Modern possibilities of organ-sparing treatment of uterine fibroid

Clinical case

Abstract

Uterine fibroid is a benign tumor originating from myometrial cells, which due to the various exogenous and endogenous factors has the potential for rapid multi-localized growth, progression of clinical symptoms, and impact on the physical and mental health of women, leading to deterioration in their quality of life. It often impedes reproductive function, causing infertility and pregnancy loss.
Despite the availability and variety of conservative treatment methods, hysterectomy remains the treatment of choice for large uterine fibroids, which permanently deprives women of the possibility of childbearing.
This article presents a clinical case of successful organ-preserving treatment of a woman with a giant uterine fibroid.
A combined three-stage treatment was applied. Stage I – inducing medical menopause by administering a gonadotropin-releasing hormone agonist (goserelin 10.8 mg subcutaneously); stage II – uterine artery embolization during medical menopause; stage III – laparotomic conservative myomectomy with simultaneous abdominoplasty. One month after administering goserelin 10.8 mg, during medical menopause, the uterine volume reduced from 3257 to 2798 cm³ (a 14% decrease), and the fibroid volume from 1362 to 1065 cm³ (a 21.8% decrease). After uterine artery embolization, the uterine and fibroid volumes continued to decrease to 2424 cm³ (a 25% reduction) and 876 cm³ (a 35% reduction), respectively.
One month after uterine artery embolization, laparotomic myomectomy with abdominoplasty was performed. Following the surgery, the uterine volume decreased to 782 cm³ (a 76% reduction from the initial volume), and two months post-surgery, the uterus decreased to 58 cm³, reflecting a 98.2% reduction from the initial volume. During the postoperative rehabilitation period, to prevent abnormal uterine bleeding, recurrence of uterine fibroids, and to ensure effective contraception, the levonorgestrel-releasing intrauterine system was placed.
Conclusions. Organ-preserving conservative methods offer a safe and accessible treatment option for women with uterine fibroids who have not yet fulfilled their reproductive plans. The described combination of methods makes it possible to preserve the uterus and realize the reproductive function.