by Pedro Miranda

Created on: March 23, 2009   Last Updated: April 02, 2009

Fibroids are benign tumors of the smooth muscle of the uterus. The term is actually a misnomer since they do not derive from fibrous tissue. The proper term is leiomyoma or simply myoma.

They are the most common tumor in women, with the highest prevalence occurring during the fifth decade of life. A study done in the Washington DC area showed that fibroids were present in more than 80% of African American women and more than 70% of white women by age 50.

However not all of these patients need treatment. Only a third of the women who have myomas will become symptomatic from them. They are more likely to grow and become symptomatic in women who haven't had children. Why some women develop myomas and some do not is unknown; family history plays a part.

Risks factors for fibroids include: Early onset of menses, increasing age, low parity (small number of children), use of tamoxifen (Used in treatment and prevention of breast cancer), obesity, and, in some studies, a high fat diet.[i]

Fibroids only need to be treated if symptomatic. Symptoms that may be caused by myomas include: Pelvic pain, Painful periods (dysmenorrhea), Pain with intercourse (dyspareunia), Abnormal or excessive menstrual bleeding (Menometrorrhagia), Presence of a mass in the abdomen, pelvic pressure, urinary incontinence, urinary obstruction or urinary frequency can also be caused by fibroids. Anemia can be the presenting symptom in fibroids that cause excessive menstrual bleeding (Menorrhagia). Very large or numerous fibroids can also cause obstruction of the ureters (tubes that take the urine from the kidneys to the bladder)

Treatment of myomas can be surgical, medical or radiological.

Surgical therapy is the mainstay of treatment.

For myomas in younger, reproductive age women that desire further family, the treatment of choice is a myomectomy, that is: removal of the myomas via excision or shelling them out of the uterus. Depending on the individual patient this can be done laparoscopically through several small incisions in the abdomen, or open, the classic traditional way, often needed if there are many fibroids, or if they are deep in the uterus.

In women who no longer desire children, or who are beyond their reproductive years the definitive surgical treatment is hysterectomy (removal of the uterus). This can be done vaginally, which is the preferred route if possible, laparoscopically, a combination of both, or abdominally. In women beyond their reproductive years myomectomy is not recommended since there are usually smaller myomas left behind that will grow in size later. As many as 25% of women who have a myomectomy will later require a hysterectomy.[ii]

Medical treatment of myomas is based on reducing the circulating levels of estrogen and progesterone. This can be achieved with drugs called GnRH agonists, the most well known of this is DepoLupron. Reduction in size from 40-50% has been reported; however, once therapy is discontinued there is re-growth of the tumors which by 6 months after treatment will have reached their pretreatment size. The most common indication for this therapy is to shrink the tumors to facilitate surgery, or to shrink the uterus enough to make a vaginal approach feasible.

The radiologic treatment of myomas consists of the embolization of the uterine artery with different substances under X ray control. Post procedure pain is common for the first 24 hours and may last up to 2 weeks. Although the uterus remains in place, its blood supply is severely impaired and pregnancy is discouraged. If fertility is a factor myomectomy is preferred over uterine artery embolization.

[i] Vern L Katz, Comprehensive Gynecology, 5th ed, p441.

[ii]Ob Cit p446

Learn more about this author, Pedro Miranda.
Click here to send this author comments or questions.