NeoExplorer
Leiomyoma
Leiomyoma is a benign tumor of the smooth muscle cells in the uterus, called the myometrium. It is rather common, especially in women over 30. It can occur in several different uterine locations and therefore have different terminology for where it arises. [1] [2]
Epidemiology
1/4 women over the age of 30 will have a fibroid. Incidence increasing with age to 70% of white women and 80% of black women by the age of 50. Unfortunately, incidence is twice as common in black woman than white. There is also a genetic predisposition to Leiomyoma. [3]
Etiology
A fibroid in the uterus is compromised of monoclonal cells arising from the myometrium. Often times a particular mutation, like defects in RNA polymerase II and its role in cell transformation, are associated with these fibroids. [4]
Gross Anatomy
Different type of leiomyoma fibroids have varying severities when it comes to associated complications and symptoms. Larger fibroids in areas vital to mucosa function are the most impactful. Numerous fibroids are also more likely to cause worsening symptoms and complications. [1]
[5]
Diagnosis
Diagnosis is generally made through a physical exam and a evaluation of the patients clinical history. The physical exam reveals an enlarged uterus that is often irregular in shape. This can be further confirmed through an ultrasound.
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pelvic sonograms can be a cost-effective method for confirming a diagnosis rapidly
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MRI can confirm the degree of fibroid development on a vascular level
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MRI are also helpful in determining the relationships of fibroids to serosal and mucosal surfaces [3]
(3)
Signs and Symptoms
Patients can present without symptoms or with symptoms such as:
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infertility/poor pregnancy outcomes
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chronic pelvic pain
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heavy menstrual bleeding
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anemia
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constipation
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UTI
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urinary incontinence [1] [2]
Treatment
There are three main goals for treatment of patients with leiomyoma fibroids:
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relieve bothersome signs and symptoms
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reduce the leiomyoma size
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maintain or improve a woman's fertility
These objectives are highly dependant on a patients age and reproductive goals. [7]
Treatment options:
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hormonal
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intrauterine devices
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non-hormonal options such as NSAIDs
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often referred to as medical management
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often the initial intervention
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surgical intervention
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remains the most successful intervention
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hysterectomy
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the only treatment that provides definite therapy [7]
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Prognosis
Dependant on desire for future fertility. Some will have great prognosis and remain without symptoms and complications for years. Others will fail medical management and have recurring fibroids for years. [1]
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