Uterine leiomyomas epidemiology, diagnosis, and management

Introduction Uterine leiomyomas (leiomyomata or fibroids) are benign, smooth muscle tumors of the human uterus that represent one of the most common gynecological problems in women of reproductive age. While most leiomyomas are asymptomatic, they can result in debilitating symptoms that significantly impact quality of life. They are the primary indication for nearly 600 000 hysterectomies performed each year in the USA, and for 37 000 myomectomies performed annually. Risk factors for the development of myomas, complications and symptoms related to fibroids, and reproductive outcomes related to these benign tumors are areas of controversy. Patients are frequently confused or unaware of the range of options available for myoma treatment. This chapter reviews the epidemiology, symptomatology, diagnosis, medical therapy, and surgical treatment of fibroids. Controversies still existing in the literature are also reviewed as are suggested future directions for research and current principles for counseling patients with fibroids. Epidemiology The exact incidence of leiomyomas in women of reproductive age is difficult to ascertain for several reasons. Primarily, the majority of fibroids are asymptomatic, resulting in low clinical detection rates. Cadaveric studies are also hampered by the fact that many fibroids regress in size with age. Furthermore, different diagnostic methodologies have highly variable sensitivities for the detection of uterine leiomyomas, further affecting incidence rates.