The management of Uterine Leiomyomas

Posted by e-Medical PPT
The majority of fibroids are asymptomatic and will not require intervention or further investigations.
For the symptomatic fibroid, hysterectomy offers a definitive solution.
However, it is not the preferred solution for women who wish to preserve their uterus.
The predicted benefits of alternative therapies must be carefully weighed against the possible risks of these therapies.
In the properly selected woman with symptomatic fibroids,the result from the selected treatment should be an improvement in the quality of life.

Introduction
Uterine leiomyomas are the most common gynaecological tumours and are present in 30% of women of reproductive age.
The majority of uterine leiomyomas are asymptomatic and will not require therapy.
However,75% of hysterectomies are performed for menorrhagia with fibroids.

Clinical Features
The vast majority of leiomyomas are asymptomatic.
The most common symptom of uterine leiomyoma is abnormal uterine bleeding.
In published series of myomectomies , 30% of women suffered from menorrhagia.

The mechanism of fibroid-associated menorrhagia is unknown.
Vascular defects,
Submucous tumours, and
Impaired endometrial hemostasis
have been offered as possible explanations.

Pelvic pain is rare with fibroids and it usually signifies degeneration, torsion, or, possibly, associated adenomyosis.
Pelvic pressure, bowel dysfunction, and bladder symptoms such as urinary frequency and urgency may be present.

Urinary symptoms should be investigated prior to surgical management of fibroids to exclude other possible causes.

In the postmenopausal woman presenting with pain and fibroids, leiomyosarcoma should be considered.
Clinical examination is accurate with a uterine size of 12 weeks (correlating with a uterine weight of approximately 300 g) or larger.

Ultrasonography is helpful to assess the adnexa if these cannot be palpated separately with confidence.
Although reliable in measuring growth,routine ultrasound is not recommended as it rarely affects clinical management.
In women with large fibroids, diagnostic imaging will occasionally demonstrate hydronephrosis, the clinical significance of which is unknown.
Complete ureteric obstruction is extremely rare.
In women who present with abnormal uterine bleeding,it is important to exclude underlying endometrial pathology..

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