Diagnosis
The gynecological palpation often provides initial indications, but this is usually confirmed by a cell examination via smear, which should be inconspicuous in the case of a myoma. An ultrasound examination through the vagina or abdomen (vaginal or abdominal sonography) is also suitable for finding a diagnosis, as larger fibroids may already be visible. If no results are available yet, uterine or laparoscopy (hysteroscopy or laparoscopy) is still possible.
A myoma should always be approached therapeutically if it causes physical symptoms or has already led to infertility. If there is no longer a desire to have children or the symptoms of the myoma are not too pronounced, drug therapy can be used. The aim here is to use hormone therapy to inhibit the growth of the myoma and, if possible, to reduce its size.
Disadvantages of hormonal treatment are, on the one hand, the menopausal symptoms triggered by the hormone therapy (e.g. hot flushes, osteoporosis, mood swings and vaginal dryness) and, on the other hand, the fact that the growth of the myoma continues after the medication is discontinued. The use of painkillers is usually mainly symptom-oriented and is intended to make the symptoms more tolerable. Surgical treatment (myoma surgery) is always advisable if a malignant event could not be ruled out or dangerous complications occur.
An existing desire for children in the case of infertility is also an indication for myoma surgery. The type of operation depends on the extent of the myoma and family planning. If only single fibroids are present and there is a desire for a child, the uterus should be spared as much as possible.
Depending on the position of the myoma, this can be achieved by means of a laparoscopy or laparoscopy incision or uterine endoscopy. In this procedure, the tumors can first be assessed and then gently removed using a viewing device (endoscope) that is inserted through the navel or vagina. If there is no desire to have children and if the fibroids are very extensive, the entire uterus should be removed during myoma surgery (hysterectomy).
Depending on the size of the fibroids, this can be done by abdominal incision or through the vagina. A further therapeutic option is the removal of both uterine arteries (myomembolization). In this procedure, catheters are inserted into the uterine arteries on both sides through small incisions in the groin and polyvinyl alcohol particles are used to close these vessels. The desired result is a reduction in the size of the fibroids by cutting off the blood supply, but this is often only temporary.