The Myoma Center
Dr. med. Constantin Zwergel
As the most common benign tumors in women, fibroids have a significant impact on fertility and are often associated with symptoms such as bleeding and pain. At our Myoma Center, we can provide you with comprehensive advice and offer you a suitable treatment from a wide range of alternatives.
Contents
- Appointments / Registration
- The Myoma Center
- Questions and answers
- Fertility and myoma therapy
- Supporting offers
What are fibroids?
To the interview on YouTube
In this interview, Dr. Constantin Zwergel answers questions about fibroids.
What are fibroids?
Myomas are benign tumors in the uterine muscles. They develop from a cell and can grow, which can cause discomfort.
What are the factors influencing fibroids?
Fibroids are usually dependent on female hormones such as oestrogen. This is why they are often an issue for women of childbearing age, i.e. from the first period to the menopause.
What is the likelihood of a woman getting a fibroid?
The probability depends on various factors, such as ethnicity. African Americans have a higher incidence. About half of all women will have a fibroid in their lifetime, but not all fibroids need to be treated.
How are fibroids diagnosed?
The diagnosis can be made by a gynecologist in private practice. The first step is a patient consultation to determine the symptoms. Of course, a clinical examination in the form of abdominal palpation and an ultrasound examination, which can be performed through the abdominal wall or vaginally, is also important. This allows the presence, number and size of fibroids to be diagnosed. Can fibroids be malignant? More than 99% of fibroids are benign tumors. Malignant fibroids are usually detected by abnormalities during an examination.
What symptoms do fibroids cause?
Myomas can cause various symptoms depending on their location. There are fibroids that are located in the uterine cavity and therefore often cause bleeding disorders or problems during pregnancy. Fibroids that protrude into the abdominal cavity can anatomically press on other organs such as the bladder and cause urinary problems or pain.
When do fibroids need to be treated?
Myomas should be treated if they cause discomfort. Small fibroids without symptoms or abnormalities can sometimes be left as they are. Exactly these questions are discussed individually in the myoma consultation.
Therapy options
Prof. Dr. Dr. Schippert explains the options for drug therapy for fibroids.
What options are there for treating fibroids with medication?
There are various preparations that have been admitted for myoma therapy. The relatively new preparations can treat bleeding disorders such as heavy or painful bleeding and are usually well tolerated with relatively few side effects. They interfere with the hormonal balance and remove hormones from the body so that the fibroid is starved. Older preparations artificially put the patient into menopause, which leads to stronger side effects and therefore the newer preparations are preferred. However, it is not possible or permitted to become pregnant with these preparations, which is why it is important to consider which patients will benefit from drug therapy.
Contraceptive pills are not myoma therapy. Although they can treat bleeding disorders, the female hormones they contain can promote the growth of fibroids.
What are the advantages and disadvantages of this therapy?
The advantages are that women who do not want or cannot undergo surgery for various reasons or who are already close to the menopause can avoid surgery. Younger women are more reluctant to choose this therapy, as the period until the menopause is still very long and the desire to have children is not feasible, if this exists.
Dr. med. Cornelia Dewald explains the options for radiological therapy.
What options are there for treating fibroids radiologically?
Fibroids can be treated radiologically with minimally invasive uterine fibroid embolization. This procedure is particularly suitable for patients in whom the uterus is to be preserved, who do not want surgery or where surgery under general anesthesia is not possible. A small incision is made under local anesthesia using the keyhole technique, usually in the groin. From there, a catheter is inserted into the vessel that supplies the fibroid in the uterus with blood. By sealing this vessel with microparticles, the fibroid can no longer be supplied with blood and nutrients, so that it becomes smaller over the following weeks and months and therefore no longer causes symptoms. Focused ultrasound can also be used to treat fibroids.
Who carries out this treatment?
Uterine fibroid embolization is performed in the Radiology Department at the MHH. Patients are admitted to the gynecology department and the treatment is then carried out in the radiology department under X-ray control. The radiology department also carries out daily catheter examinations in other specialist areas and is therefore a specialist in this field.
What are the advantages and disadvantages?
The advantages of uterine myoma embolization are that no general anaesthetic is required, there is only a very small incision in the groin and the patient is usually back on her feet quickly. Furthermore, the uterus is preserved while the fibroid is treated.
