If the leiomyoma does not cause symptoms, it does not require therapy.
If symptomatic uterus myomatosus is suspected, it should first be determined whether uterus myomatosus is actually the cause of the symptoms [S3 guideline].
An indication for therapy exists in the case of rapidly growing tumors or tumors that cause symptoms and where conservative therapy with hormones (see drug therapy) has failed.
Indications for surgical therapy are:
- Capsular rupture
- Myoma infection
- Pain
- Rapid growth
- Severe bleeding disorders
- Sterility/infertility
- Stem rotation
- Unclear diagnosis
One can distinguish the following surgical procedures:
- Uterus-preserving – myoma enucleation (removal of fibroids/ benign muscular tumors from the uterus while preserving them) – in patients with childbearing potential, small leiomyomas; usually laparoscopic (subserosal)/hysteroscopic (submucosal).
- Hysterectomy (removal of uterus; possibly subtotal: preservation of cervix/cervix) – for large uterus myomatosus; completed family planning.
Other surgical techniques
- Uterine artery embolization (synonyms: Uterine fibroid embolization; Uterine artery embolization (UAE); fibroid embolization); in this procedure, an artificial infarction – i.e., an intentional blockage of the uterine arteries – is induced in the uterus (uterus), thereby interrupting the blood supply to or For this purpose, gelatin or plastic particles the size of a grain of sand (between 500-900 micrometers) are introduced via a catheter through arteries in the groin into the respective uterine arteries. Note on uterine artery embolization: The statements of the German consensus paper published after the “4th radiological-gynecological expert meeting” last year should be noted. It states: “In the context of fertility treatment, UAE should at best be regarded as a last resort (“last solution”). Potential risks include, above all, a possible reduction in ovarian reserve (pool of available primordial follicles from which finished oocytes can develop), increased risk of abortion (risk of miscarriage), placental disorders (disorders of the placenta) and increased postpartum (“after birth”) bleeding.”
- Endoscopic ligation of the vessels of the uterus.
Other notes
- In recent years, a non-surgical, outpatient therapy option with few side effects and gentle pain has emerged with the so-called MRI (magnetic resonance imaging) guided focused ultrasound therapy (MRgFUS) (synonym: MR-HIFU = Magnetic Resonance High Intensity Focused Ultrasound). For more information, see “Focused ultrasound (MR-HIFU) of fibroids“.
- If primarily the bleeding disorder (menorrhagia; continuous bleeding) is to be treated, endometrial ablation may be indicated. Endometrial ablation (synonyms: Goldnetz method; Novasure method; endometrial ablation) is a procedure that gently and with few complications, the endometrium (endometrium) is obliterated by high-frequency current, removed as much as possible and sucked out.
- Myomenukleation versus embolization of the uterine artery: women after myomenukleation have a better quality of life than after embolization. Immediately after each procedure, women who underwent embolization reported better quality of life than those who underwent myoma enucleation. After 6 months, the tide turned. Women in the myoma enucleation group reported better quality of life; this remained at the last interview after 2 years.
