From the Guidelines
The patient's ultrasound findings of uterine fibroids and a probable paraovarian cyst are considered non-acute and do not require emergency treatment, and follow-up with a gynecologist is recommended to discuss these findings and determine if any treatment is needed based on symptoms. The ultrasound shows two uterine fibroids - one measuring 2.4 x 1.5 x 2.3 cm in the back wall of the uterus and a larger one near the top of the uterus measuring 5.6 x 7.1 x 5.5 cm. Both have minimal blood flow. There is also a probable paraovarian cyst (a fluid-filled sac near but separate from the right ovary) measuring 3.2 cm. The uterus itself is normal sized at 11.5 x 6.5 x 9 cm, and both ovaries appear normal. The endometrial lining is 11.9 mm thick.
- Uterine fibroids are common benign muscle growths that often don't require treatment unless they cause symptoms like heavy bleeding or pain, as supported by a study published in the Journal of the American College of Radiology 1.
- The paraovarian cyst is likely benign and may resolve on its own, with a low risk of malignancy, as demonstrated by a recent meta-analysis by Parazzini et al 1.
- Follow-up with a gynecologist is recommended to discuss these findings and determine if any treatment is needed based on symptoms, taking into account the patient's individual risk factors and medical history.
- The American College of Radiology recommends that simple cysts up to 10 cm in diameter on transvaginal ultrasonography performed by experienced ultrasonographers are likely to be benign and may be safely monitored using repeat imaging without surgical intervention, even in postmenopausal patients 1.
- In this case, since the paraovarian cyst is less than 5 cm in diameter, no additional management is required, and follow-up in 8-12 weeks is recommended to confirm its functional nature or to reassess for cyst wall abnormalities 1.
From the Research
Uterine Fibroids
- Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent 2.
- They can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia 2.
- Ultrasonography is the preferred initial imaging modality for diagnosing uterine fibroids 2.
- Management should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the experience of the physician 2.
Treatment Options
- Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs 2.
- Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause 2, 3, 4.
- Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery 2, 5.
- GnRH antagonists represent a new therapeutic option for premenopausal women with uterine fibroids, allowing a superior reduction in menstrual bleeding and uterine fibroid volume compared to the placebo group 6.
Diagnostic Findings
- The ultrasound findings indicate the presence of uterine fibroids, with two heterogeneous structures seen within the myometrium and near the fundus 2.
- The endometrial strip measures 11.9 mm, and the right ovary is normal in size and appearance, with a probable right paraovarian cyst measuring up to 3.2 cm.
- The left ovary is normal in size and appearance, measuring 2.2 cm x 1.4 cm x 1.2 cm.
Future Perspectives
- A deeper knowledge of biological mechanisms at the basis of the genesis and growth of uterine fibroids could pave the way for the development of innovative targeted therapies 3.
- The development of new emerging options, such as GnRH antagonists, represents hopeful alternatives that could potentially overcome the limitations of currently employed drugs for uterine fibroids 3, 4, 6.