Drug treatment of uterine fibroids

Miomi su benigni tumori glatkih mišića maternice. Predstavljaju najčešće tumore maternice kao i najčešće tumore zdjelice. Incidencija mioma kreće se od 20 do 80% u žena reproduktivne dobi, s vrhuncem između 45. i 49. godine života. Često su asimptomatski, a kada uzrokuju simptome mogu imati značajan utjecaj na kvalitetu života. Simptomi ovise o broju mioma, njihovoj veličini i lokalizaciji te se najčešće javljaju u obliku abnormalnih krvarenja iz maternice praćeni bolovima i simptomima vezanim uz pritisak mioma na okolne strukture. Pri donošenju odluke o terapijskom izboru, u obzir se uzimaju dob pacijentice, simptomi, veličina i lokalizacija mioma, a najvažniji čimbenik je želja pacijentice za očuvanjem reproduktivnog potencijala. Danas je dostupno operativno i medikamentozno liječenje te razne nove intervencijske tehnike. Medikamentozno liječenje danas se, u pravilu, koristi za preoperativno smanjenje volumena mioma, a radi njihovog lakšeg uklanjanja i smanjenja intraoperativnih i postoperativnih komplikacija, te za kontrolu abnormalnih i obilnih krvarenja iz maternice. Razlikujemo nehormonsko i hormonsko medikamentozno liječenje mioma. Od nehormonskih preparata koriste se nesteroidni protuupalni lijekovi, traneksamična kiselina i vitamin D. U hormonskom liječenju koriste se oralna hormonska kontracepcija, maternični uložak koji otpušta levonorgestrel, gestagen treće generacije, inhibitori aromataze, GnRH agonisti i antagonisti, te selektivni modulatori progesteronskih i estrogenskih receptora. Njihovom primjenom moguće je odgoditi ili izbjeći operativni zahvat, što je za mnoge žene veoma važno kako bi se očuvao njihov reproduktivni potencijal, te istovremeno umanjiti ili ukloniti simptome i time poboljšati kvalitetu života. Liječenje mioma maternice treba biti prilagođeno svakoj pacijentici individualno, a pri tome je najvažnije uzeti u obzir želju pacijentica za očuvanjem reproduktivnog potencijala. Kako bi se kvaliteta života pacijentica poboljšala i očuvala mogućnost za trudnoću, potrebno je i dalje razvijati spoznaje o medikamentoznoj i minimalno invazivnoj terapiji mioma.Fibroids are benign tumors of the smooth muscles of the uterus. They represent the most common uterine tumors as well as the most common pelvic tumors. The incidence of fibroids ranges from 20 to 80 % in women of reproductive age, with a peak between 45 and 49 years of age. They are often asymptomatic, and when they cause symptoms they can have a significant impact on the quality of life. Symptoms depend on the number of fibroids, their size and location, and most often occur in the form of abnormal uterine bleeding accompanied by pain and symptoms related to the pressure of fibrods on the surrounding structures. When deciding on a therapeutic choice, the patient's age, symptoms, size and location of fibroids are taken into account, and the most important factor is patient's desire to preserve reproductive potential. Today, surgical and medical treatment, and various new intervention techniques are available. Drug treatment is used to preoperatively reduce the volume of fibroids, and to facilitate their removal and reduction of intreoperative and postoperative complications, and to control abnormal and profuse uterine bleeding. We distinguish between non-hormonal and hormonal drug treatment of fibroids. Non-hormonal preparations include nonsteroidal antiinflammatory drugs, tranexamic acid and vitamin D. Oral hormonal contraception, levonorgestrel-releasing intrauterine device, aromatase ihnibitors, GnRH agonists and antagonists, and selective progesterone and estrogen receptor modulators are used in hormonal treatment. By using them, it si possible to delay or avoid surgery, which is very important for many women in order to preserve their reproductive potential, and at the same time to reduce or eliminate symptoms and thus improve the quality of life. Treatment of uterine fibroids should be individualized, and the most important thing is to take into account the patient's desire to preserve their reproductive potential. In order to improve patient's quality of life and to preserve the possibility of pregnancy, it is necessary to develop knowledge about medical and minimally invasive therapy of fibroids