Myome – Entstehung, Diagnostik und Therapie

Kernaussagen

Epidemiologie

Myome sind die häufigsten soliden Tumoren der Frau. Sie sind meist hormonabhängig und durch ein gutartiges Wachstum charakterisiert. Bei ca. 20–40 % aller Frauen über 30 Jahre finden sich Myome des Uterus, die vor allem in der reproduktiven Lebensphase symptomatisch werden.

Symptomatik

Im Vordergrund stehen Blutungsstörungen, Schmerzen und Druckgefühl sowie Störungen im Rahmen der Reproduktion und Schwangerschaft. Letztere äußern sich in Aborten, Sterilität und dem vermehrten Auftreten von Komplikationen. Entscheidend ist die Lage und Größe der Myome, wobei vor allem submuköse und intramurale Myome eine Rolle zu spielen scheinen.

Diagnostik

Im Vordergrund stehen hier an erster Stelle die klinische Untersuchung und der Ultraschall als nicht invasive Untersuchungsmethoden. Das MRT oder CT sollte Sonderfällen vorbehalten bleiben.

Therapie

Die minimalinvasiven OP-Methoden, wie operative Hysteroskopie und Laparoskopie, sind die Methoden der Wahl zur organerhaltenden Resektion bzw. Enukleation von Myomen. Alternativ stehen die verschiedenen Hysterektomieverfahren bei abgeschlossener Familienplanung zur Verfügung.

Eine medikamentöse Therapieoption zur Beschwerdeverbesserung und präoperativen Myomverkleinerung stellt die Therapie mit Ulipristalacetat dar, die der Therapie mit GnRH-Agonisten überlegen ist. Die Therapie kann präoperativ zur OP-Vorbereitung erfolgen sowie als Langzeitintervalltherapie. Der Progesteronantagonist Mifepriston (RU 486) scheint ebenfalls in äquipotenter Weise eine Größenreduktion von Myomen zu verursachen, ist aber in Deutschland zu diesem Zweck nicht zugelassen. Die Embolisation der A. uterina sowie der hochintensive fokussierte Ultraschall sind für ausgewählte Patientinnen mit abgeschlossener Familienplanung und nach sorgfältiger Abwägung des Risikos und Nutzen eine Alternative. Zu beachten ist aber die relativ hohe Rate an sekundären operativen Eingriffen.

• Literatur

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