10.07.2024

Understanding fibroids and the SONATA method: Interview with Dr Schmid-Lossberg

Myomas, also known as uterine fibroids, affect many women worldwide and cause various symptoms. To better understand this condition and the latest treatment options, we interviewed Dr Schmid-Lossberg.

In this interview, she explains the causes, symptoms and treatment options for fibroids, with a special focus on the innovative SONATA method. Find out how this minimally invasive approach offers a revolutionary alternative for the treatment of fibroids.

Can you start by explaining what fibroids are and how they affect the female body? Especially for those who are not familiar with the term.

Fibroids are the most common benign tumours in women and 2/3 of all women have at least one fibroid in their uterus before they reach the menopause. Fibroids are hormone-dependent tumours and originate from the muscle layer of the uterus, which is normally responsible for contractions during labour. If the muscle fibres of the uterus do not run parallel but in a "vortex-like" pattern, fibroids can develop.

The exact cause of the development of uterine fibroids is still unknown. However, a genetic influence is suspected. Daughters of myoma patients often have fibroids again, so there is an increased incidence of fibroids within families. Some risk factors are also discussed, such as African background, women who have not given birth because they have more fertile cycles and therefore more oestrogen. Increased intake of phytoestrogens (tofu), Edc (plasticisers, endocrine dysfunction) are also discussed. Arterial hypertension and stress also appear to be important risk factors for the development of fibroids.

If symptoms are present, they can vary greatly depending on where the fibroids are located and how large they are. The most common symptom of fibroids is bleeding disorders with sometimes very heavy and frequent periods. However, symptoms of pressure on the bladder and bowel, flatulence, bloating, pain during menstruation and pain during sexual intercourse are also very common. Unfulfilled desire to have children can also be a symptom of fibroids.

What treatment options are typically available to women with fibroids?

It is important to know that only fibroids that cause symptoms or grow very large need to be treated. As fibroids are hormone-dependent, no improvement in symptoms is expected without treatment before the patient reaches the menopause.

If treatment is necessary, a distinction is made between drug therapy, which is mainly used for bleeding disorders, and surgical treatment. Depending on the size and location of the fibroids, they can be removed by laparoscopy or hysteroscopy. In some cases with very large or multiple fibroids and when family planning is complete, uterine removal can also be discussed.

What makes Sonata treatment unique compared to other treatment approaches for fibroids? Can you give us an overview of the process and how it works?

Sonata treatment has been an established method in Switzerland since 2017. It is an incision-free and very gentle treatment for uterine fibroids and has been clinically proven to be safe and effective.

Sonata treatment uses an intrauterine (inside the uterus) ultrasound treatment device to localise and target the individual fibroids. Radiofrequency energy is delivered to shrink the fibroid and relieve symptoms.

Sonata treatment can be used to treat a wide range of fibroids of different sizes and locations in the uterus - without a single incision.

A further advantage is the very gentle treatment in the uterus, which is also possible if you wish to have children at a later date. Most patients have hardly any pain after the treatment, the hospital stay is short and the patient can quickly return to everyday life within a few days.

What type of patients is Sonata treatment best suited to?

Themajority of fibroids are suitable for Sonata treatment and should be the treatment of choice before deciding on major surgery (only stalked fibroids and very large fibroids are not treatable).

The best diagnostic procedure is an ultrasound examination of the uterus to determine the location, number and size of the fibroids. This requires a high level of expertise and can be offered primarily in our consultation hours specialising in fibroids with excellent ultrasound equipment. Sometimes additional imaging using MRI (magnetic resonance imaging) may be necessary.

What results have you seen with the Sonata treatment in your patients?

The majority of my patients are very satisfied after the treatment and no longer need any further treatmentbecause their quality of life is significantly better. The ideal patient is the patient who suffers from bleeding disorders and fibroids near the uterine lining. The chances of success in these patients are very high.

My experience is consistent with the published studies. According to the literature, around 95% of patients report a reduction in bleeding and a significant improvement in quality of life after 12 months. It is important to make a good indication, i.e. to make a very individualised decision on the appropriate therapy, because every patient is different and every fibroid is different. During my specialised consultation, I take the time to examine the patient, discuss all the options and, of course, respond to the patient's needs.

Dr Schmid-Lossberg specialises in the treatment of fibroids

Klinik Pyramide am See

Dr. med. Juliette Schmid-Lossberg

Specialisation
Gynaecology, Obstetrics, Gynaecological examinations, Senology (breast care), Fibroids View more

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What are the most common misconceptions about fibroids that you notice in your practice?

Patients are often confronted with the diagnosis of fibroids, as around 2/3 of all women have at least 1 fibroid before they go through the menopause. Without proper information, fears and uncertainty arise, which I can certainly understand when you are suddenly informed about a "tumour" in the uterus. In the course of my discussion with the patient, which primarily serves to clarify what fibroids actually are and that they usually only need to be observed without symptoms, many patients are relieved.

Another important point is that fibroids are hormone-dependent tumours. Bleeding disorders are often treated with hormonal therapy, for example a pill without a break. This can work well for a while, but the growth of the fibroids can also be stimulated and the symptoms can return despite the therapy.

With regard to the sonata method, many patients who come to my consultation think that we use sonata to remove the fibroids. This is not the case. The fibroid is cauterised or treated with heat and usually shrinks within 3-12 months after the treatment. Remnants of the fibroids often remain in the uterus, but no longer cause any symptoms. The treatment does not guarantee the development of new fibroids, as the surrounding healthy tissue of the uterus is spared. As with all uterus-preserving treatments, new fibroids may develop again after the treatment. However, the risk of recurrence is lower with Sonate compared to the surgical alternatives.

Menopausal patients cannot be treated with Sonata RF ablation, as fibroids that are still causing symptoms or growing during the menopause should be removed to be on the safe side.

What advice would you give to women who have just found out they have fibroids?

If the patient has no symptoms, I usually recommend a follow-up ultrasound scan after 6 months to better assess the dynamics of the fibroids. If they are growing significantly or causing discomfort, treatment should be discussed.

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