Hysteroscopic treatment of submucosal fibroids in perimenopausal women: when, why, and how?

Abstract

Uterine fibroids are a common finding in premenopausal women. They considerably reduce the quality of life by provoking abnormal uterine bleeding and consequent anemia and pelvic pain. Over the past 20 years, radical surgery (hysterectomy) for symptomatic fibroids has been partially replaced with minimally invasive surgical procedures that spare the uterus, with lower costs and reduced morbidity. Outpatient and inpatient operative hysteroscopy have been validated as safe and effective minimally invasive treatment options for both submucosal and intramural fibroids. In such a scenario, several technological innovations and the possibility of pharmacological pretreatment have enhanced the hysteroscopic approach. However, the counseling and treatment of perimenopausal women remain a challenge for the gynecologist. The main purpose of this review is to provide an updated guide to the management of submucosal fibroids in perimenopausal women, depicting how, when, and why hysteroscopic treatment is a valuable choice to eliminate symptoms and satisfy the patient’s wish to improve their overall quality of life.

摘要

子宫肌瘤是绝经前女性的常见症状。子宫肌瘤常引起异常子宫出血, 继而导致贫血和盆腔疼痛, 极大降低了女性的生活质量。在过去的20年里, 有症状的子宫肌瘤通常进行的根治性手术（子宫切除）已经部分被微创手术所取代, 微创手术成本低, 复发率低。门诊和住院宫腔镜手术已被证实为安全的有效的微创治疗黏膜下和肌壁间子宫肌瘤的选择, 在这种情况下, 一些技术性的创新和药物预处理增加了宫腔镜手术治疗途径。然而, 对围绝经期女性的咨询和治疗依然是妇科医生的一个挑战。本综述的主要目的是为围绝经期女性黏膜下子宫肌瘤的治疗提供一个更新的指南, 阐述宫腔镜如何治疗, 何时治疗以及为什么是一种有价值的选择, 以消除症状并满足患者改善其整体生活质量的愿望。

KEYWORDS:

• Hysteroscopy
• fibroids
• climacteric
• heavy menstrual bleeding
• quality of life

Potential conflict of interest

The authors declare no conflicts of interest.

Source of funding

None.