Is there a drug that can be used to cure fibroids

Myoma

Myoma: description

A fibroid is generally a tumor that develops from muscle cells. Depending on which type of muscle cell is affected, a distinction is made between:

  • Leiomyoma: develops from smooth muscle cells. These are found in the internal organs, for example in the uterus (uterine myoma), in the kidneys and in the stomach.
  • Rhabdomyom: Develops from striated muscles that are located in the heart and skeletal muscles.
  • Fibroleiomyoma: also develops from smooth muscle cells, but also contains parts of connective tissue.

The myoma belongs to the group of benign tumors. Benign means that the tumors are growing slowly. In doing so, they do not penetrate the surrounding tissue - they are therefore not infiltrating - they just displace it. In addition, benign tumors do not form daughter tumors (metastases).

In contrast to malignant tumors, fibroids are not dangerous. Nevertheless, they can also have a major impact on the quality of life of those affected and cause dangerous complications.

Fibroids: classification according to location

Depending on where a fibroid originates in the uterus and in which direction it expands, doctors differentiate between different types of fibroids:

  • Subserous myoma: It sits on the outside of the uterus and grows from the muscle layer of the uterine wall outwards into the "outer" layer (serosa or peritoneum). Menstrual disorders do not occur here. Sometimes subserous fibroids are stalked. This style can become twisted, causing pain and complications.
  • Intramural myoma: The myoma only grows within the muscle layer of the uterus. This type of fibroid is the most common.
  • Transmural fibroid: This is where the myoma develops from all layers of the uterus.
  • Submucosal fibroid: This rather rare and often small type of myoma grows from the muscle layer of the uterus into the lining of the uterus (endometrium). This usually leads to bleeding disorders.
  • Intraligamentary fibroid: This type of fibroid develops next to the uterus.
  • Cervical myoma: This relatively rare type of fibroid develops in the muscle layer of the cervix (cervix).

What is a uterine myomatosus?

Fibroids in the uterus can appear singly or in large numbers. If only a single tumor is present, experts speak of a solitary myoma. If several fibroids develop at the same time, a so-called uterus myomatosus is present. A uterus myomatosus is usually greatly enlarged and can lead to serious complications.

facts and figures

A leiomyoma of the uterus (uterine fibroid) is not uncommon. It is the most common benign tumor in the female genital tract. About ten to twenty percent of all women over the age of 30 have a fibroid on the uterus. Most fibroids develop between the ages of 35 and 50. They are very rare before the age of 25.

About 25 percent of all women affected have no symptoms from the fibroid. The rest had more or less severe symptoms. In 2011, around 75,600 women were hospitalized with a fibroid in the uterus.

Myoma: symptoms

Fibroids do not cause symptoms in approximately 25 percent of women affected. The benign tumor in the uterus is usually only discovered by chance during a routine examination by the gynecologist.

In all other cases, fibroids cause symptoms. Which these are and how pronounced they are depends on the size and location of the fibroid.

Common signs of a fibroid are:

  • Bleeding disorders: Myomas can cause increased menstrual bleeding (hypermenorrhea), increased and prolonged menstrual bleeding (menorrhagia) and intermenstrual bleeding outside the menstrual cycle (metrorrhagia).
  • Violent, sometimes labor-like pain during menstruation. With myoma-related heavy bleeding, blood clots can form, the elimination of which is accompanied by cramps.

Less common complaints with a fibroid are:

  • Pelvic pain
  • Back pain and / or leg pain when the fibroid presses on places in the spinal cord where nerves emerge.
  • Kidney or side pain
  • Strong urge to urinate when the fibroid presses on the adjacent bladder.
  • Constipation (constipation), when the fibroid presses on the adjacent rectum.
  • Painful intercourse

More about functional disorders of neighboring organs (such as the intestine) and others Complications if you have a fibroid (e.g. if you are pregnant), read the section "Course of the disease and prognosis".

