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MYOMA
The presence of a uterus myomatosus is common; it is estimated that up to 70% of all women of reproductive age are affected by myomas. In about 30% of these women, the myoma also cause complaints (symptoms) that may require medical treatment.
COMPLAINTS
The possible symptoms of a uterus myomatosus are extremely diverse and primarily dependent on the location and size of the respective myoma. Pressure on adjoining structures due to constant growth of the myoma can lead to different symptoms including a feeling of pressure and pain.
If fibroids are located in the immediate vicinity of the uterine cavity or affect the blood supply of the endometrium (lining of the uterine cavity), this can lead to bleeding disorders and/or a reduction in fertility.
The more frequent symptoms of uterus myomatosus include:
Bleeding abnormalities
Heavy menstrual bleeding
Infertility
Increased rate of early pregnancy loss
Abdominal pain and feeling of pressure
Increase of abdominal circumference
Frequent urge to urinate and other urinary symptoms
DIAGNOSIS
Diagnosis of myomas is based on a detailed gynaecological examination and transvaginal ultrasound. Additional imaging, such as magnetic resonance imaging and additional diagnostic procedures, such as an endometrial biopsy (pipelle) can provide valuable information in specific cases.
After careful review of all findings including the respective patients symptoms and their influence on the quality of life of the patient, an individual treatment plan can be established.
THERAPY
It is of particular importance to establish a personalized treatment plan, taking into account the patients symptoms, demographics, reproductive planning, number, size and location of myomas and many other factors, in order to achieve optimal treatment outcome.
It is important to note, that not all myomas require medical therapy; asymptomatic myomas can be observed with transvaginal ultrasound in regular intervals. If the myomas begin to cause symptoms, therapy can be initiated according to the patients needs. Advantages and disadvantages of different treatment options are discussed in detail. The risk of unexpected malignancy (i.e., uterine sarcoma) is discussed with each patient depending on the individual risk profile.
WHICH OPTIONS ARE AVAILABLE?
Wait-and-see management (ie, regular ultrasound examination)
Drug therapy (hormonal and non-hormonal)
Myoma embolization or high frequency ultrasound ablation
Operative hysteroscopy (endoscopy of the uterus)
Myoma enucleation (myoma excision)
Hysterectomy (removal of the uterus)
If surgical therapy is necessary, it is carried out depending on the symptoms, the location of the fibroids, and the age and fertility situation of the patient.
The focus of operative myoma treatment is on hysteroscopy (endoscopy of the uterus) and laparoscopy.
If fibroids are extremely large, the operation (myoma enucleation/hysterectomy) may be performed through an abdominal incision (as small as possible).
Due to the complexity of these surgical procedures, it has repeatedly been demonstrated that surgical specialisation and the frequent performance of such operations (= high-volume surgeon) results in increased utilization of minimal invasive surgical approaches (eg, abdominal incision versus laparoscopy) and in improved patient outcomes.