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 less than 0.1% of patients.
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.
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.
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. Magnetic resonance imaging is particularly useful for fibroid imaging.
❑ Other diagnostic procedures include hysterosalpingography, dilatation and curettage, endometrial biopsy, and laparoscopy.
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 hysterectomy — the definitive treatment for symptomatic women who have completed childbearing — and abdominal, laparoscopic, or hysteroscopic myomectomy for patients who want to preserve fertility. Other surgical options include myolysis (a laparoscopic procedure to treat fibroids), uterine artery embolization, cryomylosis, and other variants.
❑ Tell the patient to report any abnormal bleeding or pelvic pain immediately.
❑ If a hysterectomy or oophorectomy is indicated, explain the effects of the operation on menstruation, menopause, and sexual activity to the patient.
CLINICAL TIP: Reassure the patient that she won’t experience premature menopause if her ovaries are left intact.
❑ If the patient will undergo multiple myomectomy, make sure she understands that pregnancy may still be possible. However, explain that a cesarean delivery may be necessary.
❑ In a patient with severe anemia due to excessive bleeding, administer iron and blood transfusions.
Review other book chapters online related to Uterine fibroids:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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