The most common benign tumors in women, uterine leiomyomas, also known as myomas, fibromyomas, or fibroids, are smooth-muscle tumors. They usually occur in multiples in the uterine corpus, although they may appear on the cervix or on the round or broad ligament. Though uterine leiomyomas are often called fibroids, this term is misleading because they consist of muscle cells and not fibrous tissue.
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.
Uterine leiomyomas occur in 20% to 25% of women of reproductive age and reportedly affect three times as many black women as white women. The tumors become malignant (leiomyosarcoma) in only 0.1% or less of patients.
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 don’t 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. Infertility, however, is rarely due to leiomyomas.
Clinical findings and patient history may suggest uterine leiomyomas. Bimanual examination may reveal an enlarged, firm, nontender, and irregularly contoured uterus. Ultrasound (transvaginal or pelvic) or magnetic resonance imaging allows accurate assessment of the dimensions, number, and location of tumors. Other diagnostic procedures include hysterosalpingography, dilatation and curettage, endometrial biopsy, and laparoscopy.
Treatment depends on the symptoms’ severity, the tumors’ size and location, 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 methods include taking serial histories and performing physical assessments at clinically indicated intervals and administering gonadotropin-releasing hormone (Gn-RH) analogues, which are capable of rapidly suppressing pituitary gonadotropin release, leading to profound hypoestrogenemia and a 50% reduction in uterine volume. The peak effects of these Gn-RH 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. Gn-RH analogues aren’t curative.
Surgical procedures include abdominal, laparoscopic, or hysteroscopic myomectomy — for patients who want to preserve fertility. Myolysis can successfully treat fibroids without hysterectomy or major surgery. Performed on an outpatient basis, this laparoscopic procedure coagulates the fibroids and preserves the uterus and the patient’s childbearing potential. Hysterectomy is the definitive treatment for symptomatic women who have completed childbearing, but uterine artery embolization may be an alternative in some situations.
❑ Tell the patient to report any abnormal bleeding or pelvic pain immediately.
❑ If a hysterectomy or oophorectomy is indicated, explain the operation’s effects on menstruation, menopause, and sexual activity to the patient.
❑ Reassure the patient that she most likely won’t experience premature menopause if her ovaries are left intact.
❑ If it’s necessary for the patient to have a multiple myomectomy, make sure she understands pregnancy is still possible. Explain that a cesarean delivery may be indicated.
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: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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