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Leiomyomas usually occur during the third and fourth decades, and are often multiple, although a single tumor may occur. They are usually small but may grow quite large and occupy most of the uterine wall; after menopause, growth usually ceases. Symptoms vary according to the location and size of the tumors. As they grow they may cause pressure on neighboring organs, painful menstruation, profuse and irregular menstrual bleeding, vaginal discharge, or frequent urination, as well as enlargement of the uterus.
In pregnancy, the tumors may interfere with natural enlargement of the uterus with the growing fetus. They may also cause spontaneous abortion and death of the fetus.
Small leiomyomas are usually left undisturbed and are checked at frequent intervals. Larger tumors may be removed surgically, sometimes accompanied by a hysterectomy, or medication may be prescribed to induce a temporary menopause.
Leiomyomas may sometimes cause abdominal or pelvic heaviness, abnormal uterine bleeding, frequent urination, dysparunia, or pain.
Leiomyomas are classified according to their location. Subserous leiomyomas are found in the peritoneal covering of the uterus. They may be large or small, firm protuberances from the outer surface of the uterus or be attached by pedicles. Intraligamentous leiomyomas are found in the broad ligament. They may have uterine attachment. Intramural leiomyomas are found in the muscle wall of the uterus. If large, they can give the uterus a nodular, irregular shape. Submucosal leiomyomas are found next to the endometrium. Their most common symptoms are excessive, often abnormal bleeding, abdominal cramping, or pain. Cervical leiomyomas may cause stress incontinence, polyuria, dysparunia, or increased vaginal discharge.
These tumors grow only during the reproductive years, often regressing after menopause. Surgical treatment (myomectomy or hysterectomy) may be necessary if tumors are more than 20 weeks' gestational size. Some tumors may be removed laproscopically although submucous tumors are removed by dilatation and curettage (D& C) or by hysteroscopy. Gonadotrophin-releasing hormones (GnRH) cause suppression of ovarian hormones and may cause tumors to shrink. Synonym: fibroid tumor; fibroid of uterus; fibromyoma (2); myoma uteri; uterine fibroma