Fibroid care in Munich

Fibroids are benign nodules made of muscle and connective tissue in the uterus. They occur in many women, especially in the years before the menopause. Fibroids can occur singly or in groups and vary greatly in size. Their position is often what determines the symptoms: subserosal fibroids grow on the outside of the uterus and sometimes press on the bladder or bowel. Intramural fibroids lie within the muscle wall. Submucosal fibroids bulge into the uterine cavity; they are more likely to cause heavy bleeding and can make implantation more difficult. Many fibroids cause no symptoms and are discovered by chance during an ultrasound scan. In that case, it is often enough to monitor them at sensible intervals.

Fibroids grow under the influence of the sex hormones oestrogen and progesterone. That is why they develop during the fertile years and usually shrink after the menopause. A hereditary predisposition also plays a role. In holistic gynaecology, people often speak of oestrogen dominance: an excess of oestrogen relative to progesterone, as can occur in the years before the menopause when ovulation becomes less frequent. Oestrogen dominance is not a diagnosis in its own right in conventional medicine, but an explanatory model. Prof. Schulte-Uebbing has worked on this for many years, for example in “Hashimoto's disease, progesterone deficiency, oestrogen dominance” (Menopause Congress, University of Vienna, 2012). For treatment, this means we look at your hormone balance as a whole, not just the fibroid.

Whether and to what extent environmental factors influence the growth of fibroids is still being researched. So-called endocrine disruptors are under discussion: substances from plastics, cosmetics, fragrances or drinking water that can act somewhat like oestrogen in the body. Prof. Schulte-Uebbing has done a great deal of scientific work on such substances, for example in “Hormonally active substances in drinking water and their effects on the female hormone system” (gyn, 2018; published in German). This is one reason why our practice is nicotine-free and perfume-free. In addition, body weight, exercise and diet affect your hormone balance, because fatty tissue produces oestrogen itself. We will advise you on what you can do in everyday life. We make no promise that fibroids will become smaller as a result.

Small fibroids that cause no symptoms are usually just monitored. If bleeding is heavy, medication can reduce it, and an iron deficiency is corrected. Hormonal medication can ease symptoms, and some types shrink fibroids temporarily, for instance before an operation. Fibroids can be removed surgically while preserving the uterus – depending on their position, by laparoscopy (keyhole surgery), hysteroscopy or open surgery. Once family planning is complete and symptoms are severe, removal of the uterus may also be an option. There are also procedures without an incision, such as embolisation, in which the blood vessels supplying the fibroid are closed off, or focused ultrasound. Which procedure suits you depends on size, position, symptoms and whether you wish to have a child.

Not every fibroid needs to be operated on. An operation or another procedure may make sense if heavy bleeding leads to anaemia despite treatment, if a fibroid presses noticeably on the bladder or bowel, if pain dominates your daily life or if a fibroid in the uterine cavity makes it harder to have a child. A fast-growing fibroid, especially after the menopause, should also be investigated more closely. We will tell you openly if we think a procedure makes sense, explain the options and risks and name suitable surgical centres. We continue to support you before and after the procedure. The decision is yours – made calmly and well informed.

Many women with fibroids become pregnant without any problems. However, fibroids that protrude into the uterine cavity can make implantation more difficult; in that case, removal before pregnancy may make sense. During pregnancy, fibroids can grow and cause symptoms. With the menopause, hormone levels fall and fibroids usually become smaller. If you have known fibroids, we weigh up hormone therapy during the menopause carefully and monitor it with ultrasound. If a fibroid grows after the menopause, we investigate this further promptly. That way, you and we can keep track of how things develop in every phase of life.