The destiny of myomas: should we treat small submucous myomas in women of reproductive age?
Received 12 July 2007; received in revised form 7 September 2007; accepted 7 September 2007. published online 03 January 2008.
Objective
To carry out a thorough analysis aimed at demonstrating that a “wait-and-see” approach is no longer acceptable in women of reproductive age with small submucous myomas, even if they are asymptomatic.
Design
Review article.
Setting
University hospitals.
Patient(s)
Women of reproductive age with small (<1.5 cm) submucous myomas.
Intervention(s)
“See-and-treat” hysteroscopy performed in an outpatient setting.
Main Outcome Measures(s)
a) The real endometrial surface and volume occupied by a submucous myoma; b) the high potential of a small myoma to grow during the reproductive age; c) its negative impact on reproduction through normal or assisted conception; d) the inability to perform a reliable and “safe” diagnosis, with respect to malignancy, without an eye-guided biopsy; and e) the effectiveness of “see-and-treat” hysteroscopy in removing small submucous myomas.
Result(s)
Small myomas, as hormone-dependent benign tumors, have a high potential to grow and either to become symptomatic or to cause complications during natural or assisted conception and pregnancy. Furthermore, not withstanding the risk of malignancy is rare, even the most experienced operator cannot replace the histological analysis to exclude malignancy or premalignant lesions. “See-and-treat” hysteroscopy has been demonstrated to be safe and effective in removing such small submucous myomas.
Conclusion(s)
A “wait-and-see” approach is no longer acceptable in women of reproductive age with small submucous myomas, especially if the lesion could be easily and safely removed in an outpatient setting with minimal patient's discomfort.
aDepartment of Obstetrics, Gynecology and Neonatology, II Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy
bThird Department of Obstetrics and Gynecology, “Attikon” Hospital, University of Athens, Greece
cDepartment of Obstetrics and Gynecology, University of Naples “Federico II”, Naples, Italy
dDepartment of Surgical Sciences, Unit of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
Reprint requests: Attilio Di Spiezio Sardo, Department of Gynecology and Obstetrics and Department of Pathophysiology of Human Reproduction, University of Naples “Federico II,” Via Pansini 5, 80131 Naples, Italy (FAX: 390817462905).
ABSTRACT