When numerous large tumors (especially intraligamentary mommas) are found, total abdominal hysterectomy is indicated. If the ovaries are diseased or if their blood supply has been destroyed, oophorectomy is necessary; otherwise, the ovaries should be preserved.
Ovaries generally are preserved in premenopausal women. There is no consensus about the virtue of conserving or removing ovaries in postmenopausal women, with advocates and opponents of such prophylactic castration both relying on hypothetical scenarios and not scientific studies.
[...] This type of myoma generally does not affect the menstrual flow, however, it can bring some discomfort for its size and pressure on other structures of the pelvis - the “intramurals” grow in the interior of the uterine wall and if they expand they force the uterus so it increases above its normal size. They are mommas that more commonly and generally provoke an intense menstrual flow, pelvic pain or sensation of weight - the mucous” are situated more deeply, They are mommas that appear less commonly, but they provoke intense symptoms and alter menstrual periods. [...]
[...] Thus, pain may result from degeneration associated with vascular occlusion, infection, torsion of a pedunculated tumor, or myometrial contractions to expel a subserous myoma from the uterine cavity. Pain with intercourse may result, depending on the position of the tumors and the pressure they exert on the vaginal walls. C. Pressure effects—Pressure effects are unusual and difficult to directly relate to leiomyomata, unless the tumors are very large. Intramural or intraligamentous leiomyomata may distort or obstruct other organs. Parasitic tumors may cause intestinal obstruction if they are large or involve omentum or bowel. [...]
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