Staged Minimally Invasive Management of Prolapsed Submucosal Myoma With Severe Bleeding: A Case Report of Uterine Artery Embolization, Relugolix Therapy, and Transcervical Resection.

We report the case of a 34-year-old woman with a prolapsed submucosal myoma who presented with severe genital bleeding. She was initially treated at a referring hospital, where she required a red blood cell transfusion for acute blood loss before transfer to our institution. After temporary stabilization, uterine artery embolization (UAE) was performed as an early minimally invasive intervention for the prolapsed myoma. Embolization was carried out using 500-700 μm tris-acryl gelatin microspheres (Embosphere; Merit Medical Systems Inc., South Jordan, USA). Oral relugolix (40 mg/day) was started several days after UAE and continued for approximately four months. Serial magnetic resonance imaging (MRI) demonstrated progressive tumor shrinkage from 41.6 × 23.6 mm before treatment to 24.8 × 10.8 mm and subsequently to 10.7 × 5.0 mm. After sufficient reduction in tumor size, transcervical resection (TCR) was performed successfully. The residual pedunculated lesion was resected with minimal blood loss in a seven-minute procedure. Histopathological examination showed hyalinized and degenerative leiomyoma with foreign body-type reaction, consistent with prior embolization-related change. The postoperative course was uneventful, and normal menstruation resumed after completion of medical therapy. This case suggests that a staged minimally invasive strategy combining UAE, relugolix therapy, and TCR may be an effective treatment option for prolapsed submucosal myoma with severe bleeding.