Der Gynäkologe

, Volume 45, Issue 10, pp 801–808 | Cite as

Multimodale Behandlung des Uterus myomatosus

Zwischen Organerhalt und Funktionseinschränkung
Gynäkologie aktuell

Zusammenfassung

Die Therapie symptomatische Uterus myomatosus zählt zu den Herausforderungen in der frauenärztlichen Praxis. Multimodale Therapieansätze, konservative wie interventionelle Verfahren stehen dabei zur Verfügung. Letztere können organerhaltend, funktionseinschränkend und organentfernend sein. Bei nicht abgeschlossenem Kinderwunsch ist die chirurgische Myomenukleation die einzige evidenzbasierte Methode, welche die reproduktive Funktion erhält und sie sogar verbessern kann. Als radiologisch minimal-invasives Verfahren kommt die Embolisation für die Patientinnen in Betracht, bei denen prinzipiell auch über eine Hysterektomie nachgedacht werden kann. Unter Beachtung spezifischer Kontraindikationen und nach Aufklärung über eine mögliche persistierende geringe Menstruationsblutung kann die Zervix belassen werden. Zu den neuen medikamentösen Optionen, insbesondere in Vorbereitung einer Operation, zählt Ulipristalacetat (UPA).

Schlüsselwörter

Hysterektomie Arterienembolisation Endometriumhyperplasie Reproduktive Funktion Dysmenorrhö 

Multimodal treatment of uterine leiomyomas

Organ preservation versus functional impairment

Abstract

Symptomatic uterine leiomyomas are a therapeutic challenge. This article reviews multimodal therapy approaches as well as conservative and interventional procedures of which the latter can be organ-preserving, functionally limiting and organ-removing. For women who desire fertility surgical enucleation of myomata is the only evidence-based method which retains and can even improve reproductive function. Uterine artery embolization is a radiological minimally invasive procedure which can be a possibility for patients for whom a hysterectomy might also be an option. Bearing specific contraindications in mind and following consultation about possible persistence of minimal menstrual bleeding, the cervix may be retained. Medicinal options include the new ulipristal acetate (UPA).

Keywords

Hysterectomy Uterine artery embolization Endometrial hyperplasia Reproductive function Dysmenorrhea 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum UlmUlmDeutschland

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