Uterine Fibroids

Description of the problem

There exists some diseases that though benign have not yet been comprehensively understood by the medical and scientific community relative to root causes. One such ailment is uterine Fibroids also termed as uterine leiomyomas. According to Segars and Al-Hendy (2017), it a widely occurring illness amongst women resulting in the morbidity of over 50% to 80% of those in their reproductive years as well as in postmenopausal life. Khan, Shehmar and Gupta (2014) provide that incidences registered amongst fertile women range between 20% and 40%.

Uterine fibroids form as a result of the smooth muscle cells within the tissue mutating into monoclonal tumors. The tumors also bear surrounding masses forming an extracellular matrix made up of proteoglycan, fibronectin, and collagen (Khan, Shehmar, & Gupta, 2014). The reasons behind the mutations remain vague to date though available evidence suggests that tumor development is attributable to fertility associated hormones like progestogens and estrogens (Khan, Shehmar, & Gupta, 2014). This is founded on the fact that fibroids do not occur prior to a woman’s first menstruation and are known to revert after menopause.

Consequence or Aftermath of the Problem

Uterine fibroids widely affect women accounting for a notable proportions of gynecological emergencies as well as outpatient care services even in developed nations like the UK (Khan, Shehmar, & Gupta, 2014). They are asymptomatic in nature implying that a patient often manifests multiple symptoms ranging from uncharacteristic uterine blood flow to miscarriages and infertility. The uniqueness of symptomatic manifestations determine the course of action medical practitioners take for each patient (Khan, Shehmar, & Gupta, 2014). For instance, it may cause pelvic pressure resulting in urinating problems, constipation, unrinary incontinence and frequency, hydronephrosis as well as tenesmus (Khan, Shehmar, & Gupta, 2014). Treatment strategies are therefore designed in response to the variability of notable symptoms.

Uterine fibroids compromises the health statuses of affected women subjecting them to bleeding, pain, and anemia. As Segars and Al-Hendy (2017) note, the patient’s perception of the ailment presents significant challenges such as emotional distress given that it is often associated with infertility. Another reason stems from the outcome that they tend to have challenges like failing to discern normal menstrual flow from uterine fibroids related bleeding (Ghant et al., 2016). For the individual woman, the impact that uterine fibroids has on their quality of life is quite significant (Ghant et al., 2016). These asymptomatic tumors translate to diminished productivity in the days they are able to fruitful work. The clinical manifestations associated with uterine fibroids also resigns women to miss out on participating in social events (Ghant et al., 2016).

Women being an integral part of any human society and the fact that the prevalence of this particular health problem is quite high among them, uterine fibroids are therefore noted as major public health issue. Ghant et al. (2016) posits that treatments for the disease costs approximately 34 billion dollars annually. Similarly, it is the principle cause for women being subjected to hysterectomy procedures (Soliman et al., 2017). Other than the cost of healthcare associated with it, the condition also translates to losses to the general society. For instance, many women are economic drivers based on their efforts to generate household incomes (Soliman et al., 2017). To the employers, women suffering from uterine fibroids are highly likely to miss work. This translates to absenteeism implying that proprietors are subjected to absorbing more costs other than those made for medical spending.

Summary of the Current Research

In many cases, surgical interventions are often favored among the available uterine fibroid management strategies. However, the choice of treatment accorded to each patient is dependent on factors like age as well as the inclination against surgery or “desire to preserve fertility” (Donnez, Donnez, & Dolmans, 2017). With the number of women keen on other medical intervention strategies as treatment for uterine fibroids, alternatives other than surgery are gaining support. Current research on uterine fibroids provides that there are numerous factors leading up to the clinical presentation of the disease through various symptoms (Donnez, Donnez, & Dolmans, 2017). These include steroids associated with sex, cytokines, ECM components, chemokines as well as genetic, epigenetic, and growth factors. Though progesterone and estrogen play a huge part in influencing leiomyoma development, the event that triggers the initial phases of tumorigenesis has been identified as involving somatic mutations.

Treatment using progesterone receptors modulators (SPRMs) have been employed in clinical trials. One particular SPRM, ulipristal acetate (UPA) is one the synthetic compounds presenting antagonistic or agnostic influences of progesterone pathways (Donnez, Donnez, & Dolmans, 2017). Two randomized trials indicated that Leuprolide acetate (GnRH), an agonist and UPA offered different results. 90% of the study sample reported uterine bleeding as controlled after receiving the synthetic substance for three months (Donnez, Donnez, & Dolmans, 2017). It provided a sustained impact on the disease lasting up to six months. In comparison, those treated with GnRH exhibited lesser uterine bleeding control and that subjected tended to experience quick fibroid regrowth six months after treatment.

After Reading the Evidence

Evidence gained from the work by Donnez, Donnez, and Dolmans (2017) illustrates that the current research on uterine fibroid management strategies has unlocked novel doorways for new forms of treatment. The significant advantage with the new management strategy is that clinical trials indicate that arresting tumor development is possible through sustained treatment significantly countering against uterine bleeding. This implies that there is the possibility of delaying or even eliminating the surgery option.

What did I learn doing this paper?

This paper has enabled me come to terms with the fact that there is an illness that negatively women significantly on an individual and by extension, the society. The U.S. alone commits approximately 34 billion dollars to its treatment. This is indicative of the fact that its impact on female populations is huge. For a long time, many of treatment strategies chosen were invasive and requiring surgery which often translates to infertility for women of childbearing age. Thankfully, current research has offered a ray of opportunity for many women as alternative treatment like UPA where clinical trials have shown reduction in some serious symptoms like uterine bleeding and arrested tumor development.

References

Donnez, J., Donnez, O., & Dolmans, M. M. (2017). The current place of medical therapy in uterine fibroid management. Best Practice & Research Clinical Obstetrics & Gynaecology

Ghant, M. S., Sengoba, K. S., Vogelzang, R., Lawson, A. K., & Marsh, E. E. (2016). An altered perception of normal: understanding causes for treatment delay in women with symptomatic uterine fibroids. Journal of Women’s Health, 25(8), 846-852.

Segars, J. H., & Al-Hendy, A. (2017, November). Uterine leiomyoma: New perspectives on an old disease. In Seminars in reproductive medicine (Vol. 35, No. 06, pp. 471-472). Thieme Medical Publishers.

Soliman, A. M., Anand, S. B., Coyne, K. S., Castelli-Haley, J., Snabes, M., & Owens, C. D. (2017). Examining the relationship between symptomatic burden and self-reported productivity losses among patients with uterine fibroids in the United States. Journal of occupational and environmental medicine, 59(10), 974-981.

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