Therapeutische Strategien bei Myomen

Der Großteil der diagnostizierten Myome erfordert keine Behandlung, da sie in nahezu allen Fällen gutartig sind. Treten jedoch Beschwerden auf wie z. B. Blutungsanomalien und Schmerzen, stehen einige Therapiemöglichkeiten zur Verfügung. Welche Behandlungsmethode gewählt wird, hängt von verschiedenen Faktoren ab, die im Folgenden, basierend auf Studiendaten, beleuchtet werden.

Kernaussagen

• Uterusmyome gehören zu den häufigsten gutartigen Tumoren bei Frauen und weisen eine Lebenszeitprävalenz von 70–80 % auf.

• Treten Komplikationen und Beschwerden auf, stehen medikamentöse, minimalinvasive und invasive Therapieoptionen zur Verfügung.

• Die Wahl der Therapiemethode hängt von den Beschwerden, der Anzahl und Größe der Myome und dem Wunsch der Patientin ab.

• Nichtsteroidale Antirheumatika und Tranexamsäure oder hormonelle Präparate wie z. B. das Levonorgestrel freisetzende Intrauterinpessar können bei starken Blutungsbeschwerden eingesetzt werden.

• Beim Einsatz von Gonadotropin-Releasing-Hormon-Präparaten muss der Flare-up-Effekt bedacht werden.

• Bei großen, multiplen oder ungünstig gelegenen Myomen ist die offene Myomenukleation die Methode der Wahl.

• Als alternative minimalinvasive Therapiemöglichkeiten erweisen sich die transzervikale Radiofrequenzablation und die laparoskopische Radiofrequenzablation als gute Behandlungsmethoden für Uterusmyome.

• Nach operativen Eingriffen muss der sichere Zeitabstand zwischen einer Myomenukleation und dem Beginn einer Schwangerschaft bedacht werden, um möglichst eine Uterusruptur zu vermeiden.

