Leiomyomas are benign tumors that are composed of muscle cells, and are referred to by their common name, fibroids. They are quite common in women; risk factors for their development include increasing age, obesity, African American race and early onset of menstruation. While normally clinically silent, they can often cause complications that may necessitate treatment, both medical and surgical.
Degeneration
Fibroids have a tendency to increase very rapidly in size, often outgrowing their own blood supply. This results in various degrees of degeneration, including frank tissue death and necrosis. This causes severe pain and bleeding, and the dying tissue can become infected as well. Treatment is medical in the case of pregnant patients due to the risk of bleeding, but otherwise surgery is often pursued.
Malignancy
Very rarely, the tumor converts into a sarcoma, which is a very malignant tumor. The risk of this transformation increases with age, and some doctors believe the sarcoma often simply arises in women with fibroids and there is no actual "conversion." Either way, treatment is imperative.
Mass Effects
Since fibroids can grow quite large, most of the symptoms occur because their mass affects surrounding structures. They may place pressure on urinary structures such as the ureter, resulting in obstruction to urine flow and also increased need for urination with impingement on the bladder. Often the tumor exerts pressure on an important blood vessel, decreasing blood flow to other body tissues and causing pain as well. Pain with menstruation is another very common complaint. In addition, fibroids can distort the uterine cavity, resulting in infertility.
Abnormal Bleeding
Most commonly, fibroids manifest with increased bleeding at menstruation, but midcycle spotting and normal pattern disruption have also been noted by those affected. Additionally, menstrual cycles may be longer and heavier.
References
- "Comprehensive Gynecology, 5th Edition;" V.L.D. Katz, M.D., et al.; 2007
- "American Family Physician;" Uterine Fibroid Tumors; P. Evans and S. Brunsell; May 2007
- "Surgical Clinics of North America;" Benign Gynecological Conditions; K. Boyle and S. Torrealday; April 2008
