{"paper_id":"7ca6cbdb-6e51-441f-a000-78cb0033d060","body_text":"Abstract\nThe clinical case of a 32-year-old nulliparous female with heavy abnormal uterine bleeding, anemia, and dysmenorrhea , and a 4 cm submucosal fibroid is presented. The key clinical components are reviewed regarding classical presentation of heavy prolonged bleeding with associated painful cramping, as well as examination findings and diagnostic workup. Consideration of the differential diagnosis of leiomyoma, adenomyoma, focal adenomyosis, and leiomyosarcoma is reviewed. The approach to management of uterine fibroids including medications, surgery, or minimally invasive embolization or ablative techniques is reviewed. Surgical treatment with transcervical resection of submucous leiomyoma is discussed in detail.\nSimilar content being viewed by others\nReferences\nvan Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114(6):664–75.\nCommittee on Practice B-G. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206.\nAlabiso G, Alio L, Arena S, Barbasetti di Prun A, Bergamini V, Berlanda N, et al. Adenomyosis: what the patient needs. J Minim Invasive Gynecol. 2016;23(4):476–88.\nVilos GA, Edris F, Abu-Rafea B, Hollett-Caines J, Ettler HC, Al-Mubarak A. Miscellaneous uterine malignant neoplasms detected during hysteroscopic surgery. J Minim Invasive Gynecol. 2009;16(3):318–25.\nAmerican Association of Gynecologic Laparoscopists: Advancing Minimally Invasive Gynecology W. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol. 2012;19(2):152–71.\nZupi E, Centini G, Sabbioni L, Lazzeri L, Argay IM, Petraglia F. Nonsurgical alternatives for uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2016;34:122–31.\nKroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B. Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology. 2010;255(3):834–41.\nDonnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665–86.\nMara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008;31(1):73–85.\nClark NA, Mumford SL, Segars JH. Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence. Curr Opin Obstet Gynecol. 2014;26(3):151–61.\nJacoby VL, Kohi MP, Poder L, Jacoby A, Lager J, Schembri M, et al. PROMISe trial: a pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids. Fertil Steril. 2016;105(3):773–80.\nKramer B, Hahn M, Taran FA, Kraemer D, Isaacson KB, Brucker SY. Interim analysis of a randomized controlled trial comparing laparoscopic radiofrequency volumetric thermal ablation of uterine fibroids with laparoscopic myomectomy. Int J Gynaecol Obstet. 2016;133(2):206–11.\nWorldwide AAMIG, Munro MG, Storz K, Abbott JA, Falcone T, Jacobs VR, et al. AAGL practice report: practice guidelines for the Management of Hysteroscopic Distending Media: (Replaces Hysteroscopic fluid monitoring guidelines. J Am Assoc Gynecol Laparosc. 2000;7:167–168). J Minim Invasive Gynecol. 2013;20(2):137–48.\nAyus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. 1992;117(11):891–7.\nMuzii L, Boni T, Bellati F, Marana R, Ruggiero A, Zullo MA, et al. GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study. Fertil Steril. 2010;94(4):1496–9.\nCorson SL, Brooks PG, Serden SP, Batzer FR, Gocial B. Effects of vasopressin administration during hysteroscopic surgery. J Reprod Med. 1994;39(6):419–23.\nPolena V, Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S. Long-term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol. 2007;130(2):232–7.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nElectronic Supplementary Material\n(MP4 167699 kb)\nRights and permissions\nCopyright information\n© 2018 Springer International Publishing AG\nAbout this chapter\nCite this chapter\nSalazar, C., Isaacson, K. (2018). Submucosal Fibroid, Menorrhagia, Anemia, and Dysmenorrhea. In: Moawad, N. (eds) Uterine Fibroids. Springer, Cham. https://doi.org/10.1007/978-3-319-58780-6_7\nDownload citation\nDOI: https://doi.org/10.1007/978-3-319-58780-6_7\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-319-58779-0\nOnline ISBN: 978-3-319-58780-6\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}