Der Gynäkologe

, Volume 45, Issue 11, pp 835–840 | Cite as

Uterine Leiomyome

Indikationen für konservative Therapieoptionen
Leitthema

Zusammenfassung

Uterusmyome sind gutartige Tumoren der Uterusmuskulatur, die bei mehr als einem Drittel der Frauen auftreten. Als Behandlungsmöglichkeiten stehen neben der chirurgischen Entfernung die medikamentösen, v. a. endokrinen Therapien sowie die minimal-invasiven radiologischen Interventionen zur Verfügung. In der Übersicht sollen die einzelnen Therapieansätze erklärt, diskutiert und bewertet werden.

Schlüsselwörter

Uterusmyom Prostaglandinrezeptormodulator GnRH-Agonist Myomembolisation Thermoablation 

Uterine leiomyoma

Indications for conservative therapy options

Abstract

Myomas of the uterus are benign tumors which very often occur among fertile women. In addition to surgical intervention other treatment modalities include medicinal (endocrine) and radiological interventions. This overview will review, discuss and evaluate these modalities.

Keywords

Uterine myoma Prostaglandinreceptormodulator Gonadotropin releasing hormone agonist Embolization Thermoablation 

Literatur

  1. 1.
    Carbonell Esteve JL et al (2008) Mifepristone for the treatment of uterine leiomyomas: a randomized controlled trial. Obstet Gynecol 112(5):1029–1036CrossRefGoogle Scholar
  2. 2.
    Donnez J et al (2012) Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 366(5):421–432PubMedCrossRefGoogle Scholar
  3. 3.
    Donnez J et al (2012) Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med 366(5):409–420PubMedCrossRefGoogle Scholar
  4. 4.
    Eckey T et al (2011) Non-invasive thermoablation of symptomatic uterine fibroids with magnetic resonance-guided high-energy ultrasound. Radiologe 51(7):610–619PubMedCrossRefGoogle Scholar
  5. 5.
    Engman M et al (2009) Mifepristone for treatment of uterine leiomyoma. A prospective randomized placebo controlled trial. Hum Reprod 24(8):1870–1879PubMedCrossRefGoogle Scholar
  6. 6.
    Felberbaum RE et al (2001) Preoperative reduction of uterine fibroids in only 16 days by administration of a gonadotrophin-releasing hormone antagonist (Cetrotide). Reprod Biomed 3(1):14–18CrossRefGoogle Scholar
  7. 7.
    Fennessy FM et al (2007) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery — results of different treatment protocols. Radiology 243(3):885–893PubMedCrossRefGoogle Scholar
  8. 8.
    Fiscella K et al (2006) Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: a randomized controlled trial. Obstet Gynecol 108(6):1381–1387PubMedCrossRefGoogle Scholar
  9. 9.
    Flierman PA et al (2005) Rapid reduction of leiomyoma volume during treatment with the GnRH antagonist ganirelix. BJOG 112(5):638–642PubMedCrossRefGoogle Scholar
  10. 10.
    Grigorieva V et al (2003) Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomas. Fertil Steril 79(5):1194–1198PubMedCrossRefGoogle Scholar
  11. 11.
    Gupta JK et al (2012) Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 5:CD005073PubMedGoogle Scholar
  12. 12.
    Hilário SG et al (2009) Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients. Fertil Steril 91(1):240–243PubMedCrossRefGoogle Scholar
  13. 13.
    Jirecek S et al (2004) Raloxifene prevents the growth of uterine leiomyomas in premenopausal women. Fertil Steril 81(1):132–136PubMedCrossRefGoogle Scholar
  14. 14.
    Lethaby A et al (2001) Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2:CD000547PubMedGoogle Scholar
  15. 15.
    Magalhães J et al (2007) Uterine volume and menstrual patterns in users of the levonorgestrel-releasing intrauterine system with idiopathic menorrhagia or menorrhagia due to leiomyomas. Contraception 75(3):193–198PubMedCrossRefGoogle Scholar
  16. 16.
    Mara M et al (2006) Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 126(2):226–233PubMedCrossRefGoogle Scholar
  17. 17.
    Marshall LM et al (1998) A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata. Fertil Steril 70(3):432–439PubMedCrossRefGoogle Scholar
  18. 18.
    Palomba S et al (2002) Effectiveness of combined GnRH analogue plus raloxifene administration in the treatment of uterine leiomyomas: a prospective, randomized, single-blind, placebo-controlled clinical trial. Hum Reprod 17(12):3213–3219PubMedCrossRefGoogle Scholar
  19. 19.
    Palomba S et al. (2002) Raloxifene administration in premenopausal women with uterine leiomyomas: a pilot study. J Clin Endocrinol Metab 87(8):3603–3608PubMedCrossRefGoogle Scholar
  20. 20.
    Parsanezhad ME et al. (2010) A randomized, controlled clinical trial comparing the effects of aromatase inhibitor (letrozole) and gonadotropin-releasing hormone agonist (triptorelin) on uterine leiomyoma volume and hormonal status. Fertil Steril 93(1):192–198PubMedCrossRefGoogle Scholar
  21. 21.
    Rabe T et al. (2012) Ulipristalacetat bei symptomatischem Uterus myomatosus und bei myombedingter Hypermenorrhoe. J Reproduktionsmed Endokrinol 9(2):106–126Google Scholar
  22. 22.
    Steinauer J et al. (2004) Systematic review of mifepristone for the treatment of uterine leiomyomata. Obstet Gynecol 103(6):1331–1336PubMedCrossRefGoogle Scholar
  23. 23.
    Tropeano G et al. (2012) Is myomectomy always the best choice for infertile women with symptomatic uterine fibroids? J Obstet Gynaecol Res 38(4):733–736PubMedCrossRefGoogle Scholar
  24. 24.
    Tropeano G et al. (2008) Non-surgical management of uterine fibroids. Hum Reprod 14(3):259–274Google Scholar
  25. 25.
    Tropeano G et al. (2004) Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil Steril 81(4):1055–1061PubMedCrossRefGoogle Scholar
  26. 26.
    Wise LA et al. (2004) Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol 159(2):113–123PubMedCrossRefGoogle Scholar
  27. 27.
    Zapata LB et al. (2010) Intrauterine device use among women with uterine fibroids: a systematic review. Contraception 82(1):41–55PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Universitätsfrauenklinik UlmUlmDeutschland

Personalised recommendations