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Letter to the Editor| Volume 58, ISSUE 4, P406-407, December 20, 2007

Rationale of myomectomy for perimenopausal women

  • Peng-Hui Wang
    Correspondence
    Corresponding author at: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan. Fax: +886 2 2873 4101.
    Affiliations
    Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan

    Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Hsiang-Tai Chao
    Affiliations
    Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan

    Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Wen-Ling Lee
    Affiliations
    Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Division of Endocrinology and Metabolism, Department of Medicine, Cheng Hsin Rehabilitation Center-Taipei, Taiwan
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      We were interested to read the report by Gavai et al., entitled “Can myomectomy be suggested for perimenopausal women before administering hormone replacement therapy” [
      • Gavai M.
      • Berkes E.
      • Takacs Z.F.
      • Papp Z.
      Can myomectomy be suggested for perimenopausal women before administering hormone replacement therapy?.
      ]. Uterine myomas represent the most common tumor of the female reproductive system, and are also the most common indication for hysterectomy [

      Lee WL, Yuan CC, Wang PH. Positron emission tomography and uterine leiomyomas. Gynecol Oncol; in press, doi:10.1016/j.ygyno.2007.08.005.

      ]. For women who wish to retain childbearing potential, an organ-preserving strategy, including myomectomy, uterine artery ligation or embolization, focus ultrasound surgery, and so on, has been the preferred treatment [
      • Liu W.M.
      • Wang P.H.
      • Chou C.S.
      • Tang W.L.
      • Wang I.T.
      • Tzeng C.R.
      Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas.
      ]. Besides surgical intervention, the medical approach is also used to relieve and control symptoms, although the effect is often transient [
      • Lee W.L.
      • Liu R.S.
      • Yuan C.C.
      • Chao H.T.
      • Wang P.H.
      Relationship between gonadotropin-releasing hormone agonist and myoma cellular activity: preliminary findings on positron emission tomography.
      ], and symptoms and tumor often recur after stopping medication [
      • Chia C.C.
      • Huang S.C.
      • Chen S.S.
      • Kang J.Y.
      • Lin J.C.
      • Lin Y.S.
      • et al.
      Ultrasonographic evaluation of the change in uterine fibroids induced by treatment with a GnRH analog.
      ]. We completely agree with the authors’ comment that in women who have completed childbearing, hysterectomy might be considered the treatment of choice, and psychologically, the uterus has been regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness [
      • Gavai M.
      • Berkes E.
      • Takacs Z.F.
      • Papp Z.
      Can myomectomy be suggested for perimenopausal women before administering hormone replacement therapy?.
      ]. However, we have some concern about the authors’ conclusion that abdominal myomectomy may be a satisfactory option for perimenopausal women with symptomatic fibroids who wish to retain their uterus and use hormone replacement therapy (HRT). Since the patients have a strong desire to retain their uterus and they are situated at perimenopausal, which means that the expected time to menopausal status of these women might be less than 2 years, why did the authors not consider the use of drugs, such as gonadotropin releasing hormone (GnRH) agonist, to lead to a natural menopause? The postoperative sequela after myomectomy, including pelvic adhesion, future uterine deformities, intrauterine adhesions, and reduced uterine capacity, should be kept in mind. Imai et al. reported on the treatment of perimenopausal women with uterine myoma: successful use of a depot GnRH agonist (leuprorelin acetate) leading to a natural menopause had a wonderful success rate (more than 90%) because they successfully induced a natural menopause in 19 of 21 individuals [
      • Imai A.
      • Sugiyama M.
      • Furui T.
      • Tamaya T.
      Treatment of perimenopausal women with uterine myoma: successful use of a depot GnRH agonist leading to a natural menopause.
      ]. In their report, they also found that the rise in early follicular phase serum gonadotropins, in particular follicular stimulating hormone >25 mIU/ml, may precede the natural menopause following (or during) GnRH agonist therapy in older women. It is not clear from Gavai et al.'s study how long after surgery the women had menopause. Did the authors check the hormone profile of these women? We hope to see further discussion and suggestions on this issue.
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      References

        • Gavai M.
        • Berkes E.
        • Takacs Z.F.
        • Papp Z.
        Can myomectomy be suggested for perimenopausal women before administering hormone replacement therapy?.
        Maturitas. 2007; 58: 107-110
      1. Lee WL, Yuan CC, Wang PH. Positron emission tomography and uterine leiomyomas. Gynecol Oncol; in press, doi:10.1016/j.ygyno.2007.08.005.

        • Liu W.M.
        • Wang P.H.
        • Chou C.S.
        • Tang W.L.
        • Wang I.T.
        • Tzeng C.R.
        Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas.
        Fertil Steril. 2007; 87: 356-361
        • Lee W.L.
        • Liu R.S.
        • Yuan C.C.
        • Chao H.T.
        • Wang P.H.
        Relationship between gonadotropin-releasing hormone agonist and myoma cellular activity: preliminary findings on positron emission tomography.
        Fertil Steril. 2001; 75: 638-639
        • Chia C.C.
        • Huang S.C.
        • Chen S.S.
        • Kang J.Y.
        • Lin J.C.
        • Lin Y.S.
        • et al.
        Ultrasonographic evaluation of the change in uterine fibroids induced by treatment with a GnRH analog.
        Taiwan J Obstet Gynecol. 2006; 45: 124-128
        • Imai A.
        • Sugiyama M.
        • Furui T.
        • Tamaya T.
        Treatment of perimenopausal women with uterine myoma: successful use of a depot GnRH agonist leading to a natural menopause.
        J Obstet Gynaecol. 2003; 23: 518-520