Myoma clinic with Prof. Ebert

Myomas (fibroids) are benign, hormone-related nodular tumors of the uterine muscles whose symptoms can affect the quality of life and fertility of affected women. When a uterus is affected by myomas, your gynecologist will call that condition Uterus myomatosus.

Both diagnostics and treatment must be based on the affected patient’s individual condition and needs. I have many years of experience in the treatment of myomas and cooperation with other specialists in Berlin to ensure you optimal treatment and individualized care. I would be happy to advise you.

Your contact person

Professor Dr. med. Dr. phil. Dr. h. c. mult. Andreas D. Ebert
Specialist in Gynecology and Obstetrics

If available, please bring the following to your appointment:

  • Copies of medical reports
  • Copies of surgery reports
  • Copies of histopathology examinations
  • CDs with CT or MRI images

Important: The more information is available and the better you are prepared for the appointment, the more I can help you.

What symptoms are caused by myomas?

The uterine lining undergoes cyclical changes during a woman’s childbearing years. When benign fibroid nodules change or reduce blood flow to the lining, bleeding problems can occur before, during, and after actual menstrual bleeding. Like the uterine lining, the myoma tissue also depends on the female sex hormones estrogen and gestagen, which affect it via special receptors. This explains why many symptoms of myomas occur mainly shortly before or during menstruation and why myomas can also be treated with hormones.

Typical symptoms of uterus myomatosus (myomas) are:

  • Severe menstrual pain
  • Heavy menstrual bleeding
  • Chronic lower abdominal pain
  • Painful intercourse
  • Painful bowel movements or urination
  • Failure to conceive
  • Feeling of pressure “pushing down”
  • Increase in abdominal circumference

Note: Heavy menstrual bleeding means that you have to use 5 or more large tampons or pads on days with heavy bleeding. Menstruation that causes very severe pain in the lower abdomen resulting in bed rest, illness, or excessive drug intake is not normal!!!

Myomas can also reduce fertility. This is why this disease is often detected in a vaginal examination or ultrasound to diagnose failure to conceive. 

Uterus myomatosus is a very common disease, although exact data are not available. It is assumed that up to 70% of all women of childbearing age are affected by myomas. In 30% of these women, the myomas lead to symptoms that require thorough diagnostics and usually treatment.

Could you have myomas?

The keys for diagnosing myomas are a detailed consultation with the physician and a gynecological examination. The typical symptoms often lead directly to the suspected diagnosis. A thorough gynecological examination provides additional evidence. Imaging methods such as ultrasound (or in some cases even by MRI) are very valuable to diagnose myomas or other changes of the uterus (f.e. Adenomyosis).

If you have myomas, the physician will want to use imaging procedures to answer the following important questions:

  • How many myomas are there?
  • How large are the myomas?
  • Where are they located (anterior wall of the uterus? posterior wall of the uterus?)
  • Are the myomas located outside (subserous), inside (intramural), or below the lining (submucosal?)
  • Is the myoma tissue conspicuous?

Additional methods such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are used in special cases.

How is Uterus myomatosus treated?

Important: Myomas are treated only if they cause problems (pain, bleeding, infertility). Myomas with no symptoms (asymptomatic myomas), even if they are large, are not treated and do not have to be “checked” constantly.

What are the treatment options?

  • Medical treatment with Ulipristalacetate, gestagens, GnRH analougs, and other options
  • Uterine Artery embolization (UAE)
  • MRI-guided high intensity focused ultrasound (HIFUS)
  • Surgery (depending on symptoms, the location of the myomas, and age or reproductive wishes of the affected woman)
  • Complementary treatment

The first attempt is the medical treatment of Myomas with special drugs. Because myomas have Progesterone Receptors, they respond to Gestagens (Progestin-only-Pills, many oral contraceptives consist of gestagen-estrogen combinations) or shrink when hormones are withdrawn (after administration of GnRH analogues). Today, the treatment of choice consists of individualized long-term treatment with Selective Progesterone Receptor Modulators (SPRM). In Germany, ulipristalacetate (UPA, Esmya©) has been approved for treatment by the health insurers. The patients are treated with UPA for 3, 6, or more months if the treatment is well tolerated. Bleeding is quickly stopted, which is why many women can recover from their myoma-induced iron deficiency anemia.

The most important surgical procedure for myomas is laparoscopy, which is also a treatment approach in which all myoma nodules or adhesions are removed. The operation frequently leads to considerable pain relief and improvement in pregnancy rates. If the myomas are very large, all organ-preserving operations can also be performed with a small (suitable) abdominal incision.

Myomas that are located below the uterine lining can be removed by surgical hysteroscopy. The fibroid nodules are enucleated using a special cutting loop.

For failure to conceive due to myomas, laparoscopic removal of the myomas can significantly improve fertility. A surgical laparoscopy called myoma enucleation is performed. The wound in the uterus after removal of the myomas is securely sutured. If the uterine cavity was opened during the operation, a Caesarean section is recommended for any later birth. After this treatment, patients can attempt to become pregnant approx. 4-6 months after the operation. Treatment with medication is not recommended for infertility, as the woman should not become pregnant during treatment.

If a woman no longer wishes to become pregnant, but the symptoms impair her quality of life, in addition to treatment with ulipristal acetate, myoma embolization, and an attempt with HIFU, the following typical gynecological operations are an option:

  • Sub-total laparoscopic (or abdominal) hysterectomy with ovarian conservation
  • Abdominal hysterectomy
  • Vaginal hysterectomy

In addition, we also recommend complementary treatment methods such as acupuncture or Traditional Chinese Medicine (TCM) and natural medicine to treat symptoms. No reliable data of studies are available, but many women have had good experiences, as the treatment methods support treatment with classical medicine. The most known examples are Green Tea Extract (Epigallocatechin-Gallat, EGCG) and red wine extract (Resveratrol).