Schlüsselwörter

Uterusmyome - Myomtherapie - minimalinvasive Chirurgie - Hormontherapie

Publication History

Article published online:
02 October 2025

• Literatur

• 1 Wise LA, Ruiz-Narvaez EA, Palmer JR. et al. African ancestry and genetic risk for uterine leiomyomata. Am J Epidemiol 2012; 176: 1159-1168
• 2 Jacobs A, Abou-Dakn M, Becker K. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). et al. S3 Leitlinie Therapie entzündlicher Brusterkrankungen in der Stillzeit. AWMF-Registernummer: 015/071. Stand: 2013.. Accessed July 22, 2025 at: https://www.stillen-institut.com/media/therapie-entzuendlicher-brusterkrankungen-stillzeit-2013-02-langfassung.pdf
• 3 Stewart EA, Laughlin-Tommaso SK, Catherino WH. et al. Uterine fibroids. Nat Rev Dis Primers 2016; 2: 16043
• 4 Vilos GA, Allaire C, Laberge PY. et al. The management of uterine leiomyomas. J Obstet Gynaecol Can 2015; 37: 157-178
• 5 Munro KI, Thrippleton MJ, Williams A. et al. Quantitative serial MRI of the treated fibroid uterus. PLoS One 2014; 9: e89809
• 6 Stukan M, Rutkowski P, Smadja J. et al. Ultrasound-Guided Trans-Uterine Cavity Core Needle Biopsy of Uterine Myometrial Tumors to Differentiate Sarcoma from a Benign Lesion-Description of the Method and Review of the Literature. Diagnostics (Basel) 2022; 12: 1348
• 7 Chen I, Firth B, Hopkins L. et al. Clinical Characteristics Differentiating Uterine Sarcoma and Fibroids. JSLS 2018; 22: e2017.00066
• 8 Kim JH, Kim HJ, Kim SH. et al. Sonographic and Clinical Characteristics of Uterine Sarcoma Initially Misdiagnosed as Uterine Fibroid in Women in the Late Reproductive Age. J Menopausal Med 2019; 25: 164-171
• 9 Surace A, Bau MG, Privitera S. et al. Risk of unexpected uterine leiomyosarcoma during laparoscopic procedures: Experience from a single tertiary institute in Italy. Int J Gynaecol Obstet 2022; 156: 236-239
• 10 Brohl AS, Li L, Andikyan V. et al. Age-stratified risk of unexpected uterine sarcoma following surgery for presumed benign leiomyoma. Oncologist 2015; 20: 433-439
• 11 Sohn GS, Cho S, Kim YM. et al. Current medical treatment of uterine fibroids. Obstet Gynecol Sci 2018; 61: 192-201
• 12 Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev 2017; (11) CD000547
• 13 Doherty L, Mutlu L, Sinclair D. et al. Uterine fibroids: clinical manifestations and contemporary management. Reprod Sci 2014; 21: 1067-1092
• 14 Kwas K, Nowakowska A, Fornalczyk A. et al. Impact of contraception on uterine fibroids. Medicina (Kaunas) 2021; 57: 717
• 15 Marsh EE, Ekpo GE, Cardozo ER. et al. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18–30 years old): a pilot study. Fertil Steril 2013; 99: 1951-1957
• 16 Driák D, Vasicka IJAJOG. Effect of Progestin-Dominant Combined Oral Contraception on Uterine Fibroid Development. 2017 Accessed September 22, 2025 at: https://austinpublishinggroup.com/obstetrics-gynecology/fulltext/ajog-v4-id1077.php
• 17 Moroni RM, Vieira CS, Ferriani RA. et al. Presentation and treatment of uterine leiomyoma in adolescence: a systematic review. BMC Womens Health 2015; 15: 1-5
• 18 Worm M, Zidane M, Eisert L. et al. S2k-Leitlinie zur Diagnostik und Therapie des kutanen Lupus erythematodes – Teil 2: Therapie, Risikofaktoren und spezielle Fragestellungen. J Dtsch Dermatol Ges 2021; 19: 1371-1395
• 19 Al-Hendy A, Lukes A, Poindexter A. et al. Treatment of uterine fibroid symptoms with relugolix combination therapy. N Engl J Med 2021; 384: 630-642
• 20 Wei J, Ma X, Wang W. et al. Gonadotropin-releasing hormone agonist versus expectant management for treating multiple leiomyomas after myomectomy: the study protocol for a multicentre, prospective, randomised controlled clinical trial. BMJ Open 2021; 11: e044347
• 21 Al-Hendy A, Lukes A, Poindexter A. et al. Long-term relugolix combination therapy for symptomatic uterine leiomyomas. Obstet Gynecol 2022; 140: 920-930
• 22 Lukes A, Migoya E, Johnson B. et al. A randomized open-label study of relugolix alone or relugolix combination therapy in premenopausal women. Clin Pharmacokinet 2023; 62: 1169-1182
• 23 Tezuka M, Tamai Y, Kuramochi Y. et al. Pharmacological Characterization of Linzagolix, a Novel, Orally Active, Non-peptide Antagonist of Gonadotropin-releasing Hormone Receptors. Clin Exp Pharmacol Physiol 2022; 49: 1082-1093
• 24 Al-Hendy A, Bradley LD, Taylor HS. et al. Quality of Life Improvements in Women With Uterine Fibroids: Results of Two Phase 3 Trials With Linzagolix [A107]. Obstet Gynecol 2022; 139: 31S-31S
• 25 Taylor HS, Donnez J, Bestel E. et al. Post-Treatment Efficacy and Safety Follow-Up in Women With Uterine Fibroids Treated for 52 Weeks With Linzagolix [A108]. Obstet Gynecol 2022; 139: 31S-32S
• 26 Donnez J, Cacciottola L, Squifflet JL. et al. Profile of Linzagolix in the Management of Endometriosis, Including Design, Development and Potential Place in Therapy: A Narrative Review. Drug Des Devel Ther 2023; 17: 369-380