One of the disadvantages is that the procedure can cause pain, which is why a pain pump is inserted during the procedure to prevent pain. This procedure is also suitable for patients who have completed family planning. Other treatment options are available for women who wish to have children.
Dr. Constantin Zwrgel explains myoma therapy with Sonata.
What is myoma treatment with Sonata?
In Sonata therapy, a thin instrument is inserted vaginally through the cervix into the uterus so that the fibroids can be treated locally without major surgery.
Why does the MHH Women's Clinic offer this therapy?
As an interdisciplinary myoma center, we want to offer a wide range of treatments. This treatment option is often particularly suitable for patients with certain pre-existing conditions or a history of many operations.
How does Sonata treatment work?
During treatment, Sonata is inserted into the uterine cavity through the vagina. Ultrasound is used to locate the fibroid. The fibroid is then specifically heated and treated. This causes the fibroids to shrink and at the same time the symptoms and, above all, the bleeding problems improve over the following months. This method is very gentle and leaves no incisions or scars.
Can every fibroid be treated with Sonata?
Not every fibroid can be treated with Sonata therapy, but many can. Myomas that grow purely in the uterine cavity or stalked myomas that have grown into the abdominal cavity cannot be treated with this method. All other fibroids can be treated well for the most part. This will be discussed individually in the myoma consultation.
What are the differences between this treatment method and surgical alternatives?
This method offers a number of advantages. As the operation is performed vaginally, no abdominal incision or laparoscopy is required. Patients can therefore recover relatively quickly and have no discomfort such as pain or wound healing problems. Another advantage is that the fibroids can be detected on site using ultrasound and fibroids that were not previously visible during the examination can also be detected. This means that all fibroids that can be visualized can be treated, so that only one procedure is usually necessary.
Prof. Dr. Dr. Matthias Jentschke explains surgical myoma therapy.
When should a fibroid be treated surgically?
In principle, fibroids are very common and not every woman who is diagnosed with a fibroid needs surgery. Myomas should be treated when they cause symptoms. Surgical treatment is an option, for example, if medical treatment is not desired or is unsuccessful.
Which surgical methods are available for which fibroid?
The type of surgery depends on the location of the fibroids. If the fibroid is located in the uterine cavity, access is possible by natural means with a hysteroscopy through the vagina, so that no abdominal surgery is required. The situation is different for fibroids that are located inside or outside the uterine wall. These are operated on through the abdominal cavity in a minimally invasive way using the so-called keyhole technique. A camera and instruments are inserted into the abdominal cavity through small incisions so that everything can be seen enlarged on a screen and the fibroids can then be operated on.
When does a hysterectomy make sense?
If a patient with fibroids has completed family planning and it is no longer necessary to preserve the uterus, then it makes sense to consider removing all or part of the uterus. This minimizes the risk of new fibroids forming.
There are two options. Either the uterus is removed completely, i.e. both the uterine body and the cervix. This is called a total hysterectomy.
However, the cervix can also be left in place, as this may have the advantage that the anatomy in the upper part of the vagina does not change and in this case only the body of the uterus is removed. The uterine body is separated from the cervix and removed from the abdominal cavity using a special retrieval bag.
In principle, a hysterectomy can be performed in a minimally invasive way, which is relatively gentle for the patient. This can be done with a normal laparoscopy, but can also be performed using the Da Vinci surgical robot.
In the case of very large fibroids, it may be necessary to perform an abdominal incision. This is made across the lower abdomen, similar to a caesarean section.
Fertility and fibroid therapy
When can fibroids affect the desire to have children?
Depending on various factors, fibroids can affect the desire to have children. These include the size and location of the fibroids and therefore how they affect the uterus. It also depends on the age of the person affected, whether they have menstrual problems and whether they already have children.
Which fibroids play the biggest role in the desire to have children?
These are mainly the fibroids that grow towards the uterine cavity. These are the submucosal fibroids and the intramural fibroids. However, large fibroids that grow into the abdominal cavity can also lead to serious symptoms, particularly during pregnancy, for example in the form of premature contractions or problems during childbirth.
What needs to be considered during treatment?
This is always very individual. For example, in a woman who wants to have children, the aim is to preserve the uterus, so the form of treatment must be carefully considered.
What role does a fertility center play?
The cooperation between gynecological surgery and the fertility center makes it possible to give special consideration to the desire to have children during treatment. The fertility center can also treat other fertility problems, for example if the man also has findings that affect his ability to get pregnant.
