Laparoscopic myomectomy.

Uterine leiomyomas are the most common solid pelvic tumor, occurring in 20% of women over age 35. Most are asymptomatic and can be followed with vaginal ultrasound to rule out ovarian neoplasms and rapid increases in fibroid size. Thus, surgery can usually be avoided. Hypermenorrhea is the major symptom in women with uterine leiomyomas who seek treatment. Other complaints include infertility and problems after conception including spontaneous abortion, pain from acute red degeneration during pregnancy, premature labor, fetal malposition, dysfunctional labor, obstruction of labor, retained placenta, and postpartum hemorrhage secondary to uterine atony. Fibroids require treatment when hypermenorrhea leads to anemia, pain develops from fibroid degeneration, pressure symptoms develop from large size, size increases rapidly, and when the clinician cannot properly palpate the ovaries, especially if ultrasound is not available.