Benign disease of the uterus

The benign diseases of the uterus compromise endometrial polyps, adenomyosis, and uterine fibroids or leiomyomas. Polyps are often asymptomatic, or may cause intermenstrual bleeding, and recent technological developments allow for rapid diagnosis (transvaginal sonography) and treatment (outpatient hysteroscopy and polypectomy with or without local anaesthesia). Precious little progress has been made over the past few decades in the understanding of the pathophysiology of adenomyosis, or its effective management beyond hysterectomy. Until as recently as two decades ago, the only treatment options for fibroids were hysterectomy and myomectomy, but the advent of radiological interventions (uterine artery embolization and focused ultrasound surgery) has revolutionized uterine-preserving management options of fibroid disease, while the recent emergence of selective progesterone receptor modulators has, at long last, heralded effective medical therapy for fibroids. This rapid expansion in fertility-preserving treatments for fibroids could not have been more timely since in recent years there has been a dramatic shift in the demography of childbirth, with many women postponing childbirth to their late 30s and early 40s, when fibroids are more prevalent and more symptomatic. Parallel developments in assisted reproduction technology now allow women to achieve pregnancies at an age that was unthinkable three decades ago. Even when child bearing is not an issue, hysterectomy no longer need be the only effective treatment for the menstrual disturbance and other symptoms associated with benign diseases of the uterus—new minimally invasive procedures now allow for equally effective interventions that improve women’s quality of life.