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Uterine Leiomyomas

Also called myomas, fibromyomas, and fibroids, uterine leiomyomas are the most common benign tumors in women. These smooth-muscle tumors usually occur in multiples in the uterine corpus, although they may appear on the cervix or on the round or broad ligament.

Uterine leiomyomas are often called fibroids, but this term is misleading because they consist of muscle cells and not fibrous tissue. Uterine leiomyomas occur in 20% to 25% of women of reproductive age and affect three times as many Blacks as Whites. The tumors become malignant (leiomyosarcoma) in only 0.1 % of patients.

Causes

The cause of uterine leiomyomas is unknown, but steroid hormones, including estrogen and progesterone, and several growth factors, including epidermal growth factor, have been implicated as regulators of leiomyoma growth.

Leiomyomas typically arise after menarche and regress after menopause, implicating estrogen as a promoter of leiomyoma growth.

Signs and symptoms

Leiomyomas may be located within the uterine wall or may protrude into the endometrial cavity or from the serosal surface of the uterus. Most leiomyomas produce no symptoms. The most common symptom is abnormal bleeding, which typically presents clinically as menorrhagia.

Uterine leiomyomas probably do not cause pain directly except when associated with torsion of a pedunculated subserous tumor. Pelvic pressure and impingement on adjacent viscera are common indications for treatment. Various reproductive disorders, including infertility, recurrent spontaneous abortion, and preterm labor, have been attributed to uterine leiomyomas.

Diagnosis

Clinical findings and the patient history suggest uterine leiomyomas.

• Blood studies showing anemia from abnormal bleeding support the diagnosis.
• Bimanual examination may reveal an enlarged, firm, nontender, and irregularly contoured uterus.
• Ultrasonography allows accurate assessment of the dimensions, number, and location of tumors.
• Other diagnostic procedures include hysterosalpingography, dilatation and curettage, endometrial biopsy, and laparoscopy.

Treatment

Effective treatment depends on the severity of symptoms, the size and location of the tumors, and the patient's age, parity, pregnancy status, desire to have children, and general health. Treatment options include nonsurgical as well as surgical procedures.

Nonsurgical treatment :- Conservative treatment includes taking serial histories, performing physical assessments at clinically indicated intervals, and administering gonadotropin-releasing hormone (GnRH) analogues. These drugs are capable of rapidly suppressing pituitary gonadotropin release, leading to profound hypoestrogenemia and a 50% reduction in uterine volume.

The peak effects of these GnRH analogues occur in the 12th week of therapy. The benefits are reduction in tumor size before surgery, reduction in intraoperative blood loss, and an increase in preoperative hematocrit.

Surgery :- Surgery includes abdominal, laparoscopic, or hysteroscopic myomectomy for patients who want to preserve fertility. Hysterectomy is the definitive treatment for symptomatic women who have completed childbearing.