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Mioma Uteri

Neoplasma otot polos jinak yang


berasal dari miometrium
Fibroid=mioma uteri=leiomioma
20-25%
70-80% (sonografik, histologik)

Etiologi belum diketahui


Tumor monoklonal
Tumor sensitif terhadap estrogen dan
progesteron

S:
- 50% tidak ada gejala
- Perdarahan: menoragia
- dismenorea
- Gejala anemia: pusing, lelah

- Infertilitas
- Nyeri pelvik (jarang)
terkait proses degenerasi atau terjadi
torsio
- Gejala akibat penekanan:
konstipasi, retensi urin, hidronefrosis

P
- Uterus: pembesaran, ireguler
USG:
- hipo/hiperekoik

Tatalaksana
I. Asimtomatik -> observasi dan follow up tiap 1 tahun
(ACOG 2001)
II. Tatalaksana medikamentosa
A. NSAID
B. Terapi Hormonal
C. Agonis GnRH
D. Androgen
E. Antagonis GnRH
F. Anti Progestin
III. Terapi pembedahan
G. Histerektomi
H. Miomektomi

A. NSAID
dismenorea

B. Terapi hormonal
Reasonable option for menstrual-related
symptom
American college of Obstetrician and
Gynecologist (2008) -> unpredictable effects on
leiomyoma growth: recommend close
monitoring of leiomyomas and uterine size
American Society for reproductive medicine
(2006) -> not recommended
Kontrasepsi oral kombinasi, levonorgestrelreleasing intrauterine system

C. GnRH Agonis
Ukuran berkurang s/d 50% (dalam 3
bulan terapi)
Terapi dibatasi dalam 3-6 bulan
Stop -> fibroid kembali membesar
dalam 12 minggu

C. GnRH Agonis
Indikasi:
- Tatalaksana anemia, untuk mengembalikan
level Hb normal sebelum dilakukan
pembedahan
- Tatalaksana pada wanita yang mendekati
menopause, untuk menghindari tindakan
pembedahan
- Tatalaksana preoperatif miom besar untuk
mempermudah prosedur pembedahan
- Tatalaksana pada wanita dengan
kontraindikasi medis dari pembedahan

D. Androgen
Danazol, gestrinone
Prominent side effects: acne,
hirsutism
Not used as first-line agents

E. GnRH Antagonist
Cetrorelix, ganirelix
The use of GnRH antagonists as a
treatment for fibroids requires further
evaluation

F. Antiprogestine
Mifepristone
may directly decrease the PR in the
myometrium and leiomyoma
Though the exact mechanism for
myoma size reduction is unclear
2.5 mg daily for 3 to 6 months as the
optimum treatment

Uterine artery embolization

Dengan PVA (polyvinyl alcohol)

Bedah
Abnormal uterine bleeding with resultant anemia,
unresponsive to hormonal or other conservative management
Chronic pain with severe dysmenorrhea, dyspareunia, or lower
abdominal pressure or pain
Acute pain, as in torsion of a pedunculated leiomyoma or
prolapsing submucosal fibroid
Urinary symptoms or signs such as hydronephrosis after
complete evaluation
Infertility with leiomyomas as the only abnormal finding
Recurrent pregnancy loss with distortion of the endometrial
cavity
Markedly enlarged uterine size with compression symptoms or
discomfort

Histerektomi
the most effective treatment for symptomatic
uterine fibroids
In women who have completed childbearing,
hysterectomy is indicated as a permanent
solution for symptomatic leiomyomas
The only indications for hysterectomy in a
woman with completely asymptomatic fibroids
are enlarging fibroids after menopause without
HRT, which raises concerns of leiomyosarcoma,
even though it remains very rare.

Miomektomi
for women who wish to retain their uterus,
regardless of their fertility desire.
Removal of fibroids should be considered if
they are thought to be associated with heavy
mentrual bleeding, pelvic pain and/or pressure
symptoms, and in some cases reproductive
issues.
Fibroids have a 15% recurrence rate and 10%
of women undergoing a myomectomy will
eventually require hysterectomy within 5 to 10
years