Review Question - QID 106210

This patient is presenting with menorrhagia, an enlarged uterus, and a microcytic anemia which is suggestive of a leiomyoma of the uterus. Myomectomy is the preferred management for patients who wish to remain fertile following treatment.

Uterine fibroids (leiomyoma) are a benign smooth muscle growth in the wall of the uterus. Symptoms of uterine fibroids include menorrhagia, pelvic pain, pelvic or urinary obstructive symptoms, infertility, and pregnancy loss. Menorrhagia and a microcytic anemia is a common presentation of leiomyoma. Risk factors for fibroids include black race, nulliparity, obesity, family history, and hypertension. The diagnosis can be supported with an ultrasound or an MRI and treatment is either a myomectomy if the patient wants to bear children or a hysterectomy if done bearing children.

Incorrect Answers:
Answer 1: Folate is appropriate treatment of a megaloblastic anemia (such as in an alcoholic) or in patients who are chronically and rapidly turning over red blood cells (such as patients with sickle cell disease or hereditary spherocytosis).

Answer 2: Hysterectomy is an appropriate management for women with symptomatic uterine fibroids who do not wish to become pregnant in the future. This woman is actively trying to have a child.

Answer 3: Iron is not an appropriate treatment of anemia until the diagnosis has been confirmed as a microcytic anemia in a patient with a low iron. The etiology of the microcytic anemia should always be worked up prior to merely treating the lab findings. This patient's menorrhagia is the etiology of her anemia and treating it with a myomectomy is a more effective treatment.

Answer 5: Oral contraceptive pills can be used in patients who experience abnormally heavy menses; however, it is not optimal management of menorrhagia with significant anemia in a patient with a leiomyoma.

Bullet Summary:
The most effective treatment for a uterine leiomyoma in a patient who wants to have children is a myomectomy.