Myomas can be treated with drugs, surgery or newer procedures. The type of treatment depends on the age of the patient, the family planning, the symptoms as well as the location and size of the myomas.
The growth of myomas is hormonally influenced. Estrogen antagonists are administered to shrink them. When the medication is discontinued the myomas are very likely to grow back unless they are surgically removed.
GnRH analogs – Conditions similar to menopause are induced in the body. Side effects may include menopausal complaints such as hot flashes, mood swings, loss of libido or bone loss.
Ulipristal acetate – Ulipristal acetate is a selective progesterone receptor modulator (SPRM) that blocks the effects of the gestagen progesterone (female sexual hormone) and shrinks myomas. Unpleasant side effects may include headaches, nausea and hot flashes.
Focused ultrasound (MrgFUS) - The treatment of myomas by means of focused ultrasound is a relatively new procedure, which is carried out in a few clinics in Germany and does not yet represent a standard procedure. The patient lies with her stomach above a sound source from which high-frequency sound waves are directed to the myoma. The myoma is perforated, shrinks a few weeks later and is finally broken down by the body's immune system. The treatment takes three to four hours and is very costly.
Focused ultrasound can only be used for myomas that are conveniently located so that no organs are affected. Since the method is relatively new, only a few statutory health insurance companies have so far covered the costs.
Uterine artery embolization - The artificial occlusion of blood vessels by administration of biocompatible plastics or plastic particles takes advantage of the fact that the growth of myomas depends on blood supply. When myomas are cut off from blood supply, they shrink or die off completely.
The doctor inserts a catheter (tube) into the main artery of the uterus, the uterine artery, under local anesthesia. This is done under X-ray control, for which a contrast agent is also injected. Finally, plastic particles are inserted into the artery which settle in the finer ramifications and block them. Due to the interrupted blood supply, the myomas are literally starved out.
Ideally, myomas shrink within six months to a maximum of one year and the symptoms diminish.
The plastic particles can inadvertently take other routes during injection and impair the blood flow to the fallopian tubes. This method is therefore unsuitable for patients who want to give birth to children.
Newer methods focus on the preservation of the uterus by enucleation of the myoma (myomectomy). The location of the myomas determines which method is used for enucleation:
In case the nodes grow directly under the endometrium, a hysteroscopy is often taken into account. Hysteroscopic myoma resection is done using an electrosurgical loop to divide the myoma and remove it through the vaginal passage. The use of electric current presents a risk of injury to the uterus and other organs such as the intestine.
In case the myomas are located in the uterine wall or on the outside of the uterus, they are often removed via laparoscopy.
For very large or multiple myoma cases a abdominal incision (Laparatomy) may be necessary.
Myoma enucleation can also be done using a laser as a gentle alternative to the electrosurgical blade.
A hysterectomy as therapy is considered in case the patient continuously suffers from great pain, has heavy menstrual bleeding and a rapid growth of myomas is detected. Especially when proliferation occurs on a large scale, cutting out each node is hardly possible due to a large wound surface.
Even though the ovaries are preserved during hysterectomy, this surgery affects the hormonal balance. Certain blood vessels supplying the ovaries are clamped and the production of hormones is reduced.
For women close to menopause surgical treatment is probably not necessary since some of the discomforts disappear with the cessation of hormone production, and existing myomas might degenerate.
Hysterectomy is only possible in women with completed family planning. If there is a desire to have children, uterine preserving therapies should be discussed with the doctor.