Uterine Fibroids and Bacterial Vaginosis

Uterine Fibroids and Bacterial Vaginosis

Hello Sarabjit,

This is an exciting post, Sarabjit. Uterine fibroids have become an issue of public health concern based on their impacts on overall women’s and community health and their risk to fertility health in women. According to the Institute for Health Metrics and Evaluation (2022), an estimated 226 million women globally were living with uterine fibroids, while 6480 deaths were linked to fibroids in 2019. Diagnosed women with uterine fibroids have shown a reduction in their health-related quality of life (HrQOL) (Marsh et al., 2018). There are significant racial disparities in access to reproductive health in the United States, making a majority of Black women remain undiagnosed and overburdened with uterine fibroids (Beroukhim et al., 2022). There is a need to not only develop a cure for fibroids but also focus on education and awareness to improve testing and early diagnosis and eliminate disparities in healthcare access to promote women’s fertility and mental health.

References

Beroukhim, G., Mahabamunuge, J., & Pal, L. (2022). Racial disparities in access to reproductive health and fertility care in the United States. Current Opinion in Obstetrics and Gynecology, 34(3), 138–146. https://doi.org/10.1097/GCO.0000000000000780

Institute for Health Metrics and Evaluation. (2022). Uterine fibroids-Level 4 Cause. https://www.healthdata.org/results/gbd_summaries/2019/uterine-fibroids-level-4-cause

Marsh, E. E., Al-Hendy, A., Kappus, D., Galitsky, A., Stewart, E. A., & Kerolous, M. (2018). Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. Journal of Women’s Health, 27(11), 1359. https://doi.org/10.1089/JWH.2018.7076 

Hello Sheila,

This is a good and informative post, Sheila. Bacterial vaginosis (BV) may not be a lethal bacterial infection; however, it increases the risk of early delivery, pelvic inflammation disease, and the acquisition of lethal STIs such as HIV/AIDS (Muzny et al., 2019). Using broad-spectrum activity antimicrobials such as Nitroimidazoles and Metronidazole can help combat the effects of BV. However, these antibacterial medications are associated with many side effects. Additionally, the recurrence rates of BV are incredibly high, as related studies have noted an 80 percent chance of recurrence after three months of effective infection treatment (Coudray & Madhivanan, 2020). Therefore, focus on managing infections like BV should be concentrated on adopting a more preventive rather than a responsive approach. The best-recommended methods for preventing BV are investing in personal hygiene, using unscented products and high-quality fabric around the vagina, and avoiding sex with multiple partners.

References

Coudray, M. S., & Madhivanan, P. (2020). Bacterial vaginosis—A brief synopsis of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology, 245, 143–148. https://doi.org/10.1016/J.EJOGRB.2019.12.035

Muzny, C. A., Taylor, C. M., Swords, W. E., Tamhane, A., Chattopadhyay, D., Cerca, N., & Schwebke, J. R. (2019). An Updated Conceptual Model on the Pathogenesis of Bacterial Vaginosis. The Journal of Infectious Diseases, 220(9), 1399–1405. https://doi.org/10.1093/INFDIS/JIZ342

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1. Sarabjit
A relatively frequent benign tumor in women is uterine fibroid. According to a study, the likelihood of developing fibroids climbs to 70% by age 50. The formation of fibroids, made of uterine smooth muscle cells, relies on the amount of estrogen in the blood. Physical examination and pelvic ultrasound are typically used to make the diagnosis. Back pain, pelvic pain, and irregular menstruation are all typical signs of uterine fibroids (Barjon & Mikhail, 2021).

Uterine Fibroids and Bacterial Vaginosis

Etiology

It is unknown what causes uterine fibroids specifically. According to the study, the disease begins in a cell, and then the mechanisms for cellular division start to shift. Uterine fibroids are more likely to develop when estrogen and progesterone receptors are overexpressed (Barjon & Mikhail, 2021).

Pathophysiology

An expansion of myometrium or smooth muscle tissue in the uterus causes fibroids. When estrogen and progesterone levels are high, the fibroids will grow larger. These sex hormones are necessary for the growth of fibroids (Barjon & Mikhail, 2021).

Clinical Signs and Symptoms

Heavy menstruation or abnormal uterine bleeding are frequent clinical manifestations. Uterine fibroids can also cause bowel issues, infertility, dyspareunia, pain, and pressure in the pelvis. Patients may not even have symptoms when diagnosed following an ultrasound (The American College of Obstetricians and Gynecologists, 2018).

