To Treat or Not to Treat.

I was particularly troubled by a case presentation that was made recently during our morning resident conference.

The case concerned a 42-year-old woman who had complained of menometrorrhagia for approximately 3 months. Endometrial biopsy had documented proliferative endometrium and pelvic ultrasound had indicated a 5-cm leiomyoma. After a brief, unsuccessful trial of oral contraceptives, the patient was subjected to a hysterectomy "Next case," yawned a senior resident.

What was there to discuss? The patient was relieved of her systems, the operating surgeon was content because the surgery was preapproved by the patient's insurance company and the patient was doing well postoperatively.

The pathologist was satisfied with the abnormal uterus and the gynecology resident had one more case under her belt.

"Not so fast," I said. "Do fibroids cause menometrorrhagia?"

The room was silent, so I answered my own question--in the negative. Unless they are very large, most fibroids are asymptomatic. Some submucous fibroids will produce menorrhagia, but not menometrorrhagia.

I emphasized to the residents that this is not a minor distinction. If menses are irregular in a 42-year-old woman without endometrial cancer, it is probably hormonally induced and the fibroids may be an incidental finding.