Conservative treatment of diffuse uterine leiomyomatosis

Objective: To describe the conservative treatment of diffuse uterine leiomyomatosis. Design: Descriptive study. Setting: Tertiary care centers. Patient(s): Three premenopausal women with diffuse uterine leiomyomatosis associated to persistent menorrhagia, two with desire of becoming pregnant and one with desire of preservation of the uterus. Intervention(s): Preoperative ultrasound showed symmetrically enlarged uteri with innumerable, poorly defined and small-sized (0.5-3 cm) myomas involving all the myometrium. An "extreme" myomectomy was performed in two cases, including the removal of a large portion of corporal myometrium. One patient was treated only medically with GnRH analogues (GnRH-a). Main Outcome Measure(s): Menstrual pattern and, when applicable, ability to conceive and pregnancy outcome. Result(s): Regular menses were restored in both patients who underwent surgery: one had no pregnancy desire and the other was not able to conceive after two IVF-ETs. The patient treated with GnRH-a conceived spontaneously as soon as medical treatment was discontinued; at 34 gestational weeks, an emergency cesarean section followed by hysterectomy was performed for vaginal bleeding and a healthy 2,400-g baby was born. Conclusion(s): Our experience supports the idea that a conservative approach to uterine leiomyomatosis may result in restoration of normal cycles and eventually in the birth of a viable fetus. (Fertil Steril((R)) 2004;82: 450-3. (C) 2004 by American Society for Reproductive Medicine.).