Treatment of uterine fibroids

Abstract

Uterine leiomyomas are benign tumors that arise from myometrial smooth muscle cells. They are present in 20–25% of women of reproductive age. These benign tumors are generally firm, well circumscribed and composed of smooth muscle cells in an interdigitating pattern separated by fibrous connective tissue. Fibroids are more common in black women, and on an average, 50% of all laparotomies for a pelvic pathology are performed for myomas. If asymptomatic, they can generally be managed expectantly, but 75% do have symptoms.1, 2 Up to one third of patients experience abnormal uterine bleeding and/or abdominal or pelvic pain.3 They have also been associated with both impaired fertility and poor obstetric outcome. The incidence of malignancy is small, and has been reported to be 0.29% in a study of 33,000 pathology specimens.1 Patients presenting with infertility and with abnormal uterine bleeding have a higher incidence of uterine fibroids. Possible symptoms of uterine fibroids include bleeding, pressure, pelvic pain, recurrent pregnancy loss, bladder or bowel symptoms, and infertility. Generally, uterine myomas arise from a single smooth muscle cell clone, which proliferates beyond normal control mechanisms. Surgical treatment options include laparotomy with myomectomy, hysteroscopic myoma resection, or laparoscopic myomectomy. More recently, treatment of submucosal myomas has been managed almost exclusively by operative hysteroscopy. The purpose of this manuscript is to briefly discuss symptoms and diagnosis but to primarily focus on treatment.