(Fibroids distorting the uterus.)

• Fibroids are solid tumors of the muscle cells of the uterus.
• They are very common, present in 25-50 percent of women. Most women are asymptomatic and never require treatment, though fibroids are the most common reason given for hysterectomy.
• The most frequent symptoms are abnormal uterine bleeding and pain. Patients also may report pressure, painful intercourse and urinary frequency.
• When the symptoms include abnormal uterine bleeding, other causes such as endometrial cancer should be ruled out.
• Rarely are fibroids in the uterus actually a cancer or sarcoma. 2-3/1000.of hysterectomy specimens. This is suspected more with rapidly growing fibroids.
• There are numerous therapies for fibroids:
  • Cyclic ocps or provera can be tried to decrease bleeding problems.
  • NSAIDs like ibuprofen.
  • GnRH agonists, most commonly LUPRON. May be used short-term to shrink or decrease symptomatology.
  • Hysterectomy.
  • Myomectomy: reoperation rate of 15-20 percent.
  • Endometrial ablation.
  • Uterine artery embolization.
• Sources: Surgical Alternatives to Hysterectomy in the Management of Leiomyomas. ACOG Practice Bulletin. #16, May, 2000.