Uterine leiomyomata (commonly known as fibroids or myomas) are the most prevalent gynecological condition that are noncancerous growths of the uterus often develop during a person’s childbearing years. They arise from the smooth muscle tissue of the uterus and vary in size, number, and location. These tumors are a leading cause of hysterectomies.
They can go undetected in most women, and approximately 25% of women show clinical symptoms. Although fibroids are a global burden impacting 80% of premenopausal women( 35-44 age group), they are more prevalent among Black women than among women of other races. Based on clinical diagnosis, the estimated cumulative incidence of fibroids in women
≤50 years old is significantly higher for black (>80%) versus white women (∼70%).
Uterine fibroids (leiomyomas)involves a complex interplay of genetic, hormonal, and cellular factors that lead to the development and growth of these benign tumors. While the exact mechanisms are not fully understood, several key factors contribute to their formation: firstly, we might see the Abnormalities in chromosomes 6, 7, 12, and 14 are commonly associated with fibroids, second is the Hormonal Influences; Fibroids are a result of the inappropriate growth of uterine smooth muscle tissue or myometrium. Their growth is dependent on estrogen and progesterone levels,
Estrogen stimulates the proliferation of uterine smooth muscle cells.
Progesterone enhances cell survival and inhibits programmed cell death (apoptosis).
The most important and frequently reported risk factor for uterine fibroids is race, disproportionately impacting African American women. Other risk factors include older age, premenopausal state, nonparty, family history of uterine fibroids, hypertension, food additives, tobacco, smoking and alcohol abuse and frequent consumption of soybean milk. Other important risk factors include obesity, vitamin D deficiency , and excessive vitamin E levels.
Symptoms of Uterine Fibroids vary depending on the size, number, and location of the fibroids. Many individuals with fibroids are asymptomatic, but when symptoms do occur, they can significantly impact quality of life. Common symptoms like ; Heavy Menstrual Bleeding ,
Irregular Bleeding: Spotting or bleeding between periods, painful Periods (Dysmenorrhea), Pelvic Pain or Pressure: A feeling of fullness or discomfort in the lower abdomen, enlarged Uterus, Pain During Intercourse (Dyspareunia), Frequent Urination due to Pressure on the bladder from large fibroids ,Difficulty Emptying the Bladder as Fibroids may obstruct the bladder, Constipation, Infertility, Increased risk of miscarriage, preterm labor, or cesarean delivery, lower back pain, and leg pain and swelling are some symptoms of uterine fibroids.
The initial evaluation should include a beta-human chorionic gonadotropin test to rule out pregnancy, CBC, TSH, and a prolactin level to evaluate for the non-structural causes in the differential. Include an endometrial biopsy for women over 35. Transvaginal ultrasound is the gold standard for imaging uterine fibroids. It has a sensitivity of around 90 to 99% for the detection of uterine fibroids, Hysteroscopy is where the physician uses a hysteroscope to visualize the inside of the uterus. This imaging modality allows for better visualization of fibroids inside the uterus , Magnetic Resonance Imaging MRI has the benefit of providing a better picture of the number, size, vascular supply, and boundaries of the fibroids as they relate to the pelvis. Nevertheless, it is unnecessary for a routine diagnosis when fibroids are suspected.
While deciding on treatment options for uterine fibroids, the patient's age, presenting symptoms, and desire for fertility preservation all merit consideration. Medical Management includes: Hormonal contraceptives: This treatment group includes oral contraceptive pills (OCP) and the levonorgestrel intrauterine device(IUD). OCPs are common options in the management of abnormal uterine bleeding related to symptomatic fibroids, Nonsteroidal Anti- Inflammatory Drugs (NSAIDs): Anti-inflammatories have been shown to decrease prostaglandin levels, which are elevated in women with heavy menstrual bleeding and are responsible for the painful cramping experienced in menstruation. They have not been shown to decrease the size of the fibroids. GnRH Agonist (leuprolide): This method works by acting on the pituitary gland to decrease gonadal hormone production, thus decreasing the hormone- stimulated growth of the fibroid. And some surgical methods include: • Hysterectomy. Remains the definitive treatment for fibroids, Endometrial Ablation. It offers an alternative to surgery in patients whose primary complaint is heavy or abnormal bleeding , Myomectomy: Surgical removal of fibroids while preserving the uterus. etc.

Summary

Fibroids can be a complicated diagnosis to manage for any patient who desires pregnancy, may have limited access to healthcare or has one of the non-modifiable risk factors associated with the disease. While hormone and anti-inflammatory therapy can help to slow the progression of fibroids, the emphasis has been on improving outcomes with minimally invasive and fertility-preserving procedures.

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