Uterine Fibroids (Leiomyomas, Myomas)

Fibroids– Well-circumscribed, nonencapsulated, benign tumors of the uterus.

Causes and Incidence

The etiology is unclear, but the tumors tend to grow in response to excess estrogen levels and shrink after menopause. Fibroids are the most common pelvic neoplasm and occur in about 30% of women over age 35. In the United States, the incidence is higher in black women.

Disease Process

Fibroids arise from the smooth muscle within the myometrium of the uterus. They may be seen on the intramural, submucosal, or subserous surface of the uterus or in the musculature of the cervix or broad ligaments. Tumor growth often outstrips blood supply, causing the tumor to hyalinize. The hyaline tissue may then liquefy and calcify.

Symptoms

Most fibroids are asymptomatic. Symptoms, when present, include prolonged or excessive menstrual bleeding with no change in the cycle interval. Pain, heaviness, or tenderness in the lower abdomen may also be present.

Potential Complications

Complications include hemorrhage, torsion and infection, adhesions, and infertility.

Diagnostic Tests

The diagnosis is made on abdominal and bimanual palpation of the uterus. Ultrasound scanning may be used to distinguish endometriosis from leiomyomas. Cytologic tests and cervical biopsy may be done to rule out cancer.

Treatments

Surgery
Hysteroscopic or laparoscopic myomectomy to preserve uterus for childbearing; hysterectomy to control heavy bleeding.

Drugs – None.

General
Ongoing gynecologic examinations to monitor fibroids.