Causes, Symptoms and Treatments of Uterine Leiomyomas

Uterine leiomyomas, commonly known as fibroids, are benign smooth muscle tumours of the uterus. Despite being non-cancerous, they can cause significant morbidity in women of reproductive age. This article aims to provide a comprehensive overview of uterine leiomyomas, including their causes, symptoms, diagnosis, and treatment options.

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Types of Uterine Leiomyomas

Leiomyomas can be classified based on their location within the uterus.

Intramural Leiomyomas

Intramural leiomyomas are the most common type and develop within the myometrium, the muscular wall of the uterus. These tumours can cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure.

Submucous Leiomyomas

Submucous leiomyomas protrude into the uterine cavity and are associated with severe menstrual bleeding and reproductive issues, including infertility and recurrent miscarriages.

Subserosal Leiomyomas

Subserosal leiomyomas grow on the outer surface of the uterus and may exert pressure on adjacent organs, leading to symptoms such as urinary frequency and constipation.

Causes of Leiomyoma of Uterus

The exact aetiology of uterine leiomyomas remains elusive, though several factors are believed to contribute to their development.

Genetic Factors

Research indicates that genetic predisposition plays a significant role in the development of leiomyomas. Women with a family history of these tumours are at a higher risk. Specific genetic mutations and chromosomal abnormalities have been identified in leiomyomas, suggesting a hereditary component.

Hormonal Influence

Hormones, particularly estrogen and progesterone, are known to stimulate the growth of uterine leiomyomas. These tumours often enlarge during pregnancy when hormone levels are elevated and tend to shrink after menopause when hormone levels decline. The presence of hormone receptors on leiomyomas further underscores the role of hormonal regulation.

Growth Factors

Various growth factors, including transforming growth factor-beta (TGF-β) and insulin-like growth factor (IGF), have been implicated in the pathogenesis of leiomyomas. These factors promote cell proliferation and extracellular matrix production, contributing to tumour growth.

Environmental and Lifestyle Factors

Environmental exposures and lifestyle choices may also influence the risk of developing leiomyomas. For instance, obesity, high-fat diets, and exposure to endocrine-disrupting chemicals have been associated with an increased risk of these tumours.

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Symptoms of Leiomyoma of Uterus

The clinical presentation of uterine leiomyomas varies widely, ranging from asymptomatic to severe symptoms.

Menstrual Abnormalities

Heavy and prolonged menstrual bleeding, known as menorrhagia, is a common symptom. This can lead to anaemia and fatigue. Some women may also experience intermenstrual bleeding.

Pelvic Pain and Pressure

Leiomyomas can cause chronic pelvic pain and a feeling of pressure or fullness in the lower abdomen. This is particularly true for larger tumours.

Reproductive Issues

Submucous and intramural leiomyomas can interfere with conception and pregnancy. They may cause infertility, recurrent miscarriages, and complications during pregnancy and labour.

Urinary and Gastrointestinal Symptoms

Large leiomyomas, especially subserosal ones, can press against the bladder and rectum, leading to urinary frequency, urgency, and constipation.

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Diagnosis of Leiomyoma of Uterus

The diagnosis of uterine leiomyomas typically involves a combination of clinical evaluation and imaging studies.

Clinical Evaluation

A thorough history and physical examination are crucial. During a pelvic examination, the healthcare provider may palpate an enlarged, irregularly shaped uterus.

Imaging Studies

Ultrasound is the first-line imaging modality for diagnosing leiomyomas. It provides detailed information about the size, number, and location of the tumours. Magnetic resonance imaging (MRI) is used in complex cases to further characterize the leiomyomas and assess their impact on surrounding structures.

Hysteroscopy

Hysteroscopy involves inserting a thin, lighted telescope through the cervix into the uterine cavity. It allows direct visualisation of submucous leiomyomas and can be used for both diagnostic and therapeutic purposes.

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Treatments for Leiomyoma of Uterus

The management of uterine leiomyomas depends on the severity of symptoms, the size and location of the tumours, and the patient's desire for future fertility.

Medical Management

Medical treatments aim to alleviate symptoms and reduce tumour size.

Hormonal Therapies

Gonadotropin-releasing hormone (GnRH) agonists and antagonists can shrink leiomyomas by inducing a hypoestrogenic state. However, their use is limited by side effects and the potential for rapid tumour regrowth after discontinuation.

Non-Hormonal Options

Nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid can be used to manage menorrhagia. Iron supplements may be necessary to address anaemia.

Surgical Interventions

Surgical options are considered for women with significant symptoms or those who do not respond to medical treatment.

Myomectomy

Myomectomy involves the surgical removal of leiomyomas while preserving the uterus. It can be performed via hysteroscopy, laparoscopy, or open surgery, depending on the size and location of the tumours.

Hysterectomy

Hysterectomy, the complete removal of the uterus, is a definitive treatment for leiomyomas. It is typically reserved for women who have completed childbearing or those with severe symptoms unresponsive to other therapies.

Uterine Artery Embolization (UAE)

UAE is a minimally invasive procedure that involves injecting embolic agents into the uterine arteries to block blood flow to the leiomyomas, causing them to shrink.

Prevention of Leiomyoma of Uterus

While it may not be possible to prevent uterine leiomyomas entirely, certain lifestyle modifications can reduce the risk.

Healthy Diet and Regular Exercise

Maintaining a healthy weight through a balanced diet and regular exercise can help reduce the risk of leiomyomas. A diet rich in fruits, vegetables, and whole grains and low in red meat and high-fat dairy products is recommended.

Avoiding Environmental Toxins

Limiting exposure to endocrine-disrupting chemicals found in certain plastics, pesticides, and personal care products can help lower the risk.

Regular Health Screenings

Regular gynaecological examinations can facilitate early detection and management of leiomyomas, potentially preventing complications.

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Conclusion

Uterine leiomyomas are a common gynaecological condition with a wide range of symptoms and treatment options. Understanding the causes, types, symptoms, and treatment modalities can empower women to make informed decisions about their health. Early diagnosis and appropriate management are vital to improving the quality of life for those affected by these benign tumours.