Figure II-4-10. Saline Ultrasonography Demonstrating an Intracavitary
LeiomyomaManagement. Most leiomyomas can be managed conservatively and followed
expectantly with regular pelvic examinations.
Presurgical shrinkage: After 3–6 months of GnRH analog therapy, with
resultant hypoestrogenic state, a 60–70% reduction in size of the fibroids can
be expected. However, once the leuprolide (Lupron) is terminated, there will
be a regrowth of the fibroid within 6 months. Thus, GnRH analogs cannot be
used for definitive cure, but they can be used in the adjuvant setting with
surgical therapy. If a myomectomy is done, a decrease in size will be
associated with a decrease in blood loss, and if a hysterectomy is planned,
then perhaps a vaginal instead of an abdominal hysterectomy can be