Hysteroscopic myomectomy is increasingly recommended instead of hysterectomy for women with leiomyomas and menorrhagia, particularly those who wish to retain the uterus. In addition, hysteroscopic myomectomy is widely practiced when infertility is attributed to leiomyomas. Vercellini and colleagues studied the long-term effect of the procedure on menstrual patterns and fertility.
They studied more than 100 women who underwent hysteroscopic myomectomy at an Italian center between 1991 and 1997. The average age of the women was around 35 years, and 70 percent were nulliparous. For two thirds of the women, menorrhagia was the principal symptom. Infertility was the next most common indication for treatment. The most common type of leiomyoma resected was submucous pedunculated (54), followed by sessile (30) and intramural (24). In many women, more than one lesion or type of lesion was present. Only one woman had significant hemorrhage during the procedure, and all women were discharged from the hospital within 24 hours of surgery. Thirty-four women required more than one surgery to complete myoma removal.
Mean menstrual blood loss decreased significantly in women with all types of myomas following surgery, and hemoglobin increased significantly. During the follow-up period, the cumulative rate of myoma recurrence was 34 percent over three years. The type of myoma did not appear to influence the probability of recurrence. The three-year cumulative probability of recurrent menorrhagia was 30 percent and was not influenced by the type of myoma. Of the 40 women complaining of infertility, 15 achieved pregnancy during the follow-up period. The conception rates were 46 percent in women with pedunculated lesions, 33 percent in those with sessile myomas and 16 percent in women treated for intramural lesions.
The authors conclude that hysteroscopic myomectomy provides an effective and safe therapy for menorrhagia, with about a 30 percent rate of recurrence over a three-year period. Some infertile patients conceived following surgery, with rates between 16 and 46 percent, depending on the type of myoma resected. The authors recommend concomitant laparoscopic examination of infertile patients to detect any additional factors preventing conception or implantation.