EpistemisSymptomatic submucosal myoma
Specialty: Gynecology and breast.
Why it occurs
- Benign tumor of smooth muscle cells of the myometrium that proliferates towards the endometrial cavity, altering the vascularization of the overlying mucosa and limiting normal myometrial contractility during menstruation
Initial workup
Detailed transvaginal gynecological ultrasound (submucosal fibroids are visualized as well-defined round intracavitary hypoechoic masses). Sonohysterography (vaginal instillation of saline solution during ultrasound, which precisely delimits the percentage of myoma protruding into the cavity, ESGE classification: G0, G1, G2). Diagnostic hysteroscopy (gold standard that allows the mass to be directly visualized and resection planned).
red flags
Acute massive uterine hemorrhage with giant clots that causes hemodynamic instability (shock, hypotension, tachycardia) and requires emergency admission, rapidly evolving severe iron deficiency anemia, unbearable acute colicky pelvic pain with a sensation of uterine straining (myoma born or delivered through the cervical canal), fever or foul-smelling purulent discharge due to necrosis of the prolapsed myoma.
Standard management
- Tranexamic acid 1000-1500 mg orally every 8 hours for a maximum of 4 days during bleeding attacks
- Ulipristal acetate 5 mg per day orally for 3 months as a preoperative treatment to reduce the size of the fibroid and control bleeding — note: under strict control of liver profile due to risk of severe liver toxicity
- Selective progesterone receptor modulators or GnRH analogues (triptorelin 3.75 mg IM monthly) to induce temporary preoperative amenorrhea and correct anemia. The definitive treatment of symptomatic submucosal myoma type G0 or G1 is myomectomy by surgical hysteroscopy.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 1
- Treatment options
- 3