Uterine fibroids: diagnosis and therapy
First, the doctor will collect medical history and accurately according to the complaints, questions. At the time of gynaecological palpation examination, he may, possibly, a uniform enlargement or bulbous changes of the buttons. The diagnosis can almost always be made by ultrasound examination through the vagina. Rarely, a hysteroscopy or laparoscopy (laparoscopy) is needed to bring clarity.
What kind of therapy are there?
Small fibroids that do no or only minor complaints, the only regularly monitored every 6 to 12 months with the help of ultrasound. Treatment is required only if complaints occur, or a fibroid is very large. The type of therapy is determined not only according to the complaints, but also to the age of the patient, possibly existing desire to have children and the speed of growth of the fibroid.
Hormones only sometimes helpful
Hormone therapy does not lead to a regression of the myoma but may sometimes relieve symptoms of bleeding disorders, such as increased or prolonged menstrual in the foreground, then a trial of hormones may be made. For example, oral contraceptives, i.e. the pill, the bleeding strength is reduced.
Also, an intrauterine device that continuously sets a hormone that affects the bleeding strength of positive. However, since both methods have no effect on the fibroid itself and this will grow so it is both also can, you’ll need to be close ultrasound follow-up checks.
Hormone treatment with GnRH-analogues
A more radical hormone treatment with GnRH analogues block the production of Oestrogen by the ovaries and leads to a reduction in the size of the fibroids. In principle, this corresponds to an artificial Menopause with all the possible complaints and side effects, such as osteoporosis.
After the treatment, the uterine fibroids also. This makes it clear that it can not be a long-term therapy. But, for example, to Bridge the time up to an Operation, if the fibroid is causing severe discomfort.
Surgery usually helps permanently
In the case of stronger complaints or rapid growth in size, surgical intervention is the treatment of choice. Here, different surgical procedures are available, of the so-called button-hole surgery to the abdominal incision. Which method is chosen depends on the size and the location of the fibroid.
These factors are also decisive, whether the tumor can be isolated or removed – especially if there are multiple fibroids present in the uterus must be removed. In younger women wishing to have children you will of course try to get the uterus. Isolated away, uterine fibroids, however, have sometimes a tendency to reappear.
Embolization of fibroids
A newer treatment option is embolization of fibroids. Here, the supply vessels blood (left and right Arteria uterina) of the fibroid with the smallest plastic particles embolized, so closed. Previous results have shown that by this treatment the majority of women the uterine fibroids, and discomfort make it clear; data on the long-term results are yet.
Because in this method, for infertility and during the implementation of repeated fluoroscopy with x-ray radiation, is applied the method so far only in the case of women, their family planning is complete.
Drug treatment of fibroids instead of SURGERY
In addition, a drug treatment of uterine fibroids as an Alternative to surgery. The active ingredient ulipristal acetate can be used for the preoperative treatment of moderate to severe symptoms as well as in the long-time-interval-therapy, and without a time limitation.
Ulipristal acetate may reduce the volume of uterine fibroids and the discomfort associated with it so strongly, that an operation should not be necessary.
Desire for children and pregnancy
Fibroids can make it difficult to conceive and a miscarriage, foster children’s desire and pregnancy, represent special situations, in connection with fibroids. During pregnancy, the risk that the child will be under powered, when the placenta sits over the fibroid, especially in the second pregnancy half. Furthermore, the tendency of births to be premature. For this reason, larger fibroids should be removed before pregnancy. This also applies when a pregnancy fails without other apparent reasons.
After the menopause fibroids, or at least the complaints are usually. In the case of organ preserving surgery is always the danger that again uterine fibroids. In very rare cases (0,2–0,5 %) can transform the fibroid in a malicious Myosarkom. This is also why regular check-UPS are important.
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- Uterine fibroids – often annoying, almost always harmless
- Uterine fibroids: diagnosis and therapy