leiomyomas
LEIOMYOMAS

Leiomyomas or uterine fibroids are benign tumors of the uterus that consist of smooth muscle and extracellular matrix collagen and elastin.

Most common solid pelvic tumors and one of the most frequent clinical conditions encountered in gynecologic practice.

They tend to grow during the reproductive years and usually regress during menopause.

 

Introduction

  • Also called fibroids, these are benign tumors of the uterus that consist of smooth muscle and extracellular matrix collagen and elastin
    • Though pathogenesis is not yet well defined, fibroids are thought to develop from the myometrium after a smooth muscle cell’s neoplastic transformation followed by the formation of a connective tissue component and a pseudocapsule 
    • Malignant transformation is extremely rare 
  • Most common solid pelvic tumors and one of the most frequent clinical conditions encountered in gynecologic practice
  • Tend to grow during reproductive years and usually regress during menopause
    • Development is stimulated by estrogen and progesterone
  • Fibroids occur more often in women of African descent than in Caucasian or Asian women 

Signs and Symptoms

  • About 50% of fibroids are asymptomatic
  • Symptoms vary depending on size, number, and location of the fibroids
  • Abnormal uterine bleeding clinically manifests as menorrhagia leading to iron-deficiency anemia
  • Pelvic mass and pelvic pressure symptoms: Increased abdominal girth, urinary frequency and urgency, urinary incontinence or retention, dysuria, hydronephrosis, constipation, tenesmus, rectal pressure, low back pain
  • Infertility, non-cyclic pelvic pain, dyspareunia and dysmenorrhea
  • Obstetric complications: Rapid growth of the fibroid, red degeneration and pain, spontaneous miscarriage, breech presentation, preterm delivery, primary cesarean section, low birthweight infants 

Risk Factors

  • Factors that increase the risk of uterine fibroids include:
    • Age >40 years old
    • Early menarche <10 years old
    • Family history of uterine fibroids
    • Obesity
    • Nulliparity
    • Race (African descent) 
    • Genetic factors
    • Alcohol and caffeine intake
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