FIBROID TUMORS OF UTERUS
(Myomas; Leiomyoma)

What is It?

* A benign growth of cells in the muscular wall of the uterus.* Cells are composed of muscle cells, and not fibrous tissue. May be present as solitary or multiple tumors.* Common condition, not cancerous.* Present in 20 to 25% of women of child-bearing age.

Causes

* Unknown.* Need estrogen for maintenance, as they are extremely rare before puberty or after menopause, and they sometimes grow rapidly in pregnancy.

Signs and Symptoms

* Often no symptoms. Discovered on a routine pelvic examination.* About 30% of patients report heavier and more frequent menses.* Increased menstrual discomfort.* Bleeding between periods.* Painful sexual intercourse or bleeding after intercourse.* Anemia (weakness, fatigue, and paleness).* Feelings of pressure on the urinary bladder or rectum.* May cause infertility.

Risk Factors

* Use of estrogen replacement therapy and use of oral contraceptives with high estrogen content.* Genetic factors.Fibroid tumors are 3 to 9 times more common in black women than Caucasian women.

Prevention

Cannot be prevented at present.

Diagnosis and Treatment General Measures

* Diagnostic tests may include laboratory blood studies, ultrasound; MRI, laparoscopy; or hysterosalpingogram.* Treatment will be individualized depending on symptoms, diagnostic tests, age of the patient and desire for future pregnancy.* For minimal symptoms, no treatment may be needed. Follow-up every 3-6 months.* Surgery may be recommended for certain situations and several different surgical procedures are possible. If surgery is recommended, be sure you understand all aspects of it before making a decision.* Record dates of bleeding and number of pads used each day.

Medication

* If you have a small fibroid, don't take contraceptive pills with a high estrogen content. Estrogen may cause fibroids to enlarge. Consider other forms of contraception, such as a diaphragm, cervical cap, IUD, condom, or contraceptive foam, sponge or jelly.* Iron supplements if you are anemic from excessive blood loss.* Estrogen must be used with caution in post-menopausal women with fibroids.

Activity

No restrictions unless surgery performed. Then you may need bed rest for a period of time, some restricted activity, and no sexual intercourse for approximately one month.

Diet

No special diet.

Possible Complications

* Malignant change in the fibroid tumor (occurs in less than 0.5%). This rare complication is usually signaled by very rapid growth.* Complications can occur in pregnancy such as spontaneous abortion and premature labor.* Fibroids may return following surgery to remove them.

Prognosis

* If surgery is not necessary prior to menopause, these tumors usually decrease in size without treatment after menopause.* Hospitalization, if surgery is necessary. Fibroids are generally removed surgically if they cause excessive bleeding, become malignant, or produce symptoms that interfere with conception or pregnancy.* Fibroids can often be removed surgically without removing the entire uterus. The ability to conceive continues as long as the uterus remains.