Benign diseases of the uterus or diseases in which the uterus is affected are often very complicated.
In addition to endometriosis, these uterine diseases include severe, painful and irregular menstrual bleeding, cysts, polyps, fibroids, dropping of the uterus or inflammation of the uterus.
All these diseases can lead to significant limitations in the quality of life of the patient. Fortunately, they can be treated successfully in most cases.
The uterus is a hollow organ, whose shape resembles an upside-down pear. The baby grows up inside the uterus during pregnancy. As such, the uterus is susceptible to a variety of diseases, with endometriosis among the most common uterine diseases. Other possible conditions include:
Most fibroids are small, not noticeable and are discovered by chance during a routine check by a gynaecologist. This means that many women do not even feel that they have fibroids; some women only have one fibroid and others have several. Fibroids are most commonly associated with symptoms in women between the ages of 30 and 50. The most common symptoms include:
In most patients, the above-mentioned symptoms mainly occur in the time before and during their monthly period. However, in the case of pronounced fibroids, the symptoms may persist over a longer period of time.
Fibroids are stimulated by female sex hormones (i.e. oestrogen and progesterone). Under the influence of hormones, the growths begin to grow. Conversely, this means that fibroids cannot grow without the hormones produced by the woman’s body. Therefore, fibroids only appear after puberty.
After the last period, i.e. the menopause, fibroids normally no longer continue to grow as the hormone levels drop again.
Furthermore, hereditary factors also likely play a role in the development of fibroids. Fibroids are more common in women whose mothers also suffer(ed) from fibroids. It is also observed that women with severe obesity develop fibroids more frequently, although it is not clear whether the obesity itself contributes to the formation of fibroids.
Fibroids, on the other hand, are rarer in women who have given birth several times and in women who have been taking the contraceptive pill for several years.
Fibroids are diagnosed by a specialist as part of a gynaecological examination. This includes palpation in which larger fibroids are often already discovered. An ultrasound examination can also provide information – especially if the fibroids are smaller and thus difficult to palpate. This is usually done via the vagina. In isolated cases, an MRI scan (magnetic resonance imaging) is ordered to determine the exact extent and location of the fibroids and their relationship to the surrounding organs.
In addition, an examination of the uterus (hysteroscopy) may be necessary (in the case of fibroids that have settled on the inside of the uterus). If, on the other hand, the fibroids are located on the outside of the uterus, a laparoscopy may be the method of choice.
If the fibroids press on the urinary tract, the gynaecologist may perform a kidney ultrasound, possibly in conjunction with a pyelogram. A pyelogram is the imaging of the urinary tract with the aid of a contrast agent under X-ray radiation.
Last but not least, the doctor can arrange for a blood test and analysis of the patient’s hormone levels.
Fibroids are only treated if they cause pain, impair fertility and thus the desire to have children, or could lead to problems during pregnancy. Therefore, when choosing a suitable therapy method, it is important to consider whether or not a woman is still trying to conceive. Which therapies are considered also depends on the severity of the symptoms and the size and location of the fibroids.
The objectives of fibroid treatment are to reduce menstrual bleeding, alleviate any pain, cramps and feelings of pressure, resolve problems associated with emptying the bladder and with digestion and maintain or optimise fertility.
Gynaecologists have several treatment options to choose from:
Radiofrequency ablation is a minimally invasive surgical method that makes it possible to treat fibroids without incisions and with little pain and gently due to using heat. The heat treatment shrinks the fibroids within weeks and months.
Painkillers are to be taken after consultation with the gynaecologist, who will also carefully monitor the efficacy of hormonal treatment.
As the above-mentioned surgical methods do not cause extensive injuries, no special behaviour is usually required in this regard. However, patients are usually advised to take it easy for a while and to refrain from heavy physical work and intensive exercise for the first four weeks after the operation.
In general, regular gynaecological check-ups are recommended for patients with suspected fibroids or who have already been diagnosed with one or more fibroids.
Fibroids are benign tumours that develop from muscle cells. Depending on the type of muscle cell affected, fibroids are differentiated into the following types:
Fibroids consist of muscle cells and connective tissue and vary according to size, shape and location. They are differentiated according to the place where they have settled in the uterus:
No – today’s experts believe that a fibroid does not develop into a malignant tumour (known as a sarcoma), but rather that a sarcoma develops independently of a fibroid. In contrast to benign fibroids, the sarcoma penetrates the surrounding tissue. Furthermore, cancer cells can reach more distant tissue via the blood and lymph vessels and form metastases there. Treatment of a sarcoma depends on its stage at the time of discovery and differs clearly from therapy for a fibroid.
Yes, fibroids can cause problems during pregnancy. Due to the severely altered female hormone levels during pregnancy, fibroids can increase considerably in size during this time and significantly increase the woman’s risk of miscarriage or premature birth. In addition, fibroids can complicate the development of pregnancy as they prevent the embryo from being implanted into the uterine cavity. In individual cases, the gynaecologist decides whether a fibroid needs to be treated in a woman trying to conceive or in a pregnant woman, and if so, in what form.