Uterine
myoma is a common benign tumour in women and most cases do not require treatment. Excessive
uterine bleeding is usually due to a submucous
myoma or an intramural
myoma that is encroaching into the uterine cavity. After eliminating endometrial
malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing
hormone agonist until menopause. Hysteroscopic
myomectomy is highly effective in controlling
menorrhagia that is related to submucous
myoma. Concomitant
endometrial ablation improves
menorrhagia; however, the subsequent
hysterectomy rate remains the same. For those with an intramural
myoma, abdominal
myomectomy results in good
bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family,
hysterectomy remains the most effective treatment for excessive
uterine bleeding. Compared with
uterine artery embolization (UAE), it is associated with better improvement in
pelvic pain. Nevertheless, UAE is a good alternative to
hysterectomy.