First, the doctor will raise the medical history and ask for the complaints. In the gynecological palpation examination, he may possibly feel a uniform magnification or nodular changes. The diagnosis can almost always be made by ultrasound examination through the vagina. Rarely, a womb or laparoscopy is necessary to clarify.
Which therapy is there?
Small fibroids that cause little or no discomfort are only monitored regularly every 6 to 12 months using ultrasound. There is no need for treatment until complaints occur or a fibroid is very large. The type of therapy depends not only on the symptoms, but also on the age of the patient, possibly existing desire for children and growth rate of the fibroid.
Hormones only sometimes helpful
A hormone therapy does not lead to a regression of the fibroid, but can sometimes relieve discomfort standing bleeding disorders such as increased or prolonged menstruation in the foreground, then a treatment trial with hormones can be done. For example, by oral contraceptives, so the pill, the bleeding strength is reduced.
An intrauterine pessary, which continuously releases a hormone, also has a positive influence on bleeding strength. But since both methods have no influence on the fibroid itself and this can thus grow as well as regress, close-mesh ultrasound must be performed.
Hormone treatment with GnRH analogues
A more radical hormone treatment with so-called GnRH analogues blocks the estrogen production of the ovaries and thus leads to a reduction of the fibroids. In principle, this corresponds to an artificial menopause with the possible corresponding symptoms and side effects, such as osteoporosis.
If you stop the treatment, the fibroids also grow again. This makes it clear that this can not be a long-term therapy. However, it is useful, for example, to bridge the time to surgery if the myoma causes severe discomfort.
Surgery usually helps permanently
For more discomfort or rapid growth, surgery is the treatment of choice. Here are various surgical procedures available, from the so-called buttonhole surgery to the abdominal section. Which method is chosen depends on the size and the location of the fibroid.
These factors are also crucial, whether the tumor can be removed in isolation or - especially if there are multiple fibroids - the uterus must be removed. In younger women with a desire to have children, of course, you will always try to maintain the uterus. Isolated distant fibroids, however, sometimes have a tendency to recur.
Embolization of fibroids
A newer treatment option is the embolization of fibroids. In this case, the supplying blood vessels (left and right uterine artery) of the myoma are embolized with the smallest plastic particles, ie closed. Previous results have shown that this treatment significantly reduces myomas and discomfort in the majority of women; Data on the long-term results are still pending.
Since this procedure can lead to infertility and repeated x-ray fluoroscopy during the procedure, the procedure has so far been used only on women whose family planning is complete.
Drug treatment of fibroids instead of OP
In addition, there is a drug treatment of fibroids as an alternative to surgery. The active substance ulipristal acetate can be used for the preoperative treatment of moderate to severe symptoms as well as in the long-term interval therapy without time limit.
Ulipristal acetate can reduce the volume of the fibroids and the associated discomfort to such an extent that surgery is no longer necessary.
Desire for children and pregnancy
Fibroids may complicate conception and may contribute to a miscarriage - the desire to have a baby and pregnancy are therefore special situations related to fibroids. During pregnancy, especially in the second half of pregnancy there is a risk that the child will be underserved if the placenta sits over the fibroid. Furthermore, there is a tendency to premature birth. Therefore, larger fibroids should be removed before pregnancy. This also applies if a pregnancy is absent without further apparent reasons.
After the menopause fibroids or at least the symptoms usually recede. In organ preserving operations, there is always a risk that fibroids will form again. In very rare cases (0.2-0.5%) the myoma can turn into a malignant myosarcoma. This is another reason why regular check-ups are important.