A 29yrs old nulliparous woman complains of severe menorrhagia and lower abdominal pain since 3months .On examination there was a 14 weeks size uterus with fundal fibroid .The treatment of choice is
Routes of myomectomy : Abdominal myomectomy Vaginal myomectomy: Done in case of submucosal pedunculated fibroid Hysteroscopic myomectomy: Submucosal fibroid which cannot be removed by simple vaginal route can be removed with the help of hysteroscope use when myoma <5 cms in size Laproscopic myomectomy: Indicated for pedunculated subserosal fibroids <10 cms in size Intramural fibroids can also be removed by laproscopy but it is very time consuming Myolysis or myoma coagulation using lazer: In this procedure lasers are used to drill holes into substance of intramural myoma As the patient is having severe menorrhagia and chronic abdominal pain These indications are strong enough for surgical intervention .earlier size of fibroid >12 weeks was also an indication of surgery Indications of myomectomy Myomectomy is specifically indicated in an infeile woman or woman desirous of bearing child ,uterus should be retained Ref Shaw 16/e pg 395
Myomectomy
GnRH analogues
Hysterectomy
Observation
Anatomy of the female genital tract