SeminarUterine fibroids
Section snippets
Epidemiology
Myomas respond to the gonadal steroids oestrogen and progesterone, and their epidemiology parallels the ontogeny and life-cycle changes in reproductive hormones. Myomas have not been described in prepubertal girls. Although they have been reported occasionally in adolescents, most women are in their 30s or 40s when the myomas become symptomatic. In many women the symptoms are relieved at the time of menopause, when menstrual cyclicity and steroid hormone concentrations wane. However,
Pathophysiology
The pathophysiology of myomas is not well understood. However, genetic predisposition, as well as steroid hormone concentrations, has a role in formation and growth of these tumours, as do growth factors important in fibrotic processes and angiogenesis. The function and structure of the endometrium are important to the pathogenesis of myoma-related bleeding. Increasing attention to research on this disorder, highlighted by events such as the Advances in Uterine Leiomyoma Research Conference
Treatment
Uterine myomas, as benign tumours, can generally be managed expectantly unless they cause symptoms. Several factors determine treatment, including the size and location of the myomas, the presenting symptoms, the age and reproductive desires of the patient, and the skill of the surgeon. There has been little evidence-based assessment of myoma therapies. The US Agency for Healthcare Research and Quality has undertaken a comprehensive survey of evidence-based treatment for myomas, and a final
Future directions
The biology of uterine myomas has traditionally been explained in terms of steroid hormones, and thus all current medical therapies manipulate these hormones, There are innovative ways to modulate the actions of both oestrogen and progesterone selectively. The use of GnRH antagonists rather than the more common GnRH agonists gives the additional benefit of a rapid onset of action.60, 61 Although this approach may not give benefit for long-term treatment, for preoperative management it will be a
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