Uterine leiomyomata
From Medical-Wiki
The most common uterine tumors are uterine leiomyomata (UL). These are benign smooth muscle tumors. They are symptomatic in approximately one-quarter of reproductive age females. They are also the most common cause for hysterectomy in the United States. While debated, it is felt by some that UL may evolve into malignant leimyosacrcoma.
UL are steroid-hormone dependent tumors—especially sensitive to estrogen and progesterone for their overall growth and development.
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Demographics
UL are very common in women older than 30 years of age and very rare in woman below the age of 18. UL tend to regress after menopause.
Clinical presentation
The nature of ULs determines their clinical presentation. They may occur in multiple configurations—single or multiple—with great size variation. They may also be accompanied by profuse menstrual bleeding, pelvic pain, and pelvic pressure. Infertility may also be a secondary problem.
Morbidity & mortality
Relative to overall uterine complications, UL are associated with hemorragic degeneration, disseminated intravascular coagulation, hemoperitoneum, premature rupture of membranes, dystocia, inversion of the uterus, antepartum and postpartum hemorrhage, breech presentation, placental abruption and postpartum sepsis. [1]
Diagnosis
Radiological findings
Ultrasonography, both transabdominal and transvaginal, is the imaging technique of choice for ULs. Calcified ULs may be visualized on plain radiography, but there is rarely enough detail for this study to be of significant clinical use. MRIs may sometimes be of help defining specific anatomy if ultrasonography fails to do so. CT scans are of little use when evaluating a UL. [2]
Treatment
There is no doubt that patient perceptions and physician attitudes influence the means of treating ULs. Two studies demonstrated, “that a variety of clinical, patient, hospital and physician characteristics are important determinants of treatment in women with a primary diagnosis of leiomyoma.” [3]
One of the newer treatment methods is uterine artery embolization. A study of 58 women concluded, “Uterine artery embolization is an endovascular method for the treatment of uterine leiomyomas that is clinically effective in most patients and that induces a progressive reduction in the size of the largest leiomyomas.” [4]
Even though there is ever increasing opposition to hysterectomy because of its high rate of occurrence, there is one reality that makes the procedure attractive: hysterectomy is the only procedure that prevents future ULs from occurring.
However, there are a great number of alternative surgical treatments including myomectomy, laparoscopic myomectomy, and hysteroscopic procedures. Myomectomies are of particular value in women who want to preserve their child-bearing ability. Hysteroscopic procedures are primarily efficacious for the control of leiomyoma-related bleeding. [5]
