Dr. Rahul Manchanda
Dr. Pratibha Garg
Fibroids are generally seen in women over 35; about 25% are suffered from it in their reproductive age. Submucosal fibroids are seen in 5 – 10 %, symptoms like menorrahgia (heavy bleeding), severe dysmenorrhea (painfull menses) and infertility may lead you to see your gynecologist.
This is a case report of a 32 year old woman who presented with severe dysmenorrhea, menorrahgia and infertility. On investigation she was found to have fibroids on ultrasound. She underwent incomplete hysteroscopic myomectomy in Nov 2010. She was referred to us for further management.
Her preop ultrasound showed two subserosal and one submucous fibroid of size 21x 21×17 mm. On hysteroscopy a submucous fibroid of size 30×30 mm was seen on the posterior wall. Adhesions were seen between anterior wall and fibroid due to previous intervention.
Adhesions were removed with sharp and blunt dissection. Fibroid was resected with resectoscope.
Left lateral wall showing mild grade of adhesions, restricting the uterine cavity. These were removed with Colin’s knife. Complete resection of fibroid along with left lateral wall metroplasty was done.
She has been advised repeat hysteroscopy after her next period and has been put on sequential hormonal therapy till then.
Hysteroscopic myomectomy is a valuable technique for the treatment of submucous fibroids. Long term results shown high satisfaction rates with improved menstrual symptoms and pregnancy rates. It is highly effective, minimally invasive technique but it is still underutilized.