How does a fibroid develop

Uterine fibroids

Myoma (uterine myoma, leiomyoma): Benign growth of the muscles of the uterus. Depending on the location, a distinction is made between myomas that bulge towards the uterine cavity (submucosal myomas), myomas located in the uterine wall (intramural myomas) and myomas that protrude towards the abdominal cavity (subserous myomas). Fibroids can be very large and in extreme cases up to several kilograms. With the menopause, the fibroids go away on their own.

Uterus myomatosus: Usually numerous benign muscle tumors of the uterus (uterus) with different characteristics in size, number, shape and location. The uterus myomatosus is the most common benign tumor in women: It is believed that 30% of women over the age of 30 are affected, but three quarters of women do not notice it. Only if severe symptoms occur do they require hormonal or surgical therapy measures.

Leading complaints

Discomfort during menstruation:

  • Prolonged and unusually painful bleeding (more than 5 days)
  • Bleeding between periods, especially just before menopause
  • Bleeding with labor-like pain as the uterus reacts to the foreign body
  • Loss of blood clots (clots of clotted blood)
  • The symptoms worsened from month to month
  • Unintentional termination of pregnancy (abortion)
  • Sterility, infertility.

Complaints due to blood loss:

  • Fatigue and decline in performance
  • Infectious tendency, especially from fungi
  • Anemia, which causes tiredness and paleness.

Complaints from neighboring organs:

  • Back pain
  • Sensation of pressure and foreign bodies in the abdomen
  • Constipation and discomfort with bowel movements caused by the pressure on the intestines
  • Discomfort during intercourse
  • Acute abdomen: By rotating a (pedicled) myoma around its own axis, blood vessels running there are constricted and the blood supply is interrupted. A complex of symptoms develops, which is characterized by severe pain in the abdomen (abdomen) and a possible threat to life
  • Bladder problems with an increased need to urinate up to unwanted loss of urine (urinary incontinence).

When to the doctor

In the next few weeks if

  • the complaints mentioned occur.

The illness

Causes and Risk Factors

Uterine fibroids develop and grow under the influence of estrogen, progesterone, and other hormones such as insulin. For this reason, fibroids only exist in childbearing age. After the menopause (climacteric), growth often comes to a standstill or spontaneous regression, but myomas do not go away during the menopause. However, since they do not bleed, they rarely require treatment.

Risk factors:

  • Inheritance
  • 9 times increased risk in women of African, Afro-Caribbean, and Afro-American ancestry.

clinic

The symptoms vary depending on the size, location and number of the fibroids. The various complaints can be explained primarily “mechanically” by the enlargement and space occupation of the monthly growing uterus as a result of the myomas.

Fibroids can form in all conceivable places in and on the muscles of the uterus. Some reach an imposing size, others are hardly noticeable.
Georg Thieme Verlag, Stuttgart

Complications

In rare cases, the fibroid degenerates into one Uterine sarcoma or myosarcoma, which is localized in the uterus but is otherwise unrelated to uterine cancer. If it's not surgically removed early, it's almost always fatal.

One large fibroid or several small fibroids can prevent pregnancy from occurring. There is a slightly higher risk of premature birth in women who become pregnant despite having a fibroid.

Diagnostic assurance

The diagnosis is mainly ensured by vaginal and abdominal ultrasound. This is followed by the bimanual palpation examination, in which the gynecologist first inserts his finger into the vagina and checks the tissue or the presence of indurations. He places the second hand on the abdominal wall so that he can carefully feel the outside of the uterus.

A blood test will clarify whether there is anemia or iron deficiency. If necessary, a uterine specimen, laparoscopy or magnetic resonance imaging is also performed in order to precisely localize myomas.

treatment

The therapeutic options are as varied as the symptoms.

Wait-and-see treatment

Small fibroids do not require treatment as long as the symptoms are minor. However, the fibroids should be checked regularly by ultrasound in order to detect excessive growth and possible degeneration at an early stage.

Pharmacotherapy

Non-steroidal anti-inflammatory drugs. These include anti-inflammatory drugs such as ibuprofen or naproxen.

Pill. Myomas can generally be "immobilized" hormonally with the "pill". This is particularly useful if contraception is desired anyway and there are no ›exclusion criteria. If the “pill” is stopped, however, the symptoms quickly worsen again.

