
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Myoma

Unnecessary hysterectomy and revolution at the treatment of fibroids (leiomioma)

 

Especially in Eastern Europe, but in the USA and Great Britain the gynecologists perform too many hysterectomies. One-third of all women get a hysterectomy before they turn 60. Some experts think more than two-thirds of them don't need it, other expert’s think this number is 80-90%. Back pain, endless periods with clots the size of plums. Vaginal bleeding and anemia. Every year, symptoms like these drive thousands of women to consider getting a hysterectomy. In 2003, over 600,000 hysterectomies were performed in the USA alone, of which over 90% were performed for benign conditions (fibroids). Such rates being highest in the industrialized world has led to the major controversy that hysterectomies are being largely performed for unwarranted and unnecessary reasons. Hysterectomy is a major surgical procedure that has risks, and affects a woman's hormonal balance and overall health for the rest of her life. Because of this, hysterectomy is normally recommended as a last resort to remedy certain intractable uterine/reproductive system conditions. Hysterectomy has like any other surgery certain risks and side effects: unintended oophorectomy and premature ovarian failure, premature menopause and effects on social life and sexuality, urinary incontinence and vaginal prolapse, adhesion formation and bowel obstruction, inflammation, injury of the pelvic organs,bowels,urinary tract,ureter,bladder. thrombosis, bleeding or even death. It is a serious operation and in benign cases we have a lot of alternatives. You can see here the alternatives and you can ask for a second opinion if you think that you do not want to have a hysterectomy.

 

What are uterine fibroid tumors?

Uterine fibroids are the most common benign, solid tumors of the female genital tract, affecting between 20 and 25% of women of reproductive age. It is estimated that about 300,000 surgical procedures are performed annually in the EU for uterine fibroids, including approximately 230,000 hysterectomies. The condition is characterized by excessive uterine bleeding, anemia, pain, frequent urination or incontinence, and infertility. So far, GnRH agonists were the only approved drug treatment for uterine fibroids and their use has been relatively limited due to side effects resulting from the suppression of estrogen to post-menopausal levels (hot flashes, depression, mood swings, loss of libido, vaginitis and loss of bone mineral density). Uterine fibroid tumors are benign tumors which are made of fibrous tissue always benign and are found in most cases, in the uterus of women in their 30's and 40's. Most often fibroids occur as multiple tumor masses which are slow-growing and often cause no symptoms.

  • fibroid tumors develop after the body begins producing estrogen during the onset of menstruation
  • fibroid tumors will continue to grow only while estrogen is present
  • they will grow very quickly during pregnancy when the body is producing extra estrogen
  • the tumors shrink at perimenopause and disappear after menopause when the body stops producing estrogen
  • a woman will never develop fibroid tumors after menopause.

Treatment for fibroids

The first treatment:”Waiting for menopause”: Since most fibroids stop growing at perimenopause (5 years before menopause) and later shrink as a woman approaches menopause, the physician may simply suggest "watchful waiting." With this approach, the physician monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary, especially at younger age, when the patients want to be pregnant. Treatment will be determined by your physician(s) based on: health and medical history, extent of the disease, tolerance of the patient for specific medications, procedures, or therapies, patients’ opinion or preference, desire for pregnancy.

 

In general, treatment for fibroids may include:

-Non Operative treatment
-Drugs, hormones

  • Anti-inflammatory drugs and painkillers-This type of drug is often effective for women who experience occasional pelvic pain or discomfort.
  • Hormonal or anti-hormonal agents certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids.
  • Contraceptives: progestin injection and Mirena IUS to stop the bleeding, or pills to moderate the bleeding.
  • Gonadotropin-releasing hormone agonists (GnRH agonists)
    This approach lowers levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
  • The revolution of the treatment : the newest „dream drug” as a newspaper article writes:” Esmya(Ulipristal) is the dream drug, it's antiprogestin properties shrink fibroid by 75%! If approved it can be taken as a daily pill over 3months. Esmya has fewer side effects and lasting benefits over other antiprogestins” European Commission approves Esmya® for the treatment of uterine fibroids (myomas) and the Esmya is the newest medicine of Preglem and owned by the Hungarian pharmaceutical company Gedeon Richter Plc. It is at the drugstores from 2012 in Europe and Hungary. Ulipristal acetate controlled bleeding in over 90% of patients. Excessive bleeding was controlled significantly more rapidly with ulipristal acetate than with leuprolide acetate(GNRH).- Ulipristal acetate significantly reduced fibroid size and for patients who did not undergo surgery, the volume reduction was maintained for at least 6 months after treatment is discontinued. “Today’s approval of Esmya® means that thousands of patients suffering from fibroids across Europe will now have a new targeted approach for medical treatment of these benign tumors. Esmya® offers an effective and well-tolerated therapeutic option, while avoiding the drawbacks of currently available therapies”, said Dr. Ernest Loumaye, Chief Executive Officer of PregLem(Richter Gedeon RT)

-Radiological treatment:

  • Uterine artery embolization(UAE) is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Physicians continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue
  • Magnetic resonance guided focused ultrasound (MRGFU) is a non-invasive outpatient, procedure that uses high intensity focused ultrasound waves to ablate (destroy) the fibroid tissue. During the procedure, an interventional radiologist uses magnetic resonance imaging (MRI) to see inside the body to deliver the treatment directly to the fibroid. The procedure is FDA approved for treating uterine fibroids, but is under investigation for the treatment of breast, prostate, brain and bone cancer.

 

-Operative treatment

  • Conservative surgical therapy conservative surgical therapy uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy. It is performed by hysteroscopy, laparoscopy or laparotomy.
  • And the last possibility, what is often unnecessary :Hysterectomy: the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the United States and Europe.

 

   
 

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