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

Characteristics of submucosal leiomyomas that could cause severe hemorrhage with relugolix: an observational study

BACKGROUND

Relugolix, an oral gonadotrophin-releasing hormone receptor antagonist, was launched in Japan in 2019. Although there have been several studies on relugolix for leiomyomas, few have focused on submucosal leiomyomas. Submucosal leiomyomas cause bleeding more frequently than leiomyomas in other locations. There is only one case report described a patient treated for a submucosal leiomyoma with relugolix who developed severe hemorrhage. However, it remains unclear which characteristics of submucosal leiomyomas can lead to severe hemorrhage. Thus, the aim of this study was to investigate the characteristics of submucosal leiomyomas that would cause severe hemorrhage when treated with relugolix.

METHODS

We retrospectively reviewed records of patients who underwent treatment for submucosal leiomyoma with relugolix (40 mg once daily for up to 6 months) in our institute between December 2019 and September 2021. We evaluated the clinical course and characteristics of submucosal leiomyoma in patients who developed severe hemorrhage.

RESULTS

A total of 17 patients were treated for submucosal leiomyoma with relugolix. Two patients developed severe hemorrhage and required emergent surgery and blood transfusions. Only those two of the 17 patients had a submucosal leiomyoma of the International Federation of Gynecology and Obstetrics (FIGO) type 0, which has a stalk. In the remaining 15 patients who had FIGO type 1 or 2 leiomyoma, hemorrhage did not occur.

CONCLUSIONS

Our study suggests that the use of relugolix for FIGO type 0 leiomyomas may be associated with a risk of hemorrhage. However, relugolix may be a safe and effective treatment option for patients with FIGO type 1 or 2 leiomyomas.

Observation of Intramural Fibroid Expulsion on MRI after Uterine Artery Embolization

Uterine artery embolization (UAE) is a type of noninvasive treatment for symptomatic uterine fibroids. One of the complications of UAE is fibroid expulsion. Here, we report a case of a 45-year-old woman who underwent UAE for an intramural fibroid, which resulted in fibroid expulsion. To the best of our knowledge, there are only few reports of expulsion of intramural fibroids. The process of fibroid protrusion from the myometrium into the uterine cavity was depicted on magnetic resonance imaging (MRI) in this case. We discuss the risk factors and mechanisms of fibroid expulsion after UAE.

Prolapse of a pedunculated uterine leiomyoma through the cervix during GnRH antagonist treatment: Case report and literature review

We here describe a case of the prolapse of pedunculated submucosal leiomyoma through the cervix during the treatment of a gonadotropin-releasing hormone (GnRH) antagonist relugolix. We also present the literature review of the cases of leiomyoma prolapse during GnRH modulators. A 55-year-old woman with atypical vaginal bleeding diagnosed submucosal uterine fibroid 6 cm in diameter, and daily oral administration of relugolix was conducted. On the 35th day of the administration, heavy vaginal bleeding suddenly occurred due to leiomyoma prolapse. Finally, she underwent abdominal hysterectomy to treat heavy bleeding. To date, six cases of leiomyoma prolapse during GnRH modulators have been reported, in which all the previous cases were treated with GnRH agonists. This is the first case report of leiomyoma prolapse during GnRH antagonist treatment. Notably, leiomyoma prolapse is a possible common adverse effect of GnRH modulators for the treatment of submucosal leiomyoma, which is caused by rapid decrease in its volume.

Expulsion of a uterine myoma in a patient treated with ulipristal acetate

Description of a spontaneous expulsion of a submucosal myoma in a patient treated with ulipristal acetate.