Uterine Leiomyomas- An Insight

What Are the Uterine Leiomyomas?

Uterine leiomyomas are also called uterine fibroids. These are non-cancerous uterine fibroid growths. They occur at childbearing age. Leiomyomas can range in size, from pin size to bulky developments. Leiomyomas do not present any symptoms. They are diagnosed incidentally on physical examination or diagnosis.

What Are the Symptoms of Uterine Leiomyomas?

Generally, leiomyomas do not show any symptoms. However, depending on the size, number, and position of the uterine growth, the symptoms can be as follows:

• Heavy menstruation.

• Longer menstrual cycle.

• Spotting or bleeding without periods.

• Anemia.

• Pelvic pain.

• Increased urination.

• Constipation.

• Incomplete emptying of the bladder.

• Back Pain.

• Leg pain.

How Are the Uterine Leiomyomas Classified?

Uterine leiomyomas are classified according to the location:

• Intramural leiomyomas grow in the uterine muscle.

• Submucosal leiomyomas bulge into the uterus.

• Subserosal leiomyomas are present outside the uterus.

What Are the Causes of Leiomyomas?

The exact cause of leiomyomas is not known yet. Yet the following are the reasons attributed to leiomyomas:

• Hormonal Changes:

Estrogen and progesterone are the hormones that help in uterine development during the menstruation cycle. However, these hormones promote the growth of leiomyoma. These leiomyomas contain estrogen and progesterone receptors. This growth shrinks after menopause.

• Genetic Changes:

The genetic mutation leads to the development of leiomyomas.

• Growth Factors:

Growth factors and insulin-like growth factors might promote the formation of leiomyomas.

• Extracellular Matrix:

Cells are bound together with the help of an extracellular matrix. This extracellular matrix increases in leiomyomas. This extracellular matrix also has growth factors.

How Does a Leiomyoma Develop?

Leiomyoma develops from a stem cell from the smooth muscle of the uterus. This cell divides to form firm, rubbery growth. This growth is different from the surrounding tissue. These leiomyomas flow either slowly or rapidly. They increase in size during a growth spurt and shrink on their own. Some leiomyomas occur during pregnancy and shrink post childbirth.

What Are the Risk Factors Associated With Leiomyomas?

There are a few factors associated with uterine leiomyomas. These factors are as follows.

• Hereditary:

If it is genetically present in the mother and sister, it increases the risk of developing leiomyomas.

• Race:

Black women are at higher risk for developing leiomyomas than other races. In addition, with severe symptoms, black females can develop them at a younger age.

• Vitamin A deficiency.

• Obesity.

• Alcohol consumption.

What Are the Complications Associated With Leiomyomas?

Leiomyomas are not a life risk. However, sometimes excessive blood loss can cause anemia and may require a blood transfusion. Submucosal leiomyomas can cause infertility or miscarriages. In addition, leiomyomas can increase the risk of placental abruption, fetal growth restriction, and preterm delivery.

How to Prevent Leiomyomas?

Sometimes it is not possible to prevent leiomyomas. However, the following are the ways to avoid them:

• Healthy lifestyle changes.

• Maintaining weight.

• Use of hormonal contraceptives.

How to Diagnose Uterine Leiomyomas?

Uterine leiomyomas are found accidentally on examination by findings like the irregular shape of the uterus. Following are the methods to diagnose leiomyomas:

• Ultrasound:

Use of sound waves to confirm the presence of leiomyomas of the uterus. The ultrasound device is run over the pelvis to get images of the uterus.

• Magnetic Resonance Imaging:

MRI scans can show the location and size of these growths. MRI is done in menopausal women.

• Hysterosonography:

Hysterosonography is a saline infusion sonography. Saline solution is used to expand the uterine cavity. This technique makes it easier to obtain uterine images.

• Hysterosalpingography:

This technique uses a dye, making it easier to visualize the uterine cavity and fallopian tubes on X-ray imaging. These can help detect blockages in the fallopian tubes.

• Hysteroscopy:

Hysteroscope is a small lighted telescope. First, a hysteroscope is inserted into the cervix. Next, saline solution is injected into the uterus to check the uterine cavity and openings of the fallopian tubes.

• Laboratory Tests:

Abnormal menstrual bleeding necessitates a complete blood count to rule out other bleeding disorders.

How to Treat Leiomyomas?

There are many treatment options available to treat leiomyomas. If leiomyomas are present without symptoms, wait and watch can be the option. Following are some of the possibilities:

• Medications:

Hormonal therapy can help regulate menstruation. In addition, hormones can reduce bleeding and reduce pain.

• Gonadotropin Releasing Hormone Agonist:

These medications inhibit estrogen and progesterone. As a result, GRHA pauses the menstruation temporarily and shrinks the leiomyomas. Leuprolide, Goserelin, and Triptorelin are gonadotropin-releasing hormone antagonists.

• Progesterone Releasing Intrauterine Device:

This device relieves heavy bleeding. This device is used only for relief. It acts as a method of contraception too.

• Tranexamic Acid:

Tranexamic acid helps to reduce heavy menstrual bleeding.

• Nonsteroidal Anti-inflammatory Drugs:

These are the medicines that help with pain relief.

• Vitamins and Iron Supplements:

Vitamin supplements are used to overcome anemia caused due to excessive bleeding.

• Non-invasive Treatment:

MRI-guided ultrasound surgery is performed on an outpatient basis. It does not require any incision. MRI imaging gives the precise location of the leiomyomas. Ultrasound waves are focused. This process produces heat and destroys growth.

• Minimally Invasive Treatment:

Actual surgical procedures can be avoided, and minimally invasive treatment options can be considered.

• Uterine Artery Embolization:

Embolic agents are injected into the arteries. These embolizing agents disrupt the blood supply to the leiomyomas and bring about shrinkage.

• Radiofrequency Ablation:

Radiofrequency shrinks the blood vessels and destroys the leiomyomas. Two incisions are placed with a laparoscope, which helps locate the growth. Several needles are inserted in the growth, followed by heating.

• Cryomyolysis:

Cryomyolysis is a procedure that involves the freezing of leiomyomas.

• Laparoscopic Myomectomy:

In laparoscopic myomectomy, the leiomyomas are removed in total, keeping the uterus in place.

• Hysteroscopic Myomectomy:

When the leiomyomas are present submucosally, instruments are inserted through the vagina and cervix to remove the leiomyomas.

• Endometrial Ablation:

A specialized instrument is inserted into the uterus. This procedure emits heat, microwaves, and electric waves and removes the uterine lining.

Surgical Treatment:

• Abdominal Myomectomy:

Abdominal myomectomy is open abdominal surgery to remove the leiomyomas.

• Hysterectomy:

Hysterectomy is a surgical procedure that removes the uterus completely.

Conclusion:

Uterine leiomyomas are commonly seen in females of childbearing age. Leiomyomas rarely affect pregnancy. However, they can cause severe menstrual bleeding and pain, negatively affecting a woman's life.