Medical management:

Plan of care depends on manifestations, age of client, location and size of

tumors, clients desire to preserve fertility. Fibromyomas can be assessed for 6
months by a practitioner if the client is not pregnant, if there is no excessive
bleeding or pressure on the bladder, bowel, or ureters.

GnRh analogs may be administered to reduce size and inhibit growth of

tumors. Malignant degeneration is rare. A rapid increase in the size of the
fibromyoma is indicated by the manifestations or is detected on examination,
should be thoroughly evaluated.

Surgical management

May include, cutting off the blood to the fibroid with uterine artery
embolization or myomectomy (removal of tumor without removal of the uterus).
Both procedures preserve the reproductive organs and reproductive capability.
However, because of the increase risk that myomas may develop later, a
hysterectomy may be the preferred procedure.

Indications: three types of hysterectomy can be performed.

1. Total hysterectomy- removal of the uterus and cervix. Can be performed

either abdominally or vaginally.
2. Total hysterectomy with bilateral salphingooophorectomy (TAHBSO) removal
of uterus, cervix, fallopian tubes and ovaries. Can be performed vaginally or
abdominally.
3. Radical hysterectomy- same as TAHBSO plus removal of the lymph nodes,
upper third of the vagina, and parametrium. Usually is performed if a
malignant tumor is found.

Contraindications:

The only contraindication to hysterectomy is any health condition that

prevents surgery.

Complications:

Hemorrhage and infection are the primary complications.

Hysterescopic resection of myomas- a laser is used through a hysteroscope

passed through the cervix. No incision or overnight stay is needed.
Laparoscopic myomectomy- removal of the fibroid through a laparoscope
inserted through a small abdominal incision.
 Uterine artery embolization- polyvinyl alcohol or gelatin particles are injected
into the blood vessels that supply the fibroid via the femoral artery resulting
in infarction and resultant shrinkage.