Intramural myomas: to treat or not to treat

Abstract

A debate among gynecologic and reproductive surgeons is whether or not there is a clinical need to treat all intramural myomas. Considerations include myoma size and number, ability to access them, whether or not they compromise the endometrium, and treatment effect on gynecologic, reproductive, and obstetric outcomes. We conducted a detailed study regarding intramural myomas, their prevalence in subject populations, the imaging methods used to detect them, their growth rate, their suspected adverse effects on gynecologic, fertility, and obstetric outcomes, and the effectiveness of various treatment methods. The growing body of evidence reported in the literature supports the need to manage intramural myomas and to treat them appropriately.

Keywords: intramural myomas; magnetic resonance-guided focused ultrasound; myoma therapies; myomectomy; radiofrequency volumetric thermal ablation; uterine artery embolization.

Figure 1

FIGO leiomyoma subclassification system. Note: Reprinted from Int J Gynaecol Obstet. Vol 113(1). Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Pages 3–13. Copyright 2011, with permission from Elsevier. Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.