Management of leiomyomas in perimenopausal women.
Uterine leiomyomas, commonly called fibroids, are the leading indication for hysterectomy in the United States. Incidence increases with age from menarche to perimenopause. Regardless of their generally benign neoplastic character, uterine fibroids are responsible for significant morbidity in a large proportion of women of reproductive age. As uterine leiomyomas generally regress after menopause, the general attitude when women are approaching perimenopausal age is to avoid treatment and wait for menopause and a spontaneous resolution. When it is decided that treatment is needed, the choice for peri- and postmenopausal women is often hysterectomy. In the present paper we point out aspects of leiomyoma management that are unique to the perimenopausal period, and address future directions in care. We conclude that the management of uterine leiomyomas should not be overlooked in the perimenopausal period merely on the grounds that the pathology and symptoms are unlikely to persist after the menopause; on the other hand, opting for a quick resolution with total surgical removal of the uterus, as seen at present in many cases, should be avoided. Studies on the impact of therapy for fibroids should be performed not exclusively with premenopausal women but also with perimenopausal and postmenopausal women, both users and non-users of hormone replacement therapy.
Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, Via Tronto 10/a, 60020 Ancona, Italy; Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy. Electronic address: p.ciarmela@univpm.it.
Pasquapina
P
Ciarmela
Department of Clinical Science, Polytechnic University of Marche, Ancona, Italy.
Andrea
A
Ciavattini
Department of Clinical Science, Polytechnic University of Marche, Ancona, Italy.
Stefano R
SR
Giannubilo
Obstetrics and Gynecology Unit, Profili Hospital, Fabriano, Italy.
Pasquale
P
Lamanna
Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy.
Rosamaria
R
Fiorini
Department of Clinical Science, Polytechnic University of Marche, Ancona, Italy.
Andrea Luigi
AL
Tranquilli
Division of Reproductive Endocrinology and Infertility, University of Florida College of Medicine, Gainesville, FL, USA.
Gregory M
GM
Christman
Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, Via Tronto 10/a, 60020 Ancona, Italy.
Mario
M
Castellucci
D019468:Disease Management; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000628:therapy*; D047648:Perimenopause; D014594:Uterine Neoplasms / Q000628:therapy*; D014599:Uterus / Q000473:pathology* / Q000601:surgery; D014930:Women
Age; Leiomyoma; Menopause; Morbidity