Successful hysteroscopic myomectomy of a submucosal leiomyoma in an adolescent female: a case report

Introduction and importance: Uterine leiomyomas are rare in adolescents, making their diagnosis and management uniquely challenging. This case highlights a moderately sized, symptomatic submucosal leiomyoma in an adolescent female, successfully treated with hysteroscopic resection after the failure of medical management, and discusses key surgical considerations for effectively managing submucosal leiomyomas in this population. Case presentation: An 18-year-old nulliparous female presented several times with heavy menstrual bleeding despite an outpatient trial of oral contraceptives. Transabdominal ultrasound revealed a moderately sized submucosal leiomyoma measuring 3.8 × 4.1 × 3.6 cm. The patient was counseled on hysteroscopic myomectomy after the failure of multiple medical regimens to control her abnormal uterine bleeding. Preoperatively, she underwent a pelvic MRI to better delineate the leiomyoma characteristics. Upon performing a hysteroscopy, a FIGO type 2 leiomyoma was identified projecting from the left anterolateral wall. Diluted vasopressin was injected into the leiomyoma proper, and hysteroscopic resection was successfully performed using a MyoSure® device. The patient had an uncomplicated postoperative course, and her abnormal uterine bleeding has resolved. Clinical discussion: Uterine leiomyomas are rare in adolescents and are most often intramural, though submucosal lesions can cause severe bleeding. Refractory abnormal uterine bleeding should prompt early imaging. While ultrasound is first-line, MRI can aid in surgical planning. This case supports hysteroscopic myomectomy as a safe, fertility-sparing option when medical therapy fails. Conclusion: Uterine leiomyomas, though rare in adolescents, remain an important diagnostic consideration in patients with persistent heavy menstrual bleeding. Prompt imaging assessment and timely, fertility-sparing surgical intervention may reduce morbidity and support favorable long-term reproductive outcomes.