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.