Typically, women aged between 20 and 50 years of age develop myomas. This fact also supports the belief that myomas develop as a result of hormonal stimulation.

Your gynecologist can use an ultrasound scan to check whether or not you have myomas (number, position and size) and determine whether these are the cause of your symptoms. Talk to your gynecologist if you have at least one of the following symptoms:

• Heavy and prolonged periods
• Pain in the back or legs or a feeling of pressure in the pelvis
• Involuntary childlessness or miscarriage
• Pain during sexual intercourse
• Frequent pressure on the bladder

• Watch and wait
• Hysterectomy (surgical removal of the uterus)
• Myoma enucleation (surgical removal of the myoma with preservation of the uterus)
• MR-guided focused ultrasound (MRgFUS)
• Myoma embolization
• Hormone therapy

Essentially, it is impossible to state from the outset which myomas can be treated with MRgFUS and which cannot. This decision can only ever be made during a consultation following an initial examination, once the radiological images from the MRI (magnetic resonance imaging) scan are available and which can be used to plan any MRgFUS therapy. It is true that certain types of myoma are more difficult to treat with MRgFUS, and some myoma radiologists may refuse this type of treatment if the likelihood of the treatment being successful is too low. But even difficult myomas such as myomas that have a good blood supply, subserous myomas or myomas with a diameter of greater than 10 cm have, in individual cases, been treated successfully at the FUS Center.

• Your personal medical history and family history (e.g. allergies)
• Do you currently have any illnesses?
• Are you taking any medication?
• Are you or might you be pregnant?
• Are you able to have MRI treatment (not suitable for people who have a heart pacemaker or patients with an allergy to contrast medium, for example)

Some women have reported a feeling of warmth or heat over the skin or in the pelvis. Others experienced a short "stitch" or "burning" sensation for a few seconds when the energy was released.

You will lie on a special treatment couch in the MRI scanner and you will be able to communicate with your medical team throughout the treatment. Your doctor may tell you about possible sensations you may feel during treatment, which are perfectly normal. He will tell you to press the button in your hand if you feel that the sensations you are experiencing are more exaggerated than normal, and treatment can be stopped

The treatment normally takes 3-4 hours. You must then rest for 1-2 hours.

The length of the entire process depends on the scheduling of the investigation appointments. You will need an appointment for the preliminary examination, an appointment for the actual treatment and a further follow-up appointment after around 6-12 months.

MRgFUS treatment is carried out as an outpatient. The treatment normally takes 3-4 hours. You must then rest for 1-2 hours. You can then go home. If you have a long way to travel to get home, we also offer free overnight accommodation at our facility. You can usually return to your normal routine after 1-2 days.

Patients are generally not off sick at all, or at most are off for 1-2 days, since patients are normally able to return to their normal routines 1-2 days after treatment.

The treated myomas do not come back after successful MRgFUS treatment. New, previously untreated ones, however, can occur.

One of the big advantages of this treatment method is that the patient's fertility is completely preserved, or indeed is influenced positively by the treatment of the myoma.

Generally speaking, MRgFUS is a safe and particularly gentle method for treating myomas. Complications have occurred in only a very few cases to date; the rate of serious complications is extremely low. Talk to your doctor about your likelihood of developing the following complications:

doctor about your likelihood of developing the following complications:
• Lower abdominal pain / cramps, back or leg pain
• Nausea and / or fever
• Superficial, localized reddening / burning of the skin
• Urinary tract infection
• Vaginal discharge, spotting and / or intermenstrual bleeding is possible up to 3 months after treatment
• Allergic reaction to the contrast medium or sedative
• Circulatory problems during or after treatment
• Feeling of heat during therapy
• Nerve irritation
• Very rare: Bowel injury

Additional risks:

• There is a slight risk that the treatment will not be successful and that you will need an alternative treatment to alleviate your symptoms.
• - The treatment may have successfully reduced your symptoms, however it is still possible that further, new myomas will develop at a later stage that will require further treatment. This risk applies to all of the alternative treatments for myoma apart from hysterectomy (removal of the womb).

Worldwide, over 10,000 MRgFUS treatments have been carried out, with over 1,000 performed in the FUS Center at the hospital in Dachau (as of 02/2014).

Not all statutory health insurance companies currently cover the costs of MRgFUS treatment. Only the Techniker Krankenkasse, AOK Bayern and Barmer GEK currently cover all of the costs of this treatment. Our many years of experience and constant contact with various health insurance companies means we already have defined contacts with these companies and have cost reimbursement covered as a one-off payment with most statutory health insurance firms. We therefore apply for cover of the costs on your behalf.

Private health insurance companies will generally assume some or even all of the costs of MRgFUS treatment. We will make a request for coverage of the costs before treatment begins, with a complete list of the exact costs involved. DEBEKA is the first private health insurance company to pay all of the costs of this treatment.

Treatment costs between Euro 4,100 and 4,200 if your insurance company will not cover the costs. However there is always the option of changing insurance company. The Techniker Krankenkasse, AOK Bayern and Barmer GEK will cover all of the costs from the first day of insurance.

The MRI scans for the preliminary investigation can in principle be performed by any radiologist and then sent as DICOM images on CD by post to the FUS Center. However it must be kept in mind that the particular requirements relating to these images must be complied with.

Protocol for an MRI scan of the pelvis for presentation to your radiologist

Since the cause of myomas is still not fully understood, it is impossible to provide definitive recommendations on how to prevent them. However since it is believed that myoma growth is caused by hormones, we recommend avoiding products that contain estrogen.

Myomas are benign growths in the uterus. They should be checked regularly, however, in order to ensure treatment can be initiated if there are any changes.

If you become pregnant despite having a myoma, you can continue the pregnancy without having the myoma treated. Myomas are never removed while pregnant. If your symptoms are still present after the birth, however, discuss your further treatment options with your gynecologist.

Myomas do not necessarily prevent pregnancy, however they can cause problems during it. In certain positions, myomas can also cause miscarriages. Myomas can also make the birth itself difficult if they block the birth canal due to their location. In this situation your doctor may recommend that you have a Cesarean section. Myomas increase the risk of heavy bleeding after the birth and can prolong the time until your abdomen returns to its normal size.