Uterine Leiomyomas

Uterine leiomyomas are the most common benign tumors in women. These smooth-muscle tumors are usually multiple and generally occur in the uterine corpus, although they may appear on the cervix or on the round or broad ligament. Also known as myomas or fibromyomas, uterine leiomyomas are commonly called fibroids, but this term is misleading because leiomyomas consist of muscle cells and not fibrous tissue.

Uterine leiomyomas occur in about 20% of all women over age 35 and affect blacks three times more often than whites. Malignant tumors (leiomyosarcomas) develop from benign tumors in only about 0.1 % of patients.

Causes

The cause of uterine fibroids is unknown, but some researchers suspect that the tendency to develop uterine fibroids is inherited.

Signs and Symptoms

Usually, the patient's history reveals submucosal hypermenorrhea (the cardinal sign of uterine leiomyomas), although other forms of abnormal endometrial bleeding, as well as dysmenorrhea, are possible.

The patient may complain of pain if the tumors twist or degenerate after circulatory occlusion or infection or if the uterus contracts in an attempt to expel a pedunculated submucous leiomyoma. She may also report increasing abdominal girth without weight gain, a feeling of heaviness in the abdomen, constipation, and urinary frequency or urgency if the tumors press on surrounding organs. However, most women with leiomyomas are asymptomatic.

Palpation of the uterus may reveal irregular uterine enlargement, often asymptomatically. Palpation of the tumor may find a round or irregular mass.

Ovarian neoplasm, pregnancy, ectopic pregnancy, tube-ovarian inflammatory mass, and diverticular inflammatory mass can mimic symptoms of uterine leiomyomas and need to be differentiated in diagnosis.

Diagnostic tests

Blood studies show anemia from abnormal bleeding. Ultrasonography, dilatation and curettage, and submucosal hysterosalpingography may detect submucosal leiomyomas. Laparoscopy visualizes subserous leiomyomas on the uterine surface. Diagnostic hysteroscopy involves the use of endoscopic equipment to directly view leiomyomas in the endocervical canal and lower uterine segment.

Treatment

Medical management of uterine leiomyomas 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:

• pelvic examination every 4 to 6 months to monitor the growth of small lieiomyomas that produce no symptoms
• surgical removal and administering gonadotropinreleasing hormone analogues. These drugs are capable of rapidly suppressing pituitary gonadotropin release, leading to profound hypoestrogenemia and a 50% reduction in uterine volume. Peak effect is in the 12th week of therapy. Reduction in tumor size before surgery, reduction in intraoperative blood loss and an increase in prospective hematocrit are the benefits. It includes abdominal, laparoscopic, or hysteroscopic myomectomy for patients who want to preserve fertility.
• hysterectomy (with preservation of the ovaries, if possible), which is the definitive treatment for symptomatic women who have completed childbearing.