UTERINE LEIOMYOMAS

Uterine Leiomyomas are benign (non-cancerous) tumors. They arise from the overgrowth of smooth muscle and connective tissue in the uterus. Their common name is fibroids. Since their growth is promoted by estrogen and progestin receptors which are in fibroids, leiomyomas generally grow during pregnancy and cease growth with menopause. Estrogen replacement therapy (used after menopause) and oral contraceptives may also cause some re-growth of these fibroid tumors. Even though the causes of leiomyomas are yet unknown, they still most commonly occur as follows:
 In the body and the fundus of the uterus
 Only 3% in the cervix
 In groups instead of just a single one
 In more black women (3:1) than white (9:1)
 In half the women older than 40 years, but can develop in females at any age

Leiomyomas are distinct, round, firm, differ in size and are classified according to their location;
1. Intramural leiomyomas -------------- located within the muscular wall of the uterus
2. Submucosal leiomyomas ------------ located on the inside of the uterus lining
3. Subserous leiomyomas -------------- located on the outside surface of the uterus
Some leiomyomas may even be detached from the uterus
1. Intraligamentous leiomyomas ------ found within the broad ligaments
2. Pedunculated leiomyomas- attached by a stem making it subject to twisting or infection
3. Parasitic leiomyomas ------------ obtain its blood supply from other abdominal organs

Fibroid symptoms are related to the number of tumors, as well as their size and location. Most women with uterine fibroids have no symptoms, but some may experience symptoms as follows:
 Pain ----- abdominal cramps usually felt during menstruation
 Bleeding ----- excessive (menorrhagia) or between menstrual periods
 Frequent Urination ----- interfere with normal urinary retention and release
 Ureteral Obstruction ------ obstruct ureters, risking infection, stones and renal disease
 Constipation --------- pelvic pressure and heaviness
 Infertility --------- fibroids can interfere with fertility, depending on their location

The preferred imaging modality for the evaluation of uterine fibroids is ultrasonography (US). CT scanning is limited by their similar attenuation characteristics of fibroids. MRI and hysteroscopy (examination of the inside of the uterine cavity done with special viewing instrument) can depict the number, size, and location of the tumors.

The treatment of choice during child bearing years is a myomectomy (removal of fibroids) because future pregnancies are possible. Small asymptomatic leiomyomas are usually not treated, but should be observed at six-month intervals. Leiomyomas don’t usually require surgery unless they cause significant pressure on adjacent organs (bladder, ureters, or bowels), severe bleeding leading to anemia, or they‘re growing rapidly. Nevertheless, under certain circumstances, leiomyomas may recur, and a hysterectomy may be performed and cures the problem.

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