Definition
Uterine
fibroid (also known as uterine leiomyoma,
myoma, fibromyoma, fibroleiomyoma) is a leiomyoma (benign
tumor from smooth muscle tissue) that originates from the smooth
muscle layer (myometrium) of the uterus. Fibroids are often multiple and
if the uterus contains too many leiomyomata to count, it is referred to
as diffuse uterine leiomyomatosis. The cancerous version of a
fibroid is extremely uncommon and termed a leiomyosarcoma.
Fibroids are the most common benign tumors in females and
typically found during the middle and later reproductive years. While most
fibroids are asymptomatic, they can grow and cause heavy and painful
menstruation, painful sexual intercourse, urinary frequency and
urgency. Some fibroids may interfere with pregnancy although this appears to be
uncommon.
In the United States, symptoms caused by uterine
fibroids are a very frequent indication for surgical removal of the uterus
Cause
Genetic cause
An association with fatty acid synthase has been reported.
Familial leiomyomata
A syndrome
(Reed's syndrome) that causes uterine leiomyomata along with cutaneous
leiomyomata and renal cell cancer has been reported. This is
associated with a mutation in the gene that produces the enzyme fumarate
hydratase, located on the long arm of chromosome 1 (1q42.3-43).
Inheritance is autosomal dominant.
Sign and symptoms
Fibroids, particularly when small, may be entirely
asymptomatic. Symptoms depend on the location of the lesion and its size.
Important symptoms include
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Abnormal uterine bleeding,
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Heavy or painful periods
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Abdominal discomfort or bloating,
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Painful defecation,
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Back ache,
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Urinary frequency or retention,
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Infertility.
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During pregnancy they may also be the
cause of miscarriage, bleeding, premature labor, or interference with
the position of the fetus.
Treatment
Most fibroids do not require treatment unless they are
causing symptoms. After menopause fibroids shrink and it is unusual for them to
cause problems. In those who have symptoms uterine artery embolization and
surgical options have similar outcomes with respect to satisfaction.
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Symptomatic uterine fibroids can be treated by:
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Medication to control symptoms
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Medication aimed at shrinking tumours
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Ultrasound fibroid destruction
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Myomectomy or radio frequency ablation
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Hysterectomy
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Uterine artery embolization
