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Important considerations for women in the late reproductive and perimenopausal years desiring myomectomy

Pepin, Kristena; Reddy, Himabindua; Clark, Nisse V.b

Current Opinion in Obstetrics and Gynecology: April 22, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/GCO.0000000000000551
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Purpose of review To review important considerations in the counseling and management of women over the age of 40 desiring a myomectomy for symptomatic fibroids.

Recent findings Women in the late reproductive and perimenopausal years may choose a myomectomy over a hysterectomy for reasons of fertility preservation or a personal desire to retain their uterus. Data suggest that laparoscopic myomectomy is a low-risk procedure that can be offered to older women, though the age-related risk of uterine malignancy must be evaluated.

Summary When assessing the surgical candidacy of older women desiring myomectomy, it is important to weigh a woman's fertility potential, surgical risk, and concerns about malignancy with her desire to preserve the uterus and autonomy to choose a procedure type.

aDepartment of Obstetrics and Gynecology, Brigham and Women's Hospital

bDivision of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to Nisse V. Clark, MD, MPH, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Founders 4, Boston, MA 02114, USA. Tel: +1 617 724 3775; e-mail: nvclark@mgh.harvard.edu

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