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UTERINE FIBROID SUMMARY

  1. Uterine fibroids are remarkably common. Fine serial sectioning of uteri from 100 consecutive women who underwent to hysterectomy found fibroids in 77%.
  2. Fibroids are monoclonal, and about 40% are chromosomally abnormal; the remaining 60% may have undetected mutations.
  3. Genetic differences between fibroids and leiomyosarcomas indicate that they most likely have distinct origins and that leiomyosarcomas do not result from malignant degeneration of fibroids.
  4. Both estrogen and progesterone appear to promote the development of fibroids. Growth factors produced by smooth muscle cells and fibroblasts control proliferation and stimulate fibroid growth.
  5. First-degree relatives of women with fibroids have a 2.5 times increased risk of developing fibroids. African-American women had a 2.9 times greater risk of having fibroids, have fibroids present at a younger age, and have more numerous, larger and more symptomatic fibroids than Caucasian women.
  6. There is no definite relationship between oral contraceptives and the presence or growth of fibroids, and hormone therapy will not stimulate fibroid growth in the majority of postmenopausal women.
  7. The association of fibroids with menorrhagia has not been clearly established. Other possible causes, including coagulopathies such as von Willebrand disease, should be considered. Women with fibroids are only slightly more likely to experience pelvic pain