A 45 yr old lady, nulliparous, attends for her annual well-woman clinic. She is a known case of uterine leiomyomas diagnosed incidentally a year ago. She reports regular periods and no bowel or bladder concerns.
- Uterus sized 16 wks
- Lobular, nontender
- Multiple homogenous uterine leiomyomas
- Unchanged from last year
- Normal ovaries
- Asymptomatic leiomyomas
- No change in leiomyomas on ultrasonography
- follow-up in 12 m
- GnRH therapy
- uterine artery embolization
Follow-up in 12 m
Uterine leiomyomas are the most common solid pelvic tumor in women. Approximately 25% of the affected ladies become symptomatic. Symptoms may include abnormal uterine bleeding, pelvic pain and infertility.
Asymptomatic patients with homogenous appearance to their leiomyomas do not typically require any intervention, and expectant management with regular check-ups is preferred.
LNG-IUS is widely regarded as an effective modality of treatment for heavy menstrual bleeding in women with fibroids, increasing hemoglobin and relieving symptoms
GnRH is effective in decreasing heavy vaginal bleeding and reducing the size of the leiomyoma. However, after therapy is discontinued, symptoms often return within a few months. It is also associated with hypoestrogenic side effects, and is thus only recommended during pre-operative optimization.
Uterine artery embolization is a procedure performed by interventional radiologists targeting the uterine arteries via a transfemoral approach. The reduced blood supply leads to leiomyoma involution within 3 months of the procedure.
Hysterectomy is the most drastic option and is reserved for cases who are symptomatic and have failed more conservative approaches.
Allaire C, Laberge P-Y, Leyland N, On H. The Management of Uterine Leiomyomas. 2015; https://www.jogc.com/article/S1701-2163(15)30338-8/pdf
American College of Obstetricians and Gynecologists (2008). ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstetrics and gynecology. https://doi.org/10.1097/AOG.0b013e318183fbab
Younas MBBS MRCOG K, Hadoura MRCOG ChB EM, Majoko MBBS MRCOG F, Bunkheila MBChB FRCOG AM, Younas K. A review of evidence-based management of uterine fibroids.
Mas A, Tarazona M, Carrasco JD, Estaca G, Cristóbal I, Monleón J. Updated approaches for management of uterine fibroids. Int J Womens Health [Internet]. 2017 Sep 5 [cited 2021 Jul 22];9:607. Available from: /pmc/articles/PMC5592915/
E G, S A-S, EE M. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet [Internet]. 2020 Apr 1 [cited 2021 Jul 22];149(1):3–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31960950/