01.09.2021
It is estimated that more than half of all women will develop muscle lumps called myomas in the uterus during their lifetime. About one in three causes symptoms such as bleeding and symptoms such as a feeling of pressure or increased menstrual pain over time.
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Fibroids are growths of tissue made from muscle cells. They sit in or on the uterus and are benign. They arise because natural hormones act on the muscle cells in the uterus, causing them to overgrow. They can be small like a cherry pit or big like an apple; they can lie in the wall of the uterus or just under the lining of the uterus or under its outer covering. They can occur singly or in groups. Depending on the age at which they first appeared, some fibroids remain small; others keep growing. Only when the maturation of egg cells and thus the production of estrogen in the ovaries ceases during the menopause, the growth of these benign tumors also slows down until, in most cases, it dries up completely. In the years after menopause, the cell tissue is gradually broken down.
Two out of three fibroids remain normal for life and do not cause any symptoms of the disease. In about every third myoma disease, prolonged and increased bleeding or intermenstrual bleeding can occur, rarely also pain in the uterus or, in the case of large fibroids in the vicinity, due to the displacement of neighboring organs such as the urinary bladder, ureter or anus. “The most common symptom of fibroid disease is increased menstrual bleeding. But there are also intermenstrual bleeding and pain, ”explains Dr. med. Christian Albring, President of the Professional Association of Gynecologists and established gynecologist in Hanover. The diagnosis is secured with the help of ultrasound; only rarely do additional examinations need to be carried out.
“Which is the best treatment depends on different factors,” explains the gynecologist. “If the fibroids do not cause any symptoms, do not press the neighboring organs and are not jointly responsible for an unfulfilled desire to have children, therapy is usually not necessary, depending on age and growth. If symptoms are already present, treatment must be considered, because these symptoms tend to get worse by waiting. ”
If a woman does not want to undergo an operation, the options are limited: “Medicines can be used to inhibit the binding of the body’s own progestogen to the associated receptors,” explains Albring. “Or you can use other drugs to intervene directly in the hormonal control of the cycle in the brain and block the natural production of estrogen and progestin. The growth of fibroids is slowed down. However, this treatment leads to symptoms of menopause – a side effect that many women reject. “
In addition, there are a number of methods of shrinking or removing fibroids: these include keyhole surgery, sclerotherapy of the blood vessels that supply the fibroids with blood, or localized heating with strong ultrasound. All procedures can allow the uterus itself to be preserved. However, some of these procedures are not suitable if you still want to have children, if fibroids are too large, do not fit properly or there are too many. “It is important that the uterus heals well after an operation, the symptoms disappear and the bleeding stops,” says Albring. “Constant blood loss causes anemia in the long run with poor performance, headaches, fatigue and circulatory problems. If there is no other way out, the mucous membrane can also be obliterated or part of the uterus or the entire organ removed. ”If the lump grows quickly, it may be malignant and must be surgically clarified.
Around 70,000 complete and 25,000 partial uterine removals are currently performed in Germany each year. That is only half as many as 15 years ago. 60 percent of these are performed because of a fibroid disease that cannot be successfully treated with other methods due to persistent and health-threatening symptoms. “If you consider that up to 50 percent of all women will probably develop fibroids before menopause, that still seems to be a small number,” comments the gynecologist. “A woman who turns to her gynecologist about bleeding or other symptoms of a fibroid should not worry that she will be rushed to undergo such an operation. The first choice is always to look for a gentle therapy that makes it possible to preserve the uterus. “
Source: Press release of the professional association of gynecologists © BVF
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