Myomas & its receptors

What regulates growth of

fibroid growth?? Ans;.-Oestrogen is essential for fibroid growth. Can it be progesterone dependent as Ulipristal or Mifepristone work on myma?  Gonadotrophin-releasing hormone (GnRH) agonists downregulates the pituitary with the sub­sequent decrease in estradiol leading to decrease or shrinkage fibroid. Other studies suggest that progesterone and its receptor play a key role- The fibroid shrinkage that occurs with hypoestrogenic may be reversed by progesterone . Progesterone receptor modulators(mifepristone/ Ulipristal)  was  developed initially for preop decrease in size of myoma.

How myoma cause meno?? Why fibroids cause bleeding is uncertain. It seems likely that it is most often associated with submucous fibroids although heavy loss in the

presence of even sub serous fibroids is documented. Reasons why loss may be increased are: increased area or distortion of the uterine cavity , abnormalities of blood supply of the uterus, endometrial abnormalities, ovulatory dysfunction (i.e. associated with both disorders of ovula­tion and increased oestrogen levels).

The most likely reason would seem to be distortion of the cavity and endometrial abnormalities. In regard to the latter, studies have sug­gested that various factors known to be associated with control of menstruation are found in abnormal quantities including: prostaglandins,

Fibroids and subfertility: Why myoma cause subfertility?? For many years there was uncertainty as to whether fibroids did in fact cause infertility or were simply an association. Both fibroids and infertility are common in the older woman and in many instances fibroids are first diagnosed during pregnancy. However, data from assisted conception units indicate that the presence of submucous and possibly  intramural fibroids leads to a decrease in implantation rates. Conse­quently, there is an argument for removing fibroids in women trying to conceive and who are experiencing difficulty. However, many of the studies are poor and do not take into account other complicating factors such as ovulatory disorders or male factors. A review of the literature suggests that more research in this area is desperately needed,

Mifepristone & myoma:  Mifepristone can be prescribed for small sized myoma/myomas  but causes tempo benefits and  symp may recur after stoppage of mifepristone, It is important to consider the position, size and number of the fibroids when making any comparison between treatment modalities. UAE and possibly the levonorgestrel-secreting intrauterine system are likely to be more suitable for women with multiple fibroids than MRI-guided focused ultrasound. None of these treatments is likely to be of value in women with large fibroids where size is the main symptom as the mean decrease in fibroid volume is less than 50% in most studies.