Changing trends in treatment of leiomyomata uteri

The current literature reflects a trend toward alternatives to abdominal hysterectomy for the treatment of symptomatic leiomyomata uteri. Precision in diagnosis is aided by new techniques in ultrasound and magnetic resonance imaging. Gonadotropin-releasing hormone agonists reduce tumor and uterine bulk; relieve symptoms of bleeding and discomfort; are clearly useful as an adjunct to surgery; and in some patients may resolve symptoms, thus obviating the need for surgery, at least in the short-term. Repeated courses or long-term therapy with gonadotropin-releasing hormone agonists remain limited by the potential risks associated with long-term hypoestrogenemia. Myomectomy can be offered to symptomatic women desiring preservation of reproductive potential without incurring significant alteration in operative risk compared with hysterectomy and with a likelihood of subsequent conception exceeding 50%. Endoscopic removal of submucous or intracavitary leiomyomata is clearly technically feasible with acceptable risk by hysteroscopy and with good conception rates thereafter. Laparoscopic removal of intramural and subserosal leiomyomata uteri is also technically feasible with acceptable perioperative risk, but the need for removal of small tumors and the safety of subsequent pregnancy after removal of large intramural tumors has yet to be put into appropriate perspective.