Uterine Myoma Treatments | Dr. María Luisa Cañete Palomo

Myomas and fertility

For a woman who wishes to become pregnant, a uterine myomas can be a problem if:

They are located above the cervix, preventing sperm from crossing the uterus.

They obstructs the fallopian tubes, preventing the passage of sperm to the egg and the fertilized egg to the uterus.

They decreases blood flow to the uterus.

What are myomas?

Uterine myomas are benign (non-cancerous) tumors formed by fibers very similar to those of the uterus itself.

It is estimated that 70% of women develop myomas during their lifetime, with a higher incidence after the age of 50. They are usually asymptomatic and do not require treatment.

A patient may have one or more myomas of different sizes in the uterus, causing various symptoms, altering her quality of life and even affecting her fertility.

Many women have uterine myomas at some point in their life. However, you may not know that you have a uterine fibroid because they often cause no symptoms.

The symptoms are...

Heavy Periods.

Frequent Urination.

Pelvic pain or pressure.

Low back pain.

Constipation.

Increase in the volume of the abdomen.

Infertility.

Painful Intercourse.

Miscarriages.

Options to remove uterine myomas

Conventional treatments

Standard Myoma Treatments

There are various treatments, depending on the size, location, symptomatology and vascularization of the myoma. To apply one treatment or another, the woman's age and her fertility desires are always taken into account.

Hormonal treatments

In Spain, the drug Ryeqo is authorized, which is a GNRH antagonist that contains the active ingredients relugolix, estradiol, and norethisterone acetate. This medication is to be taken orally and is indicated to treat moderate to severe symptoms of uterine myomas in adult women who have not reached menopause, for the purpose of stopping or reducing bleeding and relieving pain and discomfort associated with myomas uterine.

Myomectomy

Myomectomy, today is the "gold standard" in the treatment of myomas in patients who want pregnancy, since it is the procedure supported by studies, you have always had experience.

Laparoscopic Myomectomy

Surgery using a laparoscope or tube that is inserted through a small incision.

Laparotomy Myomectomy

Open or classical surgery through an opening of the abdominal cavity.

Hysteroscopy

Minimally invasive technique that allows us to visualize the inside of the uterus. See more information.

Hysterectomy

The complete removal of the uterus or womb of the patient.

Alternative to surgery

Radiofrequency Ablation of Myomas

The excellent results of the treatment with the radiofrequency, RF system make it highly recommended over any other option.

Radiofrequency ablation is acts minimally invasive myoma treatment, an alternative to myoma surgery. It acts directly inside the myoma by thermocoagulating the tissue through a very fine needle that emits radiofrequency at its tip, in a controlled manner over the entire surface of the myomas and without damaging the uterine muscle.

Benefits of Radiofrequency Ablation

Alternative technique to myomas surgery.

No hospital admission required.

Avoid surgical risks.

No aggression to the uterine walls.

Rapid recovery of the patient.

Preserves the patient's fertility.

Possibility of treating several myomas in the same intervention.

Uterine Myomas Protocol 2023

Author

Dr. María Luisa Cañete Palomo.

Download PDF

Specialists in Uterine myoma treatments

When myomas are multiple or large, a Laparoscopic, Laparotomy, or Hysteroscopic Myomectomy is performed, allow to preserve the uterus.

Uterine fibroid 14 cm in size, removed by laparoscopy.

Removal of 74 uterine myomas without blood transfusion. The largest number of myomas excised in a patient using a Phannestiel Incision.

Myomas removed by laparotomy of 4.5 kg and 35 cm. The patient has achieved two pregnancies after the intervention.

Extraction of 61 uterine myoma from a 36-year-old patient. The patient had a very fast recovery, after three days he was discharged and was in his city (Bilbao, Spain).

Minimally Invasive Myoma Treatments

Uterine Myoma Embolization (UFE)

Uterine Artery Embolization is a safe technique, introduced by Ravina in 1995, then endorsed by world agencies (NICE, FDA...). It is painful in the first week after the procedure and has a risk of permanent amenorrhea (loss of periods) of 3% in patients in those under 40 years of age and 15% in those over 40 years of age.

It is not considered the first choice in patients who wish to become pregnant at some point in their life.

Conservative Treatment of Uterine Myomas

HIFU/MRgFUS

It is the destruction of myomas by ultrasound from the outside. A thermal mapping system is used to treat the myoma with the thermal effect, the procedure usually lasts 3 hours, 2-10 cm myomas can be treated although the FDA has authorized 4-5 hours of treatment. It is an effective treatment in terms of controlling bleeding and reducing the size of the myoma. The main disadvantages are the time the procedure…. the need to repeat the procedure and the price.

Vaginal Radiofrequency

Vaginal Radiofrequency It is performed under ultrasound control and the patient is sedated. First, a biopsy of the is taken and analyzed in pathological anatomy. The myoma is punctured with a radiofrequency needle and the entire myoma is treated. Subsequently, the vascularization of the myoma can be verified in the same operating room. It is a safe procedure. The controls will be made at two and six months.

We have the latest technology. Gynecological 3D Doppler Ultrasound and Elastography for myomas, two novelties in the treatment of uterine myomas.