From the Guidelines
A submucosal fibroid measuring 60.9 x 43.9 x 66.4 mm should be removed if it's causing symptoms, given its moderate to large size and potential to cause significant morbidity, as indicated by the 2024 update on the management of uterine fibroids 1.
Key Considerations
- The size of the fibroid is a significant factor, as larger fibroids are more likely to cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on adjacent organs.
- The location of the fibroid, being submucosal, increases the likelihood of it causing heavy menstrual bleeding and fertility issues compared to other types of fibroids.
- Hysteroscopic myomectomy is a preferred treatment option for submucosal fibroids, offering the benefits of shorter hospitalization and faster return to usual activities, with improvement in symptom scores and quality of life equivalent to other surgical approaches at 2 to 3 months 1.
Treatment Approach
- Hysteroscopic myomectomy is recommended for patients desiring uterus preservation, especially when the fibroid is submucosal and causing symptoms.
- The procedure involves the transvaginal, transcervical placement of a hysteroscope and removal of the submucosal uterine fibroid, with associated risks that include uterine perforation, fluid overload, and the need for blood transfusion 1.
Decision Making
- The decision to remove the fibroid should be based on the presence of symptoms, the size and location of the fibroid, and the patient's desire for future fertility.
- Patients with no desire for future fertility should be counseled about the possibilities and risks associated with pregnancy after hysteroscopic myomectomy, as indicated by the latest guidelines 1.
Monitoring and Follow-Up
- For patients not experiencing symptoms and without fertility concerns, watchful waiting with regular monitoring may be an appropriate approach, but this should be discussed with a gynecologist to evaluate the specific situation and potential risks.
From the Research
Submucosal Myoma Removal
The decision to remove a submucosal myoma depends on various factors, including symptoms, size, and location of the myoma, as well as the patient's fertility desires.
- A submucosal myoma of size 60.9 x 43.9 x 66.4 mm may cause symptoms such as menorrhagia, pelvic pain, and infertility, and may require treatment 2.
- Treatment options for submucosal myomas include hysteroscopic myomectomy, which is a minimally invasive procedure that can be used to remove the myoma while preserving fertility 2, 3.
- Medical therapy, such as gonadotropin-releasing hormone agonists, may also be used to reduce the size of the myoma and alleviate symptoms, but this treatment is usually temporary and may have side effects 4, 5.
- The size of the myoma is an important factor in determining the best treatment option, with larger myomas potentially requiring more invasive procedures such as laparoscopic or abdominal myomectomy 2, 3.
Treatment Options
- Hysteroscopic myomectomy is a preferred treatment option for submucosal myomas, as it is a minimally invasive procedure that can be used to remove the myoma while preserving fertility 2, 3.
- Gonadotropin-releasing hormone agonist therapy may be used to reduce the size of the myoma and alleviate symptoms, but this treatment is usually temporary and may have side effects 4, 5.
- Uterine artery embolization and high-intensity focused ultrasound are other treatment options that may be considered for submucosal myomas, but these procedures are usually reserved for women who do not desire future fertility 2, 5.
Fertility Considerations
- Women who desire future fertility should be treated with myomectomy, which can be performed using a laparoscopic or hysteroscopic approach 2, 3.
- Gonadotropin-releasing hormone agonist therapy may be used to reduce the size of the myoma and alleviate symptoms, but this treatment is usually temporary and may have side effects, and may not be suitable for women who desire future fertility 4, 5.