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Case 41 - A 34-Year-Old G2P2 Woman with a 4 cm Type 1 Submucosal Myoma Undergoing a Hysteroscopic Myomectomy

Published online by Cambridge University Press:  19 November 2021

Todd R. Jenkins
Affiliation:
University of Alabama, Birmingham
Lisa Keder
Affiliation:
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Affiliation:
Mayo Clinic, Rochester
Kimberly S. Gecsi
Affiliation:
Medical College of Wisconsin
David Chelmow
Affiliation:
Virginia Commonwealth University School of Medicine
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Summary

A 34-year-old gravida 2, para 2 woman presents to the gynecology clinic for increasingly heavy menstrual bleeding over the past year. Periods occur every 28–29 days and are predictable. Bleeding lasts for seven days with the heaviest bleeding occurring on days 2 and 3. On those days, she uses super tampons and maxi pads, changing them every 2 hours, and at night is using night-time pads. She has to leave long meetings at work to change protection and has menstrual accidents. She passes large clots and describes “gushing” type bleeding when on the toilet. She has tried non-steroidal anti-inflammatory drugs and tranexamic acid for bleeding with only slight improvement in heaviness; oral contraceptive pills have not worked in the past and she is not using them now. She has no relevant past medical or surgical history and denies any drug allergy.

Type
Chapter
Information
Surgical Gynecology
A Case-Based Approach
, pp. 125 - 127
Publisher: Cambridge University Press
Print publication year: 2021

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References

Munro, MG, Critchley, HOD, Fraser, IS; FIGO Menstrual Disrders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet 2018; 143(3): 393408.CrossRefGoogle ScholarPubMed
Puri, K, Famuyide, AO, Erwin, PJ, Stewart, EA, Laughlin-Tommaso, SK. Submucosal fibroids and the relation to heavy menstrual bleeding and anemia. Am J Obstet Gynecol 2014; 210(1): 38.e17.CrossRefGoogle ScholarPubMed
Stewart, EA, Nicholson, WK, Bradley, L, Borah, BJ. The burden of uterine fibroids for African-American women: results of a national survey. J Womens Health (Larchmt) 2013; 22(10): 807–16.CrossRefGoogle ScholarPubMed
Friedman, JA, Wong, JMK, Chaudhari, A, Tsai, S, Milad, MP. Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding. Curr Opin Obstet Gynecol 2018; 30(4): 243–51.CrossRefGoogle ScholarPubMed
AAGL Advancing Minimally Invasive Gynecology Worldwide, Munro, MG, Storz, K, 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; 7:167–8.). J Minim Invasive Gynecol 2013; 20(2): 137–48.Google ScholarPubMed
Laughlin-Tommaso, SK, Lu, D, Thomas, L, et al. Short-term quality of life after myomectomy for uterine fibroids from the COMPARE-UF Fibroid Registry. Am J Obstet Gynecol 2020; 222(4): 345.e122.CrossRefGoogle ScholarPubMed

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