Conservative treatment of diffuse uterine leiomyomatosis.
OBJECTIVE
To describe the conservative treatment of diffuse uterine leiomyomatosis.


METHODS
Descriptive study.


METHODS
Tertiary care centers.


METHODS
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.


METHODS
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).


METHODS
Menstrual pattern and, when applicable, ability to conceive and pregnancy outcome.


RESULTS
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.


CONCLUSIONS
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.
Clinica Ostetrico-Ginecologica dell'Università di Milano, Ospedale San Paolo, Via Di Rudini no. 8, 20142 Milan, Italy. luigi.fedele@unimi.it
Luigi
L
Fedele
Stefano
S
Bianchi
Giovanni
G
Zanconato
Silvestro
S
Carinelli
Nicola
N
Berlanda
D000328:Adult; D002064:Buserelin / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery / Q000628:therapy*; D008595:Menorrhagia / Q000209:etiology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery / Q000628:therapy*; D014594:Uterine Neoplasms / Q000601:surgery / Q000628:therapy*
D007987:Gonadotropin-Releasing Hormone; D002064:Buserelin