Leiomyomas of the uterus are more commonly known as fibroids.
They are the most common benign solid tumors of the uterus.
Prevalence varies between different racial groups but varies between 20-50%.

Fibroids may be:

1. Submucosal – within the cavity of the uterus
2. Intramural – within the wall of the uterus
3. Subserosal – on the surface of the uterus
4. Pedunculated – on a pedical arising from the surface of the uterus.

Common symptoms associated with fibroids include:

1. Bleeding abnormalities
2. Pain either with the menstrual cycle or between the cycles
3. Urinary frequency and/or urgency
4. Difficulty with bowel movements
5. Expanding abdominal size or bloating
6. Infertility
7. Pregnancy issues including preterm labor
8. Development of cancer is less than 1 in 1000.
9. Many fibroid tumors cause no symptoms.

Diagnosis can be by exam or more accurately by pelvic ultrasound:

CT scan and /or MRI play a very limited role in diagnosis.

Treatment is indicated in the presence of:

1. Abnormal uterine bleeding not responsive to medical treatment
2. Pain or pressure symptoms that interfere with quality of life
3. Urinary tract symptoms (urgency, frequency or obstruction)
4. Infertility or recurrent pregnancy loss

Treatment options include:

1. Hormone manipulation including birth control pills and other medications to control ovulation
2. Use of the Mirena IUD device especially if bleeding abnormalities prevail
3. Myomectomy which is a surgical procedure to remove the fibroids.
4. Hysterectomy is the most common surgical treatment of fibroids – can be done vaginally with minimal downtime.
5. Uterine artery embolization – especially if the patient wishes to retain the uterus.
6. Magnetic resonance imaging guided focused ultrasound surgery is a new treatment option. (investigational)

ACOG.org

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