Vaginal Expulsion of a Submucosal Myoma During Treatment with Long-Acting Gonadotropin-Releasing Hormone Agonist

Abstract

Objective: Gonadotropin-releasing hormone agonist (GnRH agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma. Case Report: A 26-year-old woman without sexual exposure was diagnosed with a submucosal myoma and treated with long-acting GnRH agonist. This patient exhibited heavy menstruation and severe anemia for 2 years and consulted our outpatient department. Transabdominal ultrasound demonstrated a 3.5-cm submucosal myoma within the endometrial cavity. The patient showed a marked suppression of serum estradiol concentrations throughout the treatment (< 20 pg/mL at the second dose injection). The volume of the uterus and uterine myoma decreased to two-thirds of the original size at the end of the second dose injection. However, a sudden onset of severe abdominal cramping pain occurred on the 76th day and a ping-pong sized mass was expelled from the vagina. She visited our outpatient department for evaluation, where ultrasound failed to detect the previous submucosal uterine myoma. A 3-year follow-up has been uneventful. Conclusion: Spontaneous expulsion of submucosal myomas might occur after the administration of GnRH agonist; hence, it may be an acceptable alternative for symptomatic females without sexual exposure.

Keywords

• gonadotropin-releasing hormone agonist
• spontaneous expulsion submucosal myoma