Diagnostic Work-up

When a patient is of childbearing age, the first test is meant to rule out pregnancy. Transvaginal ultrasonography has a 90% to 99% sensitivity to detect uterine fibroids, making it the most sensitive diagnostic technique available. The diagnosis of uterine fibroids also requires a thorough physical examination and a thorough medical history. Uterine fibroids may be indicated by a mobile, swollen, and irregularly contoured uterus on a pelvic exam.
Palpating the abdomen during a physical examination may reveal a tumor or enlarged uterus. Additionally, hysteroscopy can be performed to enhance the vision of uterine fibroids. Hysteroscopy is a tool doctors use to help remove excessive growths (The American College of Obstetricians and Gynecologists, 2018).

Non-pharmacological and Pharmacological Management

Treatment aims to lessen indications, symptoms, and patient desire for conception. The provider must consider the patient’s age, clinical appearance, and preference. The size and location of the fibroids also influence the course of treatment. In cases where a woman has no symptoms, close observation is ideal. 1) Hormonal contraceptives, the most prevalent hormonal technique being the levonorgestrel intrauterine device (IUD) and oral contraceptive pills (OCP). IUD is the therapy of choice since it has fewer adverse effects. 2) GnRH antagonists work by inhibiting the pituitary gland’s ability to produce sex hormones. The American College of Obstetricians and Gynecologists advises using this therapy within six months or fewer because long-term usage of GnRH can raise the risk of osteoporosis. 3) NSAIDs can lower prostaglandin levels, which eases uncomfortable cramping. NASID does not reduce the tumor’s growth.
Endometrial ablation is a surgical treatment option for patients who experience severe or irregular bleeding. Patients who desire to maintain their fertility can undergo uterine artery embolization, a minimally invasive procedure. To stop bleeding, the procedure restricts the blood supply to the uterus, which lowers the blood flow to the fibroids. Myomectomy is an invasive procedure for people who want to preserve their fertility (The American College of Obstetricians and Gynecologists, 2018).

Education and Follow-up

Inform patients that the majority of fibroids are benign. It’s crucial to involve people in their care. The therapy alternatives should be thoroughly discussed with patients and tailored to their needs. Inform the patient of their options and any potential side effects if reproductive treatment is requested. Organize a follow-up appointment for the patient to see a specialist in two weeks (Barjon & Mikhail, 2021)
2. Shiela
Although bacterial vaginosis (BV) can afflict women at any age, it is frequently observed in women who are in their reproductive years. The proliferation of bacteria that is naturally present in the vagina and upsets the natural balance is what leads to BV, a type of vaginal inflammation. Unprotected intercourse, several partners, new partners, douching, smelly tampons/pads, and changes in laundry detergent/fabric may all increase the risk of contracting BV, even if the cause is not fully understood. The signs and symptoms include dysuria, thin, gray, white, or green vaginal discharge, unpleasant vaginal odor, and vaginal itching. However, some women might not exhibit symptoms or warning signals (Jones, 2019). “BV has been linked to a higher chance of contracting STIs, such as the herpes simplex virus, gonorrhea, chlamydia, and the human immunodeficiency virus (HIV). Preterm birth and pelvic inflammatory illness can also result from BV.

A complete history, medical history, and sexual history must be gathered to diagnose BV accurately. Asking about previous vaginal infections and STDs is crucial, as is completing a pelvic exam when a sample of the vaginal secretions should be taken. If BV is present, vaginal cells covered with bacteria are a good marker of bacterial vaginosis. Thus these secretions should be examined for an overgrowth of anaerobic bacteria in the vaginal flora. These cells can also be examined under a microscope. A pH strip can be inserted into the vagina to assess the acidity and used to test the pH there. Another reliable sign of BV is a vaginal pH of 4.5 or above (Bradshaw & Sobel, 2016).

It is acknowledged that there are limitations to treatment because the pathophysiology of BV is still poorly understood. Most available therapies are empirical, and metronidazole is frequently used to treat BV. This drug comes as a gel that can be put into the vagina or taken orally. Another often prescribed antibiotic for BV is clindamycin, which is also available in a cream form that is put into the vagina. However, caution should be taken because this form may make latex condoms less effective.