Uterine fibroids: protocols of integrated medical/surgical treatment

Uterine fibroids are the most common solid pelvic tumor in women and in these last years their management has been deeply reviewed. An optimal integration of GnRH analogue treatment with different surgical techniques require an adequate work-up for the specific problems of each single patient. For a correct management of these patients, we divided them into 4 categories on the basis of symptoms and specific objectives to persuasive: a) perimenopausal patients; b) young patients, symptomatic or with large myomas, with no wish for more children; c) young patients, symptomatic or with large myomas, wishing to preserve fertility; d) infertile patients or patients with history of repeated miscarriages. Our suggested work-up is the following: a careful USGraphic evaluation of fibroid size and localization, a transvaginal doppler examination of the uterine blood supply, a complete haematochemical analysis, a hysteroscopy guided biopsy and a complete bone evaluation. On the basis of the above mentioned evaluations for each group we will use a different therapeutic approach in regard of either length of medical treatment (for tree to six months, for one or more cycles) or necessity of surgical treatment (with the possibility to get a natural menopausal), or different surgical techniques (operative hysteroscopy and/or laparoscopy, laparotomic myomectomy, vaginal or abdominal hysterectomy.