GnRH analogues GnRH analogues (e.g. Enantone-Gyn®) act on the brain, which then no longer releases GnRH. This immobilizes the ovaries, which leads to artificial menopause, so to speak. GnRH analogues are injected into the upper arm once a month. Their effectiveness is high: they not only stop the fibroid growth, but even make the fibroids shrink. GnRH analogues, however, lead to the typical symptoms of the onset of menopause, such as hot flashes, sweats and depression. Prolonged treatment with GnRH analogues has an unfavorable effect on bone density, there is a risk of osteoporosis. That is why this therapy is only a solution in the case of symptoms “within sight” of menopause.

In the end, many patients are not spared the surgical removal of the fibroids. In order to be able to carry out this with low risk, the GnRH analogues are often used for the months before the operation. On the one hand, the fibroids recede and on the other hand, the patient loses less blood during menstruation.

Ulipristal acetate. As an alternative to the GnRH analogues, the active ingredient ulipristal acetate has been available under the name ellaOne® since 2012. In addition to the morning-after pill, it is also approved for the preoperative treatment of uterine fibroids that are intended for an operation. In addition, ulipristal acetate is used for interval therapy for moderate to severe symptoms. It is still unclear whether fibroids can be removed more gently after treatment with ulipristal acetate than without treatment. There is also a lack of study data on the tolerability of ulipristal acetate for long-term use.

Operative therapy methods

Fibroid surgery. The extent of the operation depends crucially on the size, location and number of the fibroids. The minimally invasive procedures are less stressful. Peeling is preferred (Myoma nucleation) to use. The doctor tries to reduce the size of the fibroids with GnRH analogues in order to be able to peel them out of the uterine wall more easily with a laparoscopy and thereby preserve the uterus. The disadvantage of this method, however, is the risk of relapse.

Hysterectomy. In the case of very large, unfavorably located or particularly numerous fibroids, the doctor recommends removing the uterus (total operation, hysterectomy), especially if the family planning has already been completed. It is performed either vaginally (from the vagina, less invasive) or abdominally (from the abdomen, major surgery, but better overview for the surgeon). The removal of the uterus is justified if the uterus as a whole is greatly enlarged or other pathological changes are the result (e.g. uterine sagging, urinary or fecal incontinence). Surgical therapy has the advantage that, in contrast to therapy with GnRH analogues, the production of female sex hormones is not impaired.

The rate of complications with the removal of the uterus is surprisingly lower than with the peeling, which usually leaves large wound areas. For this reason, older women in particular sometimes prefer hysterectomy.

Embolization. During embolization, the doctor obliterates (embolizes) a blood vessel leading to the uterus with a catheter, which he pushes over the groin into a pelvic vessel. The reduced blood supply leads to a shrinkage of the myoma and a weakening of the menstrual period. This procedure is technically complex and associated with considerable radiation exposure because of the necessary fluoroscopic controls. Therefore, embolization is currently only offered by a few clinics. In addition, not all myomas are suitable for embolization.

Ultrasound therapy. Here, the fibroid is overheated or shrunk using magnetic resonance tomography (MRT) images using bundled ultrasound waves. This treatment is only suitable for small fibroids less than 8 cm in diameter. It is currently only used in a few clinics, as there is still too little experience with it.

Your pharmacy recommends

What you can do yourself

Go to your gynecologist regularly for check-ups. Unfortunately, there are no teas, relaxation techniques, gymnastics techniques or dietary recommendations that can cause fibroids to regress. At most, the perception of the complaints can be positively influenced. However, due to the progression of the complaints from month to month, this is usually not a solution. Nonetheless, illicit vision is not in fashion: today, fibroid therapy - unlike 30 years ago - by no means always involves the removal of the uterus, which many women are afraid of.

Complementary medicine

Herbal medicine.

An alternative treatment for small myomas are preparations with medicinal plants such as monk's pepper (e.g. Agnolyt®, Femicur®), the active ingredients of which lower the level of estrogen. Tea preparations made from yarrow (Achillea millefolium) can regulate the intensity and duration of bleeding and relieve cramp-like pain. You are e.g. B. A good solution if you are pregnant. Non-hormonal, "natural" drugs or therapy methods are initially desired or even required by many women. The gynecological practice shows, however, that the patients report a temporary positive effect at best, such as B. a reduction in the intensity or duration of the bleeding. Almost all patients therefore turn to the gynecologist again sooner or later with the same menstrual cramps / disorders.

Authors

Dr. med. Astrid Waskowiak, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Symptoms and leading complaints", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 10:17


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.