Short summary

This prospective cohort study is undertaken to estimate whether myomectomy increases intrauterine adhesions and induces changes in progesterone receptors of the endometrium.

Rationale

It is well known that myomas, especially submucosal and intramural, can have a negative impact on fertility. Recently, it has been shown that not only estrogen but also progesterone plays an important role in the growth of myomas as well as regulation of the window of receptivity of the endometrium. The presence of one or more myomas may interact with the endometrium not only locally but also more distantly via estrogen and progesterone receptors. This might be of importance for the implantation process. Another factor that has a negative effect on fertility is the presence of intrauterine adhesions. Other studies have described the occurrence of these after myomectomy.

Description of the cohort

A prospective study of women undergoing laparoscopic myomectomy at the gynecological department at Odense University Hospital and Aarhus University Hospital

Data and biological material

The patients will be subjected to office hysteroscopy and biopsies before and after surgery. Biopsies will be used to measure the level of progesterone receptors in the endometrium before and 3 months after laparoscopic myomectomy thereby detecting changes in the expression of endometrial progesterone receptors. Office hysteroscopy will be used to evaluate intrauterine adhesions. Baseline characteristics will be recorded including age, number and type of deliveries, menopausal status, smoking habits, and drug use including present use of hormonal treatment, BMI, co-­‐morbidity, and previous surgery. Indication for myomectomy will follow the local guidelines.

Furthermore, all women will be offered a gynecological examination including vaginal ultrasound where the presence of myoma will be described including the size of the uterus and the number and size of fibroids, and the distance to the endometrium. The myomas position will be classified according to the FIGO-­‐classification of myomas [11].

Furthermore, all women will have an MRI (standard procedure) of the pelvic region performed prior to surgery in order to define the size, position (distance mm) of the myomas in relation to the endometrium, and the size of the uterus. In cases with several fibroids MRI will be performed to map the size and position of fibroids.

The patient will be asked to answer a questionnaire about fibroid-related symptoms before and 3 months after the surgery.

Collaborating researchers and departments

Departent of Gynecology, Aarhus University Hospital

• Margit Dueholm