Evaluation of the effectiveness of hysteroscopic myomectomy in the symptoms of women with uterine myomatosis: a retrospective cohort

Abstract

OBJECTIVE: The aim of this study was to evaluate the effectiveness of hysteroscopic myomectomy in the symptoms of women with uterine myomatosis. METHODS: This is a retrospective cohort study conducted on 119 women with uterine myomatosis who underwent hysteroscopic myomectomy in a tertiary hospital from 2018 to 2023. Women of reproductive age diagnosed with submucosal myoma who underwent hysteroscopic myomectomy were included, and women who did not have the data in their medical records necessary for completion were excluded. The sociodemographic and clinical variables of these women were evaluated. RESULTS: The average age of the women was 41.4±6.8 years. Among the fibroids, 37.0% were International Federation of Gynecology and Obstetrics (FIGO) 0 and 52.5% were FIGO 1. The average size of the fibroids was 2.7±1.4 cm. There were 10.0% of complications. After myomectomy, 67.2% of the women had improvement in symptoms, 66.1% opted for hormonal treatment, and 14.3% underwent hysterectomy. Ninety percent of the women who did not show improvement in symptoms had FIGO 1 and FIGO 2 fibroids (p=0.002), and 57% had a higher number of cesarean sections (p=0.038). In addition, 61% of these women required a new approach (p<0.001), and 93% opted for treatment after myomectomy (p<0.001). Factors associated with a greater chance of women’s symptoms not improving were having more than two cesarean sections (hazard ratio [HR]=3.52, p=0.026), FIGO 1 fibroids (HR=5.75, p=0.003), and FIGO 2–3 fibroids (HR=8.25, p=0.030). CONCLUSION: Hysteroscopic myomectomy has a low complication rate, and having fibroids with a larger intramural component is the main factor responsible for myomectomy failure.