Myoma: causes and risk factors

How exactly a fibroid develops in the uterus is still unknown. Scientists suspect that the female hormone estrogen plays an important role in this. Estrogen ensures the growth of the mucous membrane that lines the inside of the uterus (endometrium). It can also affect the growth of the layer of muscle in the uterine wall. A dysregulation could be responsible for the leiomyoma of the uterus. When the estrogen production decreases after the menopause (climacteric), fibroids usually no longer occur. Existing fibroids stop growing and usually even regress.

Also one genetic cause the development of myoma is discussed. This is because fibroids occur more frequently in certain families. In addition, according to studies, African women are about nine times more likely to develop a fibroid than European women. A single gene is believed to be responsible for the development of myoma.

Myoma: examinations and diagnosis

Symptoms such as increased menstruation or an increased urge to urinate can indicate uterine fibroids. In order to investigate such a suspicion, the gynecologist first inquires in detail about existing complaints and any previous illnesses (anamnese).

After the medical history is taken, one follows gynecological palpation examination (once through the vagina and once at the same time through the rectum and over the abdominal wall). The doctor can feel a larger myoma as well as the presence of several myomas (uterus myomatosus).

With the Ultrasound examination (sonography) the suspicion of fibroids can usually be confirmed. In addition, the exact position and size of the myoma or myoma can be determined. The ultrasound examination can be carried out through the abdominal wall or through the vagina (vaginal ultrasound). Most of the time, the variant is chosen through the vagina.

If the ultrasound does not provide an accurate diagnosis (for example, in the case of a fibroid in the lining of the uterus or in the muscle wall), the doctor can Mirroring the uterus (hysteroscopy)or the abdomen (laparoscopy) carry out.

If the fibroid presses on the ureter, it may be necessary to use the kidneys and lower urinary tract Ultrasonic and an X-ray display with contrast agent (Pyelogram) to investigate.

If the test results are unclear, the doctor will sometimes call one Magnetic resonance imaging (MRI) arrange. In addition, a Blood test (if anemia is suspected) and one Measurement of hormone levels carried out.

Read more about the examinations

Find out here which examinations can be useful for this disease:

Myoma: treatment

As long as fibroids do not cause symptoms, they usually do not need treatment. However, a check-up should be carried out at the gynecologist every six to 12 months. Myoma, uterus and any complaints are then precisely assessed.

As soon as symptoms or complications arise from a fibroid or multiple fibroids, various treatment options are available. When choosing a therapy, factors such as the woman's age, family planning (desire to have children?), The type and extent of the symptoms, as well as the location and size of the myoma, are decisive. Basically, fibroids can be treated with medication (GnRH antagonists), surgically (myomectomy) or using more recent methods (embolization, focused ultrasound). In extreme cases, the uterus can also be removed entirely.

Myoma: drug treatment

There are various options for treating myoma with medication. The aim is to prevent the fibroids from growing and possibly even shrinking as a result of the preparations used. Therefore, all preparations work on a hormonal level.

Progestin

Progestins are hormones that are also found in many birth control pills. They are an antagonist of the sex hormone estrogen. Treatment with progestins can slow down fibroid growth and sometimes even shrink fibroids. This reduces the discomfort and makes a subsequent operation easier. The inhibiting effect of progestins on the growth of the uterine lining can also reduce bleeding.

GnRH analogues

GnRH analogs imitate a specific control hormone for the female hormonal balance: gonadoliberin (other names: gonadotropin-releasing hormone or GnRH). It stimulates the pituitary gland to release gonadotropins in bursts. These hormones in turn stimulate the ovaries to produce estrogens.

However, if GnRH analogues are used continuously, the level of estrogen decreases. Since the GnRH analogs stimulate consistently, the pituitary gland is less and less responsive. As a result, it makes fewer gonadotropins, which also reduces estrogen production. The fibroid is no longer stimulated to grow and can even shrink.

Ulipristal acetate

The selective progesterone receptor modulator ulipristal acetate inhibits the progesterone docking sites of myoma cells. The fibroid cells therefore lack an important growth stimulus: the fibroids shrink and myoma-related bleeding subsides.

However, the drug can seriously damage the liver. The European Medicines Agency (EMA) therefore recommends ulipristal acetate only in pre-menopausal women for whom surgery is not possible - or has not been successful.

