Successful pregnancies in women with diffuse uterine leiomyomatosis after hysteroscopic management

Objective: To describe the surgical and reproductive outcomes of early diffuse uterine leiomyomatosis with hysteroscopic myomectomy. Design: Retrospective report. Setting: University hospital. Patient(s): Five consecutive women of reproductive age with innumerable small-sized (0.5-3 cm) diffuse uterine myomas with profuse menorrhagia. Intervention(s): Use of hysteroscopic myomectomy to excise only myomas impinging into the endometrial cavity, while leaving other intramural myomas in place. Main Outcome Measure(s): Postoperative synechiae, recurrence, menstrual amount, conception, and pregnancy outcome. Result(s): A total of 10 hysteroscopic surgeries were performed, among which 1 patient had repeated adhesiolysis for postoperative synechiae, 2 experienced repeated myomectomy because of submucosal myoma recurrence, and 1 underwent a scheduled two-step procedure with gonadotropin-releasing hormone analogue treatment in between. The uterus was successfully preserved and a normal amount of menstruation was restored in all (5/5) patients. All (3/3) patients who wished to conceive had successful conceptions, with four healthy deliveries. Conclusion(s): Women with early-stage diffuse uterine leiomyomatosis can be treated by hysteroscopic resection, which has the benefits of preserving the uterus successfully, conceding a limited recurrence rate, and yielding satisfactory reproductive outcomes.