• 27 Stewart EA, Marsh EE, Donnez J. et al. Effect of the Oral GnRH Antagonist Linzagolix on Uterine Fibroid-Related Severe Anemia [A105]. Obstet Gynecol 2022; 139: 31S-31S
• 28 Tezuka M, Tsuchioka K, Kobayashi K. et al. Suppressive Effects of Linzagolix, a Novel Non-peptide Antagonist of Gonadotropin-releasing Hormone Receptors, in Experimental Endometriosis Model Rats. Clin Exp Pharmacol Physiol 2023; 50: 610-617
• 29 Buchholz S, Ortmann O. Operative Strategien bei Myomen. Frauenheilkunde up2date 2013; 7: 55-65
• 30 Lazaridis A, Kogeorgos S, Al-Achmar N. et al. The tip of the iceberg fibroid effect; when to avoid transcervical resection. the utilisation of 3d pelvic ultrasonography for fibroid mapping. Authorea 2023;
• 31 Kayatas S, Meşeci E, Oa T. et al. Experience of hysteroscopy indications and complications in 5,474 cases. Clin Exp Obstet Gynecol 2014; 41: 451-454
• 32 Vitale S. Hysteroscopic diode laser myolysis: from a case series to literature review of incisionless myolysis techniques for managing heavy menstrual bleeding in premenopausal women. Arch Gynecol Obstet 2023; 309: 949-959
• 33 Kramer KJ, Ottum S, Gonullu D. et al. Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus. PLoS One 2021; 16: e0261085
• 34 Zanolli NC, Bishop KC, Kuller JA. et al. Fibroids and fertility: a comparison of myomectomy and uterine artery embolization on fertility and reproductive outcomes. Obstet Gynecol Surv 2022; 77: 485-494
• 35 Discepola F, Valenti DA, Reinhold C. et al. Analysis of arterial blood vessels surrounding the myoma: relevance to myomectomy. Obstet Gynecol 2007; 110: 1301-1303
• 36 Mara M, Maskova J, Fucikova Z. et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31: 73-85
• 37 Kim M, Jung Y, Yun B. et al. Robotic single-site myomectomy: a single-center experience of 101 consecutive cases. Int J Med Robot 2018; 15: e1959
• 38 Jin C, Hu Y, Chen XC. et al. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2009; 145: 14-21
• 39 Asgari Z, Pourhoseini S, Hosseini R. et al. Short-term risk of fibroid recurrence after laparoscopic myomectomy and its associated risk factors. Shiraz E-Med J 2023;
• 40 Yu S, Xiang Y. The influence of intraoperative ultrasound monitoring on the risk of recurrence and reoperation in patients with hysteromyomectomy. Contrast Media Mol Imaging 2022; 2022: 4366840
• 41 Desai P, Patel P. Fibroids, infertility and laparoscopic myomectomy. J Gynecol Endosc Surg 2011; 2: 36-42
• 42 Brucker S, Hahn M, Kraemer D. et al. Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy. Int J Gynaecol Obstet 2014; 125: 261-265
• 43 Santalla-Hernández A, Manzanares S, Naveiro-Fuentes M. et al. Obstetric outcome after ultrasound guided transvaginal radiofrequency ablation of uterine myomas. Obstet Gynecol Int J 2023; 14: 160-164
• 44 Guido R, Macer J, Abbott K. et al. Radiofrequency volumetric thermal ablation of fibroids: a prospective, clinical analysis of two years’ outcome from the halt trial. Health Qual Life Outcomes 2013; 11: 139
• 45 Hudgens J, Johns D, Lukes A. et al. 12-month outcomes of the US patient cohort in the sonata pivotal IDE trial of transcervical ablation of uterine fibroids. Int J Womens Health 2019; 11: 387-394
• 46 Toub D. A new paradigm for uterine fibroid treatment: transcervical, intrauterine sonography-guided radiofrequency ablation of uterine fibroids with the sonata system. Curr Obstet Gynecol Rep 2017; 6: 67-73
• 47 Bongers M, Gupta J, Garza-Leal J. et al. The INTEGRITY Trial: Preservation of Uterine-Wall Integrity 12 Months After Transcervical Fibroid Ablation with the Sonata System. J Gynecol Surg 2019; 35: 299-303
• 48 Pschadka G, Engelhardt M, Niehoff C. et al. Term delivery in an infertile patient after transcervical radiofrequency fibroid ablation and assisted reproductive technology. J Gynecol Surg 2019; 35: 253-255
• 49 Lukes A, Green M. Three-year results of the sonata pivotal trial of transcervical fibroid ablation for symptomatic uterine myomata. J Gynecol Surg 2020; 36: 228-233
• 50 Ichikawa S, Omori M, Sano K. et al. MR-guided Focused Ultrasound for Uterine Fibroids: A Preliminary Study of Relationship between the Treatment Outcomes and Factors of MR Images Including Elastography. Magn Reson Med Sci 2019; 18: 82-87
• 51 Lai M, Chen Y, Li H. et al. A modified bowel displacement technique for magnetic resonance imaging–guided focused ultrasound surgery in the treatment of uterine fibroids and adenomyosis. J Comput Assist Tomogr 2022; 46: 379-382
• 52 Mariara C, Obura T, Hacking N. et al. One year symptom severity and health-related quality of life changes among Black African patients undergoing uterine fibroid embolisation. BMC Res Notes 2017; 10: 240
• 53 Ramskill N, Hameed A, Beebeejaun Y. Spontaneous rupture of uterine leiomyoma during labour. BMJ Case Rep 2014; 2014: bcr2014204364
• 54 Kroncke T. An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus. Br J Radiol 2023; 96: 20220121