Uterine Fibroids

Description

Uterine leiomyomas or fibroleiomyomas (uterine fibroids) are well circumscribed, pseudo-encapsulated benign tumors composed mainly of smooth muscle but with varying amounts of fibrous connective tissue. There are three major types: Submucous: 5% of total, susceptible to abnormal uterine bleeding, infection and occasionally protrude from cervix; Subserous: Common, may become pedunculated and rarely parasitic; and Intramural: Common, may cause marked uterine enlargement.

Causes

Uterine fibroids may arise from totipotential cells normally giving rise to muscle and connective tissue cells, or they may arise from small immature smooth muscle cell nests. There is a positive correlation with estrogen stimulation (i.e., uterine fibroids are not seen before menarche, may grow rapidly during pregnancy, with use of oral estrogen, and with estrogen producing tumors. Myomas regress following pregnancy and after menopause.)

Risk factors for uterine fibroids include: Later reproductive and perimenopausal age groups. The incidence is 3-9 times higher among African-Americans.

Conventional Labs

Standard lab tests include a pregnancy test; CBC with differential count; SED rate; and a CA-125 (which may be slightly elevated in some cases of uterine myomas, but generally is more useful in differentiating myomas from various gynecologic adenocarcinomas).

Diagnostic imaging includes ultrasonography (which shows a characteristic hypoechoic appearance). A CT scan or MRI may help to differentiate complex cases. An Intravenous pyelogram (IVP) or barium enema may be ordered.

Presumptive diagnosis can be made by abdominal and pelvic examination. A fractional D & C aids in ruling out cervical, uterine carcinomas. Hysteroscopy may help diagnose submucous myomas. Laparoscopy may be useful in complex cases and in ruling out other pelvic pathology.

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