First, the doctor will take the medical history and ask exactly about the symptoms. During gynecological palpation, he may be able to palpate a uniform enlargement or bulbous changes. The diagnosis can almost always be made by ultrasound examination through the vagina. Rarely, a uteroscopy or laparoscopy is still necessary to bring clarity.
What therapy is available?
Small fibroids that cause little or no discomfort are simply checked regularly every 6 to 12 months using ultrasound. Treatment is not needed until discomfort occurs or a fibroid is very large. The type of therapy depends not only on the discomfort, but also on the age of the patient, any desire to have children, and the growth rate of the fibroid.
Hormones only sometimes helpful
Hormone therapy does not lead to regression of the fibroid, but can sometimes relieve symptoms If bleeding disorders such as increased or prolonged menstruation are the main concern, then a treatment attempt with hormones can be made. For example, oral contraceptives, i.e. the pill, reduce the intensity of bleeding. An intrauterine device, which continuously releases a hormone, also has a positive effect on bleeding intensity. However, since neither procedure has any effect on the fibroid itself and it can thus both grow and regress, close ultrasound checks must be performed.
Hormone treatment with GnRH analogs.
More radical hormone treatment with so-called GnRH analogues blocks estrogen production by the ovaries and thus leads to a reduction in the size of the fibroids. In principle, this corresponds to an artificial menopause with the possible corresponding complaints and side effects, for example osteoporosis. If the treatment is discontinued, the fibroids will also grow again. This makes it clear that this cannot be a permanent therapy. However, it is suitable, for example, to bridge the time until surgery if the fibroid causes severe discomfort.
Surgery usually helps permanently
In the case of more severe discomfort or rapid growth in size, surgery is the treatment of choice. Various surgical procedures are available here, from so-called buttonhole surgery to abdominal incision. Which procedure is chosen depends on the size and location of the fibroid. These factors also determine whether the tumor can be removed in isolation or – especially if several fibroids are present – the uterus must also be removed. In younger women who wish to have children, the attempt will of course always be made to preserve the uterus. However, fibroids removed in isolation sometimes have a tendency to recur.
Embolization of fibroids
A newer treatment option is embolization of fibroids. In this procedure, the blood vessels supplying the fibroid (left and right uterine arteries) are embolized, or sealed, with tiny plastic particles. Results to date have shown that this treatment significantly reduces fibroids and symptoms in the majority of women; however, data on long-term results are still pending. Because infertility can occur with this procedure and there is repeated fluoroscopy with X-rays during the procedure, the procedure has so far only been used in women whose family planning has been completed.
Drug treatment of fibroids instead of surgery
In addition, drug treatment of fibroids exists as an alternative to surgery. The active ingredient ulipristal acetate can be used both for preoperative treatment of moderate to severe symptoms and in long-term interval therapy without time limits. Ulipristal acetate can reduce fibroid volume and associated symptoms to the point where surgery is no longer necessary.
Childbearing and pregnancy
Myomas can make conception difficult and promote miscarriage – childbearing and pregnancy therefore represent special situations in connection with myomas. During pregnancy, especially in the second half of pregnancy, there is a risk that the baby will be undersupplied if the placenta sits over the fibroid. Furthermore, there is a tendency for premature birth. Therefore, larger fibroids should be removed before pregnancy. This also applies if pregnancy fails to occur for no other apparent reason.
Prognosis
After menopause, fibroids, or at least the symptoms, usually regress. With organ-preserving surgery, there is always a risk that fibroids will form again. In very rare cases (0.2-0.5%), the fibroid may transform into a malignant myosarcoma. This is another reason why regular check-ups are important.
