Overview
Uterine myomas, also known as fibroids, are benign tumors originating from smooth muscle cells in the uterine wall, commonly affecting women of reproductive age and potentially causing symptoms such as abnormal uterine bleeding, pelvic pain, and reproductive issues 1.Diagnosis
Ultrasound: Essential for initial diagnosis, assessing size, number, and location of myomas 1.
Grading: Classification based on location (submucosal, intramural, subserosal) and size 1.
Hysteroscopy: Used for confirmation, particularly for submucosal myomas 1.Management
Surgical: Hysteroscopic resection for submucosal myomas 1.
Medical Therapy:
- Gonadotropin-releasing hormone (GnRH) agonists: For symptom relief, often used preoperatively 1.
- Antifibrinolytics: For managing heavy menstrual bleeding (e.g., tranexamic acid) 1.
Observation: For asymptomatic or minimally symptomatic myomas 1.Special Populations
Pregnancy: Management strategies vary; surgical intervention may be considered based on symptom severity and myoma type 1.
Elderly: Focus on symptom management; surgical options may be less favorable due to comorbidities 1.Key Recommendations
Utilize pelvic ultrasound adhering to CNGOF guidelines for accurate diagnosis and reporting of uterine myomas (Evidence: Moderate) 1.
Consider hysteroscopic resection for symptomatic submucosal myomas to alleviate symptoms effectively (Evidence: Moderate) 1.
Employ GnRH agonists preoperatively for symptom control in women with significant symptoms prior to surgical intervention (Evidence: Moderate) 1.References
1 Perrot D, Fernandez H, Levaillant JM, Capmas P. Quality assessment of pelvic ultrasound for uterine myoma according to the CNGOF guidelines. Journal of gynecology obstetrics and human reproduction 2017. link