Uterine leiomyomas (fibroids or myomas) are the
most common pelvic tumor in women.
They are benign monoclonal tumors arising from
the smooth muscle cells of the myometrium.
Groosly ,Leiomyomas are
pseudoencapsulated solid tumors, well
demarcated from the surrounding
Microscopically, these appear as
smooth muscle cells in longitudinal or
cross-section intermixed with fibrous
connective tissue. Vascular structures
are few, and mitoses are rare.
Risk of Malignancy
Leiomyosarcomas are found rarely
in hysterectomy or myomectomy
specimens (incidence 0.2%).
Uterine leiomyomas are the most common pelvic tumor in
Leiomyomas have not been described in prepubertal girls, but
they are occasionally noted in adolescents.
Myomas are clinically apparent in approximately 12 to 25
percent of reproductive age women and noted on pathological
examination in approximately 80 percent of surgically excised.
Most, but not all, women have shrinkage of leiomyomas at
Early menarche (<10 years old) is associated with an increased risk of
Parity (having one or more pregnancies extending beyond 20 weeks)
decreases the chance of fibroid formation.
It has been hypothesized that the postpartum remodeling of the uterus may
have the effect of clearing smaller fibroids.
Recent studies supported this hypothesis with the finding that over a third of
women with a single fibroid identified during pregnancy had none on
postpartum ultrasound, and almost 80 percent of fibroids were smaller
In some cohorts, early age at first birth decreases risk and a longer interval
since last birth increases risk
the association of fibroid growth with agents for ovulation induction is unlikely
Most studies show a relationship between fibroids and increasing
body mass. The relationship is complex and is likely modified by
Fibroids are often described according to their location in the
the majority of myomas are small and asymptomatic.
The symptoms are related to the number, size, and location of the
Myomas can occur as single or multiple tumors and range in size from
microscopic to tens of centimeters.
The size of the myomatous uterus is described in menstrual weeks, as
with the gravid uterus. As an example, a 20-week size myomatous
uterus is not unusual, and is often associated with heavy menses,
increasing abdominal fullness similar to pregnancy
It is the most common symptom.
Heavy and/or prolonged menses is the typical bleeding
pattern with myomas .
Intermenstrual bleeding and postmenopausal bleeding
are NOT characteristic of myomas and should be
investigated to exclude endometrial pathology.
The presence and degree of uterine bleeding are
determined, in large part, by the location of the fibroid;
size is of secondary importance.
Bulk-related symptoms —
As examples, urinary frequency, difficulty emptying the bladder, and,
rarely, urinary obstruction can all occur with fibroids
Dysmenorrhea is also reported by many women with fibroids.
Leiomyoma degeneration or torsion —
Infrequently, fibroids cause acute pain from degeneration (eg, carneous
or red degeneration) or torsion of a pedunculated tumor.
Leiomyomas that distort the uterine cavity (submucosal or
intramural with an intracavitary component) result in:
difficulty conceiving a pregnancy
and an increased risk of miscarriage
leiomyomas have been associated with adverse pregnancy
fetal growth restriction,
and preterm labor and birth
Condoleezza Rice's uterine fibroid embolization was performed at
Georgetown University Hospital by interventional radiologist James
Spies, MD. The procedure took about 90 minutes and was reported
Management Clinical effect Method of
Serial Pelvic Exams
Presurgical Shrinkage Size by 70%
GnRH analog 3-6months;
regrowth after stopping
Myomectomy Preserves fertility
Embolization Preserves the uterus
Hysterectomy Fertility completed
Uterine leiomyomas (fibroids or myomas) are
the most common pelvic tumor in women .
Fibroids are often described according to
their location in the uterus (submucosal,
intramural, subserosal, cervical).
Symptoms attributable to uterine myomas
can generally be classified into three distinct
categories: abnormal uterine bleeding, pelvic
pressure and pain, reproductive dysfunction.
Relief of symptoms related to fibroids usually
occurs at the time of menopause