From the Guidelines
A leiomyoma, also known as a uterine fibroid, is a benign neoplasm composed of smooth muscle cells embedded in an extracellular matrix of collagen, fibronectin, and proteoglycan, affecting up to 80% of Black women and 70% of White women by age 50 1.
Definition and Prevalence
Uterine fibroids are the most common neoplasm of the uterus, with a multifactorial etiology involving genetic alterations, endocrine, autocrine, environmental, and other factors such as race, age, parity, and body mass index 1. The prevalence of fibroids varies with race, with Black women having a higher estimated incidence and likelihood of developing clinically significant disease at an earlier age 1.
Symptoms and Complications
Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause, with menorrhagia being the most frequent symptom, often resulting in iron deficiency anemia 1. Other common symptoms include:
- Dysmenorrhea
- Pelvic pain and pressure
- Urinary urgency and frequency
- Constipation Fibroids may also impair fertility and/or cause obstetric complications 1.
Treatment Options
Treatment choices are informed by patient preferences and symptom severity, with options ranging from medical therapy to surgery, including:
- Medical therapy (e.g., GnRH agonists, levonorgestrel-releasing intrauterine devices, contraceptive steroid hormones, and tranexamic acid)
- Myomectomy
- Endometrial ablation
- Uterine fibroid embolization (UFE)
- MR-guided focused ultrasound (MRgFUS)
- Laparoscopic radiofrequency ablation
- Hysterectomy, which is curative 1.
The choice of treatment depends on the size and location of the fibroids, symptoms, age, and whether the patient wants to have children in the future, with myomectomy and UFE resulting in equivalent symptomatic improvement at 2 years 1.
From the Research
Definition of Leiomyoma (Uterine Fibroid)
- A leiomyoma, also known as a uterine fibroid or myoma, is a benign uterine tumor that is commonly associated with abnormal uterine bleeding, particularly heavy menstrual bleeding (HMB) 2.
- Uterine fibroids are the most common form of benign uterine tumors and are composed of smooth muscle and fibroblast components, as well as a substantial amount of fibrous extracellular matrix 3.
- They are clonal neoplasms of the uterus and can be extremely heterogeneous in their pathophysiology, size, location, and clinical symptomatology 3.
Characteristics of Leiomyoma
- Leiomyomas arise due to the transformation of the layer of smooth muscle cells of the corpus uteri, the myometrium 4.
- They are hormone-dependent tumors and are more common in obese women and women of African origin 4.
- In more than half of cases, leiomyomas remain asymptomatic, but they can cause a range of symptoms including abnormal menstrual bleeding, pain, and reproductive issues 5.
Clinical Attributes of Leiomyoma
- Uterine leiomyomas can cause substantial morbidity and healthcare costs for women of reproductive age 3.
- They are a leading cause of gynaecological hospitalization and a common reason for hysterectomy 5.
- The frequency of uterine fibroids varies depending on the diagnosis and population investigated, but it is estimated to range from 5.4% to 77% in reproductive women 5.
Diagnosis and Treatment of Leiomyoma
- Clinical diagnosis of uterine leiomyomas can be hindered in some cases, and medical treatment is not always sufficient 4.
- Treatment options for uterine fibroids include painkillers, supplementation, birth control, hormone therapy, gonadotropin-releasing hormone (GnRH) agonists, and surgical removal of the fibroids 5.
- More research is needed to understand the molecular mechanisms behind the origin and development of leiomyomas and to develop effective treatments 5.