BreastCentre Zurich

Myomas are benign, nodular tumours made of muscle and connective tissue of the uterus. In less than one per cent of cases, they contain malignant cells. Even though fibroids are generally harmless, they can cause noticeable symptoms in around one in four women affected, for example heavy or irregular bleeding, pain or an unfulfilled desire to have children.

Types of fibroids, symptoms and causes

Myomas are common and can occur at various locations inside or outside the uterus. A distinction is made between different types of fibroids depending on their location:

Submucosal fib roids grow under the lining of the uterus inside the uterus and often protrude into the uterine cavity. They can cause heavy or prolonged menstrual bleeding.
Intramural fibroids are located in the muscle wall of the uterus and are the most common form.
Subserosal fibroids are located on the outside of the uterus and can press on neighbouring organs, such as the bladder or bowel.
Intraligamentous fibroids grow in the retaining ligaments that stabilise the uterus in the pelvis.
Pedunculated fibroids are connected to the uterus via a stalk of tissue. They can occur both in the uterine cavity (intracavitary) and on the outside of the uterus (subserosal).

If several fibroids occur simultaneously in or on the uterus, we speak of a uterus myomatosus.

Paper-artistic depiction of a uterus with flowers on a pink background.

Causes of fibroids

The exact causes of fibroid growth are still not fully understood. However, there are several factors that can influence the development and growth of fibroids:

Hormones: female sex hormones - especially oestrogen - promote growth.
Genetic predisposition: Fibroids often run in families.
Ethnic origin: Women of African origin are more frequently affected.
Lifestyle: Factors such as stress, diet, alcohol, caffeine, smoking and lack of exercise may play a role.
Pre-existing conditions: Obesity, high blood pressure or diabetes can increase the risk.
Childlessness: Women without pregnancies have a slightly increased risk.

During pregnancy, fibroids can grow significantly due to hormonal changes. After the menopause, however, new fibroids usually no longer form and existing lumps often shrink.

Frequency and symptoms of fibroids

Up to 70 per cent of women between the ages of 40 and 50 develop these benign lumps in the uterus. This makes them one of the most common tumours of the female reproductive organs. The size can vary greatly: from tiny lumps the size of a pinhead to fibroids the size of a child's head. Many women do not even notice their fibroids. However, around a quarter of those affected develop noticeable symptoms that can significantly impair their quality of life.

Not every fibroid causes symptoms. However, if symptoms do occur, they can vary greatly:

Prolonged or increased periods (hypermenorrhoea)
A feeling of pressure in the abdomen and on other organs, such as the bladder or bowel
Pain in the lower abdomen, pelvis or during sexual intercourse
Constipation or frequent urge to urinate
Unfulfilled desire to have children

These symptoms can have a significant impact on your daily life. We take your symptoms seriously and provide you with comprehensive advice.

Causes of fibroids

The exact causes of fibroid growth are still not fully understood. However, there are several factors that can influence the development and growth of fibroids:

Hormones: female sex hormones - especially oestrogen - promote growth.
Genetic predisposition: Fibroids often run in families.
Ethnic origin: Women of African origin are more frequently affected.
Lifestyle: Factors such as stress, diet, alcohol, caffeine, smoking and lack of exercise may play a role.
Pre-existing conditions: Obesity, high blood pressure or diabetes can increase the risk.
Childlessness: Women without pregnancies have a slightly increased risk.

During pregnancy, fibroids can grow significantly due to hormonal changes. After the menopause, however, new fibroids usually no longer form and existing lumps often shrink.

How do we make the diagnosis?

Myomas are often discovered by chance during a gynaecological examination or through imaging of the lower abdomen. We also frequently detect fibroids when investigating complaints. Fibroids are the rule rather than the exception, especially in women in their fifties. However, the proportion of patients with fibroids and the desire to have children has also increased, as the desire to have children is increasingly being sought after the age of 30.

We carry out a thorough diagnosis in our fibroid consultation: We use gynaecological palpation and ultrasound examinations to identify the location and size of the fibroids. Sometimes we also recommend cross-sectional imaging to obtain even more precise information. We will then advise you in a detailed consultation and show you the treatment options.

If you have any complaints or would like a consultation, you are welcome to contact us at any time.

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Pregnant woman holding ultrasound picture, pink baby jacket and shoes in a basket next to her.

Fibroids and pregnancy

Submucosal fibroids in particular, which are closer to the uterine cavity, can lead to an unfulfilled desire to have children, miscarriages or premature labour during pregnancy. In addition, fibroids often grow rapidly during pregnancy. Surgical removal or shrinkage of the fibroids can improve your fertility. After such treatment, pregnancy is usually possible after just a few months.

We will be happy to discuss with you whether treatment makes sense in your case.

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Treatment options for fibroids

Whether and how we treat you depends on the size, location and symptoms of the fibroids as well as your current life situation and your wishes. The options range from regular observation to drug and radiological therapies to surgical removal of the uterus.

Observation: In the case of asymptomatic fibroids, an annual check-up is usually sufficient. Treatment is then not necessary - except in the case of very large fibroids that are pressing on surrounding organs.
Drug treatment: Various drugs are available that can reduce bleeding or inhibit the growth of fibroids.
Surgical treatment: In severe cases or if you want to have children, fibroids can be surgically removed. Possible procedures are
- Hysteroscopic fibroid removal: The fibroid is carefully removed during a hysteroscopy.
- Sonata treatment: The fibroids are localised using ultrasound in a minimally invasive procedure and heated using small electrodes, which causes them to shrink. Several fibroids can be treated in one session. This procedure is particularly suitable for fibroids in the uterine wall and can also be used if you wish to have children.
- Myoma enucleation: The troublesome fibroids are removed from the uterus by laparoscopy or abdominal incision. Pre-treatment with medication may be advisable for larger fibroids. Pregnancy is also possible after this procedure.
- Hysterectomy: Removal of the uterus is the safest treatment for very large or numerous fibroids with severe symptoms. We usually perform this minimally invasive procedure using laparoscopy. Completed family planning is a prerequisite.

After organ-preserving therapies, fibroids can also recur as long as the menopause has not yet occurred.

Sonata procedure for the gentle treatment of fibroids

With the Sonata procedure, we can offer a very low-complication, short and incision-free treatment method for treating the symptoms. Find out more in our video.

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Surgeons in the operating theatre with medical equipment and protective clothing.

Sonata treatment procedure at Zollikerberg Hospital

Under anaesthetic, we insert the Sonata probe into the uterine cavity via the vagina.
This probe, which is only a few millimetres wide, allows the fibroid (or several fibroids) to be precisely visualised using ultrasound and then heated.
With the help of tiny electrodes, we conduct a precisely dosed current into the fibroids. In this way, we heat and destroy the fibroids without damaging the surrounding tissue.

Depending on the size, the treatment takes between one and seven minutes per fibroid. Over the following weeks and months, the fibroid gradually shrinks and after three months you will have a 90 per cent reduction in your symptoms.

Prevention of fibroids

There are currently no known measures to effectively prevent fibroids. As fibroids often cause no symptoms, especially in the early stages, regular gynaecological examinations are important. This allows us to initiate appropriate treatment at an early stage if necessary.

We will be happy to assist and advise you in our fibroid consultation at Zollikerberg Hospital.