Epidemiology
The uterine leiomyomas or myomas are the more frequent benign tumors of the female genital system (Figure 1 & 2). Almost 40% of the female population is diagnosed with uterine myomas, while 2/3 of those are presented during the reproductive age. It is also interesting that 20% of the hysterectomies worldwide are performed because of uterine leiomyomas.
The uterine leiomyomas or myomas are the more frequent benign tumors of the female genital system (Figure 1 & 2). Almost 40% of the female population is diagnosed with uterine myomas, while 2/3 of those are presented during the reproductive age. It is also interesting that 20% of the hysterectomies worldwide are performed because of uterine leiomyomas.
Symptoms
Almost the half of the women with uterine leiomyomas is presented with pelvic pain, and tenderness. However, some of them are diagnosed with anemia because of pathologic hemorrhage from the genital tract. The rest of the cases are asymptomatic and the diagnosis becomes after transvaginal or transabdominal ultrasound (TVUS & TAUS) of the pelvis and of the genital tract. In some cases the diagnosis of myomas introduces during the exploration of sub-fertility couple. Symptoms and signs of the woman are depended mainly from the size, the number and the position and the myomas.
Almost the half of the women with uterine leiomyomas is presented with pelvic pain, and tenderness. However, some of them are diagnosed with anemia because of pathologic hemorrhage from the genital tract. The rest of the cases are asymptomatic and the diagnosis becomes after transvaginal or transabdominal ultrasound (TVUS & TAUS) of the pelvis and of the genital tract. In some cases the diagnosis of myomas introduces during the exploration of sub-fertility couple. Symptoms and signs of the woman are depended mainly from the size, the number and the position and the myomas.
Treatment
Total hysterectomy with/without adnexectomy (fallopian tubes and ovaries) is a radical approach for patients with gross uterine myomas, heavy bleeding and for women who not desire fertility preservation (Figure 3). The enucleation is the most common conservative surgical therapeutic approach of leiomyomas. The enucleation is fertility sparing operation and it is the therapeutic option for younger aged patients (Figure 4). The former treatments (hysterectomy or enucleation) can be done via laparotomy or laparoscopy (Figure 5).
Total hysterectomy with/without adnexectomy (fallopian tubes and ovaries) is a radical approach for patients with gross uterine myomas, heavy bleeding and for women who not desire fertility preservation (Figure 3). The enucleation is the most common conservative surgical therapeutic approach of leiomyomas. The enucleation is fertility sparing operation and it is the therapeutic option for younger aged patients (Figure 4). The former treatments (hysterectomy or enucleation) can be done via laparotomy or laparoscopy (Figure 5).
Conservative medical approach is also offered of patients with uterine myomas. Medication which is used for the treatment of myomas is mainly the GnRH-analog and the aromatase inhibitors. Both of them down-regulate the production of the estrogen, which is the critical hormone of the myomas’ development. However, the use of the medical treatment for uterine myomas is temporary, especially for patient in reproductive age. The medication is used to postpone the surgical treatment because of patient’s medical pathology or severe anemia (heavy uterine bleeding because of myomas), which must be improved before the surgical approach.
Συμπέρασμα
Η αντιμετώπιση των λειομυωμάτων της μήτρας σήμερα είναι πολύπλευρη και απαιτεί εξατομίκευση της θεραπείας, η οποία είναι ανάλογη του αριθμού και του μεγέθους των λειομυωμάτων, καθώς και της ηλικίας και των απαιτήσεων της ίδιας της γυναίκας.
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IOANNIS Α. KALOGIANNIDIS MD, PhD
Associate Professor
Obstetrics Gynecology -
Gynecologic Oncology
Obstetrics Gynecology -
Gynecologic Oncology
SEE ALSO
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Colposcopy
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