title: Vaginal expulsion of a submucosal myoma during treatment with long-acting gonadotropin-releasing hormone agonist.
abstract: OBJECTIVE
  Gonadotropin-releasing hormone agonist (GnRH agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma.
  
  
  METHODS
  A 26-year-old woman without sexual exposure was diagnosed with a submucosal myoma and treated with long-acting GnRH agonist. This patient exhibited heavy menstruation and severe anemia for 2 years and consulted our outpatient department. Transabdominal ultrasound demonstrated a 3.5-cm submucosal myoma within the endometrial cavity. The patient showed a marked suppression of serum estradiol concentrations throughout the treatment (< 20 pg/mL at the second dose injection). The volume of the uterus and uterine myoma decreased to two-thirds of the original size at the end of the second dose injection. However, a sudden onset of severe abdominal cramping pain occurred on the 76th day and a ping-pong sized mass was expelled from the vagina. She visited our outpatient department for evaluation, where ultrasound failed to detect the previous submucosal uterine myoma. A 3-year follow-up has been uneventful.
  
  
  CONCLUSIONS
  Spontaneous expulsion of submucosal myomas might occur after the administration of GnRH agonist; hence, it may be an acceptable alternative for symptomatic females without sexual exposure.
authors.affiliation: Department of Obstetrics and Gynecology, Cardinal Tien Hospital-Hsintien, Taiwan.
authors.forename: Lily
authors.initials: L
authors.lastname: Wen
authors.forename: Jen-Yu
authors.initials: JY
authors.lastname: Tseng
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D000328:Adult; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy*; D014621:Vagina
chemical_list: D007987:Gonadotropin-Releasing Hormone