According to the Committee for Risk Assessment in the Field of Drug Safety (PRAC), however, ulipristal acetate is no longer suitable for generally alleviating myoma symptoms.

  • Women who take the preparation should have their liver function checked by a doctor at least once a month. To do this, the doctor measures the liver values ​​in the blood. If they are abnormal, the fibroid drug should be discontinued and liver function should be monitored for a while.
  • If there are signs of liver damage, women should see their doctor immediately. Such warning symptoms are, for example, upper abdominal pain, nausea, vomiting, poor appetite, tiredness and yellowing of the skin or eyes.

Note: The active ingredient ulipristal acetate is also contained in the morning-after pill. However, this is only taken once. In addition, there have been no reports to date that it can also cause liver damage. The EMA's warning therefore only applies to the Ulipristal preparation for myoma treatment.

Myoma: Surgical Treatment

In the case of a very large fibroid, severe symptoms from the benign tumor or multiple fibroids (uterus myomatosus), surgery is the method of choice. Even if it is not clear whether it is a malignant tumor (sarcoma), surgery is necessary. In most cases this will do the entire Uterus removed (hysterectomy)either through the vagina, rectum, or an incision in the abdomen.

If the fibroid is small and the woman still wants to have children, it is also possible to remove fibroids in isolation. That happens through Exfoliation of the fibroids (myoma enucleation). Depending on the type of myoma, different methods can be used. For example, the doctor can remove the fibroid through an incision in the abdomen or through the vagina. In addition, laparoscopic removal has increased significantly in recent years. Three small punctures are made in the abdominal wall before the doctor cuts out the fibroid with a long, narrow tube (the laparoscope).

Myoma: embolization

Another method of treating fibroids in the uterus is percutaneous transcatheter embolization. The doctor closes the blood vessels that supply the fibroid with nutrients. As a result, myomas regress - ideally within six months to a maximum of one year.

Myoma: Focused Ultrasound

For fibroids that are in a favorable location, there is another treatment option that can be considered: focused ultrasound. The patient lies prone over a sound source. From this against high-frequency sound waves, which are directed exactly to the place where the myoma is located. The focus of the sound waves creates so much heat at this point that the fibroid dies. It is then broken down by the cells of the immune system. This treatment takes about three hours and is very expensive. Since the procedure is relatively new, the costs are usually not covered by the health insurance company.

Read more about the therapies

Read more about therapies that can help here:

Myoma: disease course and prognosis

The course of the disease in a fibroid depends on the location and size of the benign tumor. Accordingly, symptoms and complications of different degrees can occur. Affected women should - even if the fibroids cause no symptoms - regularly go to the gynecologist for preventive examinations in order to avoid possible complications. To the possible Complications belong:

  • Urinary tract infections and painful urinationwhen the fibroid presses on the bladder / ureter
  • Bladder, bowel or kidney dysfunctionwhen the fibroid is pressing on these organs
  • Anemia Heavy and / or prolonged menstrual periods due to iron deficiency (iron deficiency anemia)
  • Sudden Stem rotation a pedunculated subserous myoma, which causes severe pain and requires rapid surgery
  • Problems with the fertility or during the pregnancy

Myoma & Pregnancy

In principle, a fibroid in the uterus does not constitute an obstacle to pregnancy. Infertility occurs in affected women only in rare cases, for example when the fibroid lies in front of the fallopian tube.

A fibroid can cause a variety of problems during pregnancy. As estrogen-dependent tumors, fibroids grow faster during pregnancy because the body then produces more of the sex hormone. Due to their increasing size and location, fibroids can trigger pain, cause positional anomalies in the child (such as the breech position) or block the birth canal - in which case a caesarean section is necessary. Premature labor can also occur - fibroids have been shown to increase premature and miscarriage rates. If the fibroid grows directly under the lining of the uterus or in the uterine cavity, it can lead to an ectopic pregnancy in addition to a miscarriage.

No risk of cancer

Contrary to previous assumptions, experts no longer believe that a myoma can lead to cancer (a so-called sarcoma). Recent genetic studies suggest that a sarcoma develops independently from a fibroid. Nonetheless, check-ups should be done regularly to avoid complications from one Myoma to be able to recognize and treat early on.

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