Submucosal Fibroid, Menorrhagia, Anemia, and Dysmenorrhea

  • Christina Salazar
  • Keith IsaacsonEmail author


The clinical case of a 32-year-old nulliparous female with heavy abnormal uterine bleeding, anemia, and dysmenorrhea, and a 4 cm submucosal fibroid is presented. The key clinical components are reviewed regarding classical presentation of heavy prolonged bleeding with associated painful cramping, as well as examination findings and diagnostic workup. Consideration of the differential diagnosis of leiomyoma, adenomyoma, focal adenomyosis, and leiomyosarcoma is reviewed. The approach to management of uterine fibroids including medications, surgery, or minimally invasive embolization or ablative techniques is reviewed. Surgical treatment with transcervical resection of submucous leiomyoma is discussed in detail.


Submucous fibroid Hysteroscopy Resectoscope Abnormal uterine bleeding Dysmenorrhea 

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  1. 1.
    van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114(6):664–75.CrossRefPubMedGoogle Scholar
  2. 2.
    Committee on Practice B-G. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206.CrossRefGoogle Scholar
  3. 3.
    Alabiso G, Alio L, Arena S, Barbasetti di Prun A, Bergamini V, Berlanda N, et al. Adenomyosis: what the patient needs. J Minim Invasive Gynecol. 2016;23(4):476–88.CrossRefPubMedGoogle Scholar
  4. 4.
    Vilos GA, Edris F, Abu-Rafea B, Hollett-Caines J, Ettler HC, Al-Mubarak A. Miscellaneous uterine malignant neoplasms detected during hysteroscopic surgery. J Minim Invasive Gynecol. 2009;16(3):318–25.CrossRefPubMedGoogle Scholar
  5. 5.
    American Association of Gynecologic Laparoscopists: Advancing Minimally Invasive Gynecology W. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol. 2012;19(2):152–71.CrossRefGoogle Scholar
  6. 6.
    Zupi E, Centini G, Sabbioni L, Lazzeri L, Argay IM, Petraglia F. Nonsurgical alternatives for uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2016;34:122–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B. Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology. 2010;255(3):834–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008;31(1):73–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Clark NA, Mumford SL, Segars JH. Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence. Curr Opin Obstet Gynecol. 2014;26(3):151–61.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Jacoby VL, Kohi MP, Poder L, Jacoby A, Lager J, Schembri M, et al. PROMISe trial: a pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids. Fertil Steril. 2016;105(3):773–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Kramer B, Hahn M, Taran FA, Kraemer D, Isaacson KB, Brucker SY. Interim analysis of a randomized controlled trial comparing laparoscopic radiofrequency volumetric thermal ablation of uterine fibroids with laparoscopic myomectomy. Int J Gynaecol Obstet. 2016;133(2):206–11.CrossRefPubMedGoogle Scholar
  13. 13.
    Worldwide AAMIG, Munro MG, Storz K, Abbott JA, Falcone T, Jacobs VR, et al. AAGL practice report: practice guidelines for the Management of Hysteroscopic Distending Media: (Replaces Hysteroscopic fluid monitoring guidelines. J Am Assoc Gynecol Laparosc. 2000;7:167–168). J Minim Invasive Gynecol. 2013;20(2):137–48.CrossRefGoogle Scholar
  14. 14.
    Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. 1992;117(11):891–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Muzii L, Boni T, Bellati F, Marana R, Ruggiero A, Zullo MA, et al. GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study. Fertil Steril. 2010;94(4):1496–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Corson SL, Brooks PG, Serden SP, Batzer FR, Gocial B. Effects of vasopressin administration during hysteroscopic surgery. J Reprod Med. 1994;39(6):419–23.PubMedGoogle Scholar
  17. 17.
    Polena V, Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S. Long-term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol. 2007;130(2):232–7.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Minimally Invasive Gynecologic SurgeryNewton Wellesley Hospital, Harvard Medical SchoolNewtonUSA

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