Clinical findings ascribed to leiomyomas:
(1) abnormal uterine bleeding
(2) pelvic pain and/or pressure
(3) lower urinary tract symptoms and urgency
(4) infertility
(5) spontaneous abortion
(6) preterm labor
Presence of problems caused by leiomyomas: 1 or more of the following:
(1) asymptomatic leiomyomas that are large enough to be palpable abdominally and that are of concern to the patient
(2) excessive uterine bleeding with either
(2a) anemia due to acute or chronic blood loss
(2b) profuse bleeding with flooding or clots or repetitive periods lasting more than 8 days
(3) pelvic discomfort due to the leiomyomas (one or more of the following)
(3a) acute and severe
(3b) chronic lower abdominal pressure
(3c) chronic low back pain
(3d) bladder pressure with urinary frequency not due to urinary tract infection
Contraindications:
(1) desire to maintain fertility
(2) asymptomatic leiomyomas < 12 weeks of gestation in size
Actions prior to performing hysterectomy:
(1) exclude cervical malignancy
(2) if abnormal uterine bleeding is present, exclude endometrial malignancy
(3) if abnormal uterine bleeding is present, eliminate anovulation and other treatable causes of abnormal bleeding
(4) assess surgical risk related to anemia if present
(5) assess medical risks for surgery
(6) assess psychological risk for surgery
Alternative therapies:
(1) myomectomy, especially if maintenance of fertility is desired
(2) gonadotrophin releasing hormone agonists (GnRH)
(3) NSAIDS for pain
(4) oral contraceptives
