Uterine Leiomyomas, Current Concepts: Pathogenesis, Impact on Reproductive Health, and Medical, Procedural, and Surgical Management
Section snippets
Leiomyoma Growth and Development
To understand medical therapy of leiomyomas requires some understanding of the myriad genetic factors and growth and steroid hormones that potentially influence leiomyoma development and growth. Unfortunately, estrogens have been perceived by many as the key, and even only stimulators of myoma growth, largely because the volume of a leiomyoma typically decreases following menopause. On the surface, this process seems to be simply related to hypoestrogenemia, even though the endocrinologic
Abnormal Uterine Bleeding
The mechanisms involved in leiomyoma-associated AUB are only beginning to be understood. First, leiomyomas themselves are typically and strikingly solid and relatively avascular, so bleeding from the myoma itself is probably rare. On the other hand, the myoma may be surrounded by a relatively rich vasculature. When hysteroscopy demonstrates submucous leiomyomas (Lsm) in women with heavy menstrual bleeding (HMB), in most instances the tumors are covered by endometrium, whereas in others
Diagnosing and Characterizing Leiomyomas
Because uterine leiomyomas are highly prevalent and frequently asymptomatic, it is important to both obtain a detailed and structured history and undertake a careful evaluation of the uterus before concluding that leiomyomas are contributing to the clinical problem. Just because there are symptoms and leiomyomas, the two are not necessarily related in a cause-effect fashion.
The diagnosis of leiomyomas is generally accomplished with one or a combination of hysteroscopy and radiologic techniques
Expectant Management of Leiomyomas
The process of watchful waiting is an option for most women with leiomyomas; however, counseling is difficult, in part because of variability in the natural course of any group or collection of tumors. The Fibroid Growth Study followed 262 leiomyomas in 72 women using sequential MRI scans over a period of 12 months. The median growth rate was 9%, but serially measured volume varied from an 89% reduction to a 138% increase.40 Tumors in the same women grew at different rates, and whereas growth
Medical Management of Leiomyomas
The use of medical therapy has expanded due to new information about the factors that affect myoma growth, the availability of new therapeutic agents, and a more reasoned understanding of the relationship of leiomyomas to symptoms. However, it is unlikely that these agents will have much of a role for women with infertility and AUB-Lsm because reduction (not elimination) of the structural distortion of the cavity is unlikely to result in improved fertility or pregnancy performance.
Myomectomy
In 1845, Atlee65 first reported removal of leiomyomas via laparotomy, traditionally called abdominal myomectomy. The principles of contemporary abdominal myomectomy were established by Bonney,66 with his publication of 20 years of experience and amplified by his 1946 report of 806 cases. The low morbidity and mortality were remarkable, with only 2 deaths in the last 400 cases (overall mortality of 1.1%).
Like many surgical procedures that were introduced in the 19th and 20th centuries, abdominal
Summary
Leiomyomas are such common tumors of the uterus that at least two-thirds of women will have at least one by the age of 50. Despite this high incidence, we know relatively little about their cause, growth and development, and contribution to the genesis of reproductive disorders. The prevalence of lesions puts women with associated but unrelated symptoms at risk for unnecessary and/or unsuccessful interventions, especially if they have not been carefully evaluated and counseled. Indeed, because
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Deoxyelephantopin, a novel naturally occurring phytochemical impairs growth, induces G2/M arrest, ROS-mediated apoptosis and modulates lncRNA expression against uterine leiomyoma
2020, Biomedicine and PharmacotherapyCitation Excerpt :In this study, we have also shown that DOE significantly decreased the expression of ECM component like α-SMA and collagen mRNA expression in UL cells support the notion that DOE might suppress some signaling pathways which are actively involved in ECM production. It is reported that DOE has the ability to activate the β-Catenin pathway to trigger apoptosis by suppressing the expression of Cyclin and Cyclin D [16,20,51,52]. It is reported that DOE decreases the expression of mRNA matrix metalloproteinase (MMP-2 and MMP-9) and increases the expression of the tissue inhibitor of matrix metalloproteinase (TIMP1 and TIMP2) in cancer cells [53,54].
Diagnostic Imaging: Obstetrics
2016, Diagnostic Imaging: ObstetricsImaging for Uterine Myomas and Adenomyosis
2014, Journal of Minimally Invasive GynecologyCitation Excerpt :Hysterectomy remains the definitive treatment option. Other treatment options that enable uterine preservation include myolysis via freezing or hypothermia and hyperthermic ablation via laser or radiofrequency electrical energy [20–26]. An in-depth discussion of these various techniques is beyond the scope of this article.
Cutaneous Hamartoneoplastic Disorders
2013, Emery and Rimoin's Principles and Practice of Medical GeneticsEmergency Evaluation and Management of Vaginal Bleeding in the Nonpregnant Patient
2012, Emergency Medicine Clinics of North AmericaCitation Excerpt :Most clinically relevant fibroids are submucosal. The symptoms of fibroids vary from common complaints of abnormal uterine bleeding to rare presentations related to excessive growth and mass effect on adjacent organs (Table 1).6 Fibroids can present with a combination of symptoms, making the diagnosis challenging.
Endovascular Embolization of Uterine Myomas and Adenomyosis
2023, Diagnostic and Interventional Radiology in Gynecological and Obstetric Diseases
Disclosures: Consultant for Aegea Inc, Bayer Healthcare, Boston Scientific, Ethicon Endosurgery, Ethicon Women's Health and Urology, Gynesonics Inc, Idoman Teoranta, Karl Storz Endoscopy Americas.