Conservative treatment of fibroids

A subserosal uterine leiomyoma complicated with intra-abdominal haemorrhage: A case report

“…The fibroid parenchyma is typically hypovascular, and small centripetal vessels often supply the internal bulk of the fibroid compared to the arteries supplying the peripheral aspect of the fibroid which are usually larger than those supplying the normal myometrium [ 7 ]. Moreover, a significant portion of the uterine arterial supply is shunted towards uterine leiomyoma with venous drainage through dilated veins that cross the surface of the fibroid and enter the larger channels at the periphery of the myometrium [ 8 ]. These vascular abnormalities produce prominent and weak superficial blood vessels and are particularly associated with fibroids greater than 10 cm in diameter [ 7 ].…”

A practical approach to laparoscopic myomectomy for large uterine leiomyoma – a case report

“…6 According to Istre, GnRH agonists should not be routinely used prior to leiomyoma surgery and their use should be limited to cases where the size of the uterus is > 600 mL. 7 GnRH agonists such as leuprolide or goserelin are administered once every month for up to six months and can reduce leiomyoma size to 67.1% of baseline during standard treatment. 7,8 Notwithstanding the favourable effects of GnRH agonists, leiomyoma enucleation may be cumbersome as these agents induce hyaline degeneration, producing an ill-defined pseudocapsule that obscures surgical cleavage planes.…”