What is the standard of care for a premenopausal woman with fibroids, heavy bleeding, and dysmenorrhea?—DEBORAH DONNELL, BSN, RN, Jackson, Miss.

If the patient does not wish to have any further pregnancies, the standard of care is hysterectomy. If, however, continued fertility is desired, there is a lack of rigorous trials evaluating the effectiveness of management options. Hormonal treatments may provide relief of heavy bleeding and/or reduction in uterine size, but results are mixed and the effects of long-term use on future pregnancies are unknown. Myomectomy, uterine artery embolization, and magnetic resonance–guided, focused ultrasound surgery are options. The most recent practice guidelines from the American College of Obstetricians and Gynecologists were issued in 2008. More recent guidelines were published by French researchers in the European Journal of Obstetrics & Gynecology and Reproductive Biology (2012;165[2]:156-164).—CLAIRE O’CONNELL, MPH, PA-C

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These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.