Characteristics of Submucous Myomas and the Risk of Anemia

Abstract

Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas >60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 >10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if > of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.

Keywords: anemia; hemoglobin; metrorrhagia; myoma grade; myomas.

Figure 1

The regression tree depicting the relation between anemia and its statistically significant predictors, i.e., grade and menorrhagia/metrorrhagia. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia/metrorrhagia. In the patients with myomas type 1–2, the possibility of having anemia varies according to the presence or absence of menorrhagia: in the former case, the possibility is estimated at 54%, while in the latter case, the possibility decreases to 24%.

Figure 2

ESGE classification of submucous myomas. They classified the submucous myomas into three groups according to their protruding %: <50%, 50–79%, and >80%. From: (https://elearning.rcog.org.uk//uterine-cavity-surgery/hysteroscopic-myomectomy/classification-submucous, accessed on 30 August 2022).