Juniper Publishers : Uterine Myoma Symptoms & Quality of Life
JUNIPER PUBLISHERS- JOURNAL OF GYNECOLOGY AND WOMEN’S
HEALTH
Journal of Gynecology and Women’s Health-Juniper
Publishers
Authored by S Nafees Bano*
Introduction
Uterine Myoma or leiomyomas are benign tumors of the uterine muscle and the leading cause of hysterectomy [1].
These are clinically detectable in 25% to 80% of women in community-
based studies; thus many women have the disease without receiving any
treatment [2].
Little is known about the clinical burden of symptomatic fibroid
disease or about the decisionmaking process regarding fibroid therapies [3,4]. Uterine myoma is the most prevalent benign gynecological tumor [5]. Treatment of this condition has undergone a significant transformation in recent years [6].
It is known that Uterine Myoma causes abnormal
uterine bleeding and pelvic pain as main symptoms, impairing Women's
health related quality of life. However, this last parameter was the
object of fewer researches [7].
Various studies have been done to assess the quality of life of
patients diagnosed with Uterine Myoma with the use of the only validated
measure for fibroid-specific quality of life (UFS-QOL) [8].
The 2011 evidence review on fibroids conducted by the
United States' Agency for Healthcare Research and Quality (AHRQ)
provided a comprehensive assessment of multiple areas where additional
research regarding uterine fibroids is needed [9].
The AHRQ report included as prioritized research questions assessing
the "burden of disease” and how "acquisition and processing of available
information” allow patients and providers to "identify and choose
strategies for fibroid management [10].”
Qualitative studies are important to explore Women's
feelings about the impact of Uterine Myoma in their lives, the barriers
or problems related to pharmacological treatment of Uterine Myoma and
to understand their motivations for requesting clinical and/or surgical
treatment.
Finally, understanding the perspective of disease
from the patient's point of view is seen as increasingly important to
optimize health. For uterine fibroids, obtaining this information is
very timely given that uterine fibroids are one of the three high-impact
research topics announced by the Patient Centered Outcomes Research
Institute for 2013 [10].
Women discussed the impact of Uterine Myoma and
discussion categories were built, leading to four recognizable major
themes, which were: knowledge (beliefs and attitudes) towards UL; fear,
unfairness and discouragement; changes in social and professional
activities due to bleeding and pelvic pain; and medications for Uterine
Myoma [11].
Beliefs and Attitudes Towards Uterine Myoma
The study showed that participants were concerned
that uterine myoma could develop into cancer. Their fear of such an
outcome was a motivational factor for seeking clinical and/or surgical
assistance, and was obvious from their facial expressions as they
discussed the disease. The misconception of uterine myoma as a
preneoplastic disease of uterine cancer was a justification to undergo
hysterectomy. While several participants had relatives with
gynecological malignant neoplasms, others also reported acquiring this
information from family members, their partner, or acquaintances, rather
than directly from a woman who had experienced this type of cancer [11].
Another group of participants reported having little
information about leiomyoma. Some of these women were dissatisfied with
their lack of knowledge about the disease and sought out information
about it. Physicians and media (internet and television) were their main
sources of information. The discussion indicated that the women
believed their physicians were responsible for providing them with
knowledge [11].
Fear, Unfairness and Discouragement
Women referred that bleeding and pelvic pain caused a
huge sensation of fear, especially because of the unpredictability of
these symptoms. Most patients had already tried pharmacological
treatment and experienced therapeutic failures, which made them feel
discouraged; they felt they did not have enough strength to keep on
trying clinical treatment. Unfairness was another feeling reported by
women; they could not understand how they used medications correctly and
they did not work [11].
Changes in Social and Professional Activities Due to Bleeding and Pelvic Pain
The participants reported that bleeding and pelvic
pain limited their domestic and social activities. Some women reported
going to hospitals after many episodes of uterine bleeding and pelvic
pain. Professional activity was also impaired by symptoms. Many women
used their symptoms to justify their decision to undergo hysterectomy [11].
Adverse Effects Using Medications
Most medication-related complaints were associated
with the use of hormonal therapies, which had a negative impact on the
patients' lives. Such medication was easily recognized by these women
due to its subcutaneous route of administration. Despite its beneficial
effects on uterine bleeding and pelvic pain, in general, most women
reported that their quality of life considerably worsened after using
this drug; they reported unpleasant vasomotor and urogenital symptoms
usually associated with hypoestrogenism. Add-back therapy was offered to
these patients; however, only few patients could actually use the
medication due to financial limitations [11].
The study had found that women with uterine myoma had
a negative impact in their quality of life when the symptoms had
started, and treatment failure with medications triggered diverse
negative sensations and modified coping strategies towards this disease [11].
The wrongful association of uterine myoma with cancer
was widely reported by patients during the interviews. However, we
could not find any uterine myoma study discussing the effects of
cancerophobia. In fact, the risk for leiomyosarcoma is extremely low,
and this tumor is often incidentally detected in hysterectomy specimens [12].
Moreover, lack of knowledge of the actual physiopathology of the
disease may influence the treatment decision-making process; therefore,
it is worrisome that women do not have adequate knowledge to make the
right decision [11].
These findings likely have cost implications for both
individuals and the healthcare system and the existing literature on
costs of uterine fibroids is limited. For example, the cost of both
missed work days and limitations on productivity and career advancement
need to be studied to understand the true costs of uterine fibroids [10].
Last, but not least, studying treatments for uterine
fibroids is critical. Hysterectomy has been the primary therapeutic tool
in the gynecologic armamentarium for uterine fibroids for decades.
However, the strong findings related to reproductive concerns in the
women of all ages suggests that educating this particular group about
alternative to hysterectomy is especially important.
Understanding and addressing the needs of the
severely affected women with uterine fibroids are key goals for
healthcare providers and researchers [10].
More research needs to be done regarding uterine-sparing alternatives
to hysterectomy. A variety of effective techniques can be used based on
the woman's symptoms, her fibroid burden, and her reproductive plans [4].
Conclusion
Uterine myoma are a major source of morbidity for
reproductive-age women. Uterine myoma symptoms impair Women's lives
significantly It was shown during interviews that uterine bleeding lead
to negative sensations, such as fear and unfairness. These feelings
impair the social and health world of women who suffer with this
disease. Individual differences in disease representation may correspond
to differences in Women's relative stress levels. This indicates the
importance of identifying other medical and psychological concerns of
women diagnosed with this disease.
Health professionals need to comprehend individual
and cultural differences contributing to a woman's understanding of her
condition. Quality of information is important to the patient and to all
who surround her [13].
Treatment of this pathology is multidisciplinary (involving psychology,
nursing, and many other fields). The doctor-patient relationship, in
addition to other motivational factors, should be considered during the
patient's decision-making process. Moreover, verbal and nonverbal
communications from the patients should be considered.
Acknowledgement
This study related to Uterine Myoma and effect of
Unani Formulation was done at NIUM, Bangalore from 2005 to 2007. The
Uterine Fibroid symptoms and the effect on Quality of life was also
studied with the only validated UFS-QOL questionnaire [8].
There was significant improvement in the QOL after the treatment. I am
thankful to the Director & the Ministry of AYUSH for the funding of
the research work.
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