Treatment of uterine myoma abroad

Uterine myoma or uterine fibroid is a benign tumour arising from the smooth muscle cells of the original organ. Myoma remains among the most common gynaecological pathologies and reaches 25% in the structure of all the female diseases.


According to autopsy datas, myomas of different size are identified in 80% of women. Meanwhile, clinical signs are present in just 35% of patients suffering from this disease. 


uterine myoma treatment abroad


Causes of uterine myoma

Exact causes of uterine myoma remain unknown. Two main theories exist explaining the origin of the tumour. First one says, myoma is a defect of the embryonic development. The second one presupposes pathological changes in the cells of a mature uterus and is more pathogenically justified. 


Risk factors of uterine myoma:

  • Taking oral contraceptives
  • Abortions in medical history
  • Inflammatory diseases of the pelvic organs
  • Absence of childbirth


uterine myoma symptoms


Symptoms of uterine myoma

65% of women don’t have any symptoms because of the small size of the tumour and absence of the clinical picture of the disease. It doesn’t influence fertility and it doesn’t violate the quality of one’s life. 


35% of patients have manifested symptoms like:

  • Intermenstrual bleeding
  • Increased duration and intensity of menstrual bleeding
  • Feeling of pressure in the lower abdomen
  • Pain in the lower abdomen, which increases during menstruation, may have a cramping character


Frequent bleedings lead to iron deficiency anaemia manifested by the following symptoms: pallor of the skin, shortness of breath, tachycardia (rapid pulse).


If the tumour grows significantly larger in size, the symptoms of bladder or rectum compression occur. Bladder compression is evidenced by the frequent need to urinate. Rectum compression is manifested by constipations up to intestinal obstruction. 


uterine myoma diagnostics


Diagnostics of the uterine myoma

Ultrasound is the main method for diagnosing uterine myoma. It can not only detect myomatous nodes, but also determine their characteristics:

  • Size
  • Structure
  • Location
  • Number
  • Type of growth


Except for the ultrasound of the pelvic organs there are also improved and more informative diagnostics measures with the use of ultrasound. The following techniques are among them:

  • Hydro sonography means ultrasound diagnosis is carried out after injecting a saline solution into the uterus. The contrast of all intrauterine structures significantly improves in the liquid medium. Hydro sonography allows you to establish the correct diagnosis with a probability close to 100%.
  • Dopplerography is an ultrasound with a Doppler sensor used to measure the speed of blood flow in the vessels, assess the condition of veins and arteries. Dopplerography is used in planning the treatment of uterine fibroids by uterine artery embolization, as well as to evaluate the effectiveness of the operation.
  • Angiography is an X-ray method of diagnostics with contrasting agent injection into the blood vessels. It is used before the embolization of uterine arteries.
  • Hysteroscopy is an endoscopic examination, when a special instrument called a hysteroscope is introduced into the uterus. The diagnostic method can immediately become curative if the doctor performs removal of the myomatous nodes.
  • Laparoscopy is a diagnostic operation performed in case of subserous nodes, or if the tumours are located in the retroperitoneal space.


uterine myoma treatment abroad


Treatment of uterine myoma abroad

Therapeutic tactic is determined by a number of factors. The main ones are:

  • Size, structure, location of the malformation
  • The presence or absence of symptoms, their severity
  • Age of the woman and her desire to maintain (restore) the reproductive function


If a woman does not plan on having children then conservative therapy is applied directed at the bleeding stop and anemia correction. Conservative treatment is used if nodules size is up to 3 cm. If myoma is larger than that, then surgery is indicated even if a woman doesn’t plan on childbirth.


Surgical treatment techniques are:


Hysterectomy is the removal of the uterus which is the most effective method of treating fibroids. This does not affect the quality of one’s sexual life. There may be a deficiency of estrogen after surgery, but it is compensated with hormonal drugs. This method of treatment is unacceptable for women who want to maintain fertility.


Indications for the removal of one’s uterus removal with myoma:

  • Size of uterus is more than of that of a 15-week-pregnancy
  • Uterus growth more than 4-week-pregnancy
  • Suspicion of the malignant oncological process
  • Cervical uterine myoma
  • Dysfunction of neighbouring organs (bladder, kidney, intestine)
  • Violation of trophism (nutrition, blood supply) of the myomatous node
  • Persistent bleeding when it is impossible to perform organ-saving operations


uterine myoma surgical treatment abroad


Surgery can be performed through the laparotomic (by open access) or laparoscopic (introduction of the optical system and surgical instruments through small incisions) access.


Specialists in German hospitals prefer laparoscopic procedures. They are harder to perform and require the advanced equipment, though it’s a win-win situation:

  • Lower risk of complications
  • Shorter rehabilitation period
  • Better aesthetic effect


Laparoscopy cannot be performed if the uterus is of a large size (more than 17-week-pregnancy), the location of the myomatous node is on the back wall of the uterus, and if there are some accompanying gynaecological diseases.


  • Transcervical myoectomy is the main organ-saving operation, which is carried out in most European hospitals. Its possibility depends on the shape of the myomatous node, its size and location. The tumour is removed with a hysteroresectoscope or laparoscope. They use mechanical, electrical or laser methods to remove the malformation. Transcervical myoectomy is indicated if a nodule size is 5-10 cm. If they are larger, preliminary treatment with hormonal preparations is possible. It helps to reduce the size of the formation by 30-35%.
  • Embolization of the uterine arteries is an effective non-surgical technique for the treatment of uterine fibroids, which is successfully performed in German hospitals and European hospitals. It leads to a decrease or disappearance of symptoms. After uterine arteries are blocked, there is a regression of the myomatous nodes. The size of the uterus decreases by 2.5 times one year after the procedure, and the tumour decrees significantly.
  • Laparoscopic occlusion of uterine arteries is aminimally invasive method of treatment, involving the ligation of uterine arteries. It is less effective than embolization, but it is safer and better tolerated by patients.


uterine myoma innovative treatment abroad


Innovative treatment of uterine myoma

At the momentthere are many effective techniques of radical or symptomatic uterine myoma treatment. New therapeutic approaches are being developed regularly, directed at the reduction of tissue trauma while removing the tumour.


Radiofrequency ablation is a high-tech, minimally invasive method for treating uterine myoma, which does not require surgical intervention. A needle device is inserted into the myomatous node through the abdominal wall. Myoma tends to warm up to a high temperature and then its destruction occurs.

Distant thermocoagulation of nodes is an innovative method of treatment, which is used in some German hospitals for the treatment of uterine myoma. The procedure is performed under the visual control of a magnetic resonance imaging. The focused energy of ultrasonic waves is used to heat the nodes, resulting in necrosis (death) and rejection of the tumour.


Benefits of such a treatment technique are:

  • Absence of surgery, therefore, there is no long recovery period
  • Minimal risk of complications
  • Procedure is held on an outpatient basis and takes only 1 to 3 hours


The effectiveness of distant thermocoagulation of myomatous nodules is about 75%. The need for another procedure occurs in 20% of women. At the moment, studies are continuously aimed at obtaining more accurate information about the effectiveness of using focused high-frequency ultrasound in uterine myoma treatment.


uterine myoma prognosis


Prognosis for uterine myoma

Life and work capacity prognosis for uterine myoma is favourable. The worst possible outcome is the malignancy of the tumour. But, it turns into sarcoma only in about 0.1% of patients. 


Reproductive function depends on the nodule size, its location, presence of the accompanying pathology. One of the possible consequences is infertility. If pregnancy indeed comes, the risk of miscarriage sharply increases and reaches up to 10-40%. 


Uterine myoma increases the risk of following complications while pregnant:

  • Fetal hypotrophy
  • Anatomical damage to the foetus
  • Premature delivery
  • Bleeding in the postpartum period


Uterine myoma doesn’t change its size during pregnancy in 50% of cases. 20% of patients experience regression of  the tumour, while 30% of patients experience the progression on the tumour. The volume of malformation grows at a rate of 12-25%. Small myomatous nodes are more likely to regress, larger tumours are likely to increase in size.



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