gynecology and obstetrics
Uterine Fibroids
Introduction
Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. Fibroids frequently cause abnormal uterine bleeding and pelvic pressure and sometimes urinary or intestinal symptoms, infertility, or pregnancy complications. Diagnosis is by pelvic examination, ultrasonography, or other imaging studies. Treatment of patients depends on symptoms and desire for fertility and preferences regarding surgical treatments. Treatment may include estrogen-progestin contraceptives, progestin therapy,tranexamic acid, and surgical procedures (eg, hysterectomy, myomectomy). Uterine fibroids (leiomyomas) are the most common pelvic tumor, occurring in approximately 70% of White women and 80% of Black women in the United States by age 50 ( References ). Many fibroids are small or asymptomatic. There is an increased risk of uterine fibroids in Black women and those with early menarche, obesity, and hypertension; high parity (3 or more births) is associated with a decreased risk ( Fibroids are smooth muscle tumors that usually arise from the myometrium. Locations of fibroids in the uterus are Subserosal Intramural Submucosal Occasionally, fibroids occur in the broad ligaments (intraligamentous), cervix, or, rarely, fallopian tubes. Some fibroids are pedunculated, and others are sessile. Submucosal fibroids may extend into the uterine cavity (intracavitary submucosal fibroids). The International Federation of Gynecology and Obstetrics (FIGO) classification system for causes of abnormal uterine bleeding ( Etiology ) has a subclassification for location of fibroids and the degree to which they protrude into the endometrial cavity ( Most patients have multiple fibroids. Each fibroid develops from a single smooth muscle cell, making them monoclonal in origin. Because they respond toestrogen, fibroids tend to enlarge during the reproductive years and decrease in size after menopause. Fibroids may outgrow their blood supply and degenerate. Degeneration is described as hyaline, myxomatous, calcific, cystic, fatty, red (usually only during pregnancy), or necrotic. Although patients are often concerned about cancer in fibroids, sarcomatous change occurs in < 1% of patients. Fibroids may be Subserosal (under the outer surface of the uterus) Intramural (in the wall of the uterus) Submucosal (under the lining of the uterus) Their shape may be Pedunculated (growing on a stalk) Sessile (broad-based and mainly within the myometrium without protrusion) 