HYSTEROSCOPIC MYOMECTOMY

Hysteroscopic myomectomy seems to be the treatment of choice in patients with submucous fibroids and menorrhagia. The present study evaluates the efficacy of hysteroscopic myomectomy for the treatment of symptomatic patients with submucous myomas, and the advantages of preoperative medical treatment. Seventeen women with symptomatic uterine myomas underwent hysteroscopic myomectomy. All had menorrhagia of 6-18 months' duration and severe anaemia. All received leuprolide depot 3.75 mg every 28 days for 2-3 months before surgery. Hysteroscopic follow-up was scheduled after 2 months. The operation was performed easily in all cases. At follow-up the uterine cavity was found to be normal in 14 cases; in the remaining three the myomectomy was completed during a second hysteroscopy. Regular menstrual cycles resumed within 32-63 days; 1 year later two patients reported recurrent symptoms requiring intervention. Gonadotrophin-releasing hormone (GnRH)-agonist therapy was effective in decreasing the size and vascularity of myomas. GnRH-agonist administration reduced the risk of fluid overload, and allowed the myoma to be easily separated from and dissected off the surrounding myometrium. Haemoglobin and haematocrit normalized within 3 months of GnRH-agonist administration. Thus, hysteroscopic myomectomy is effective as treatment for menorrhagia, is less invasive than alternatives and allows a shorter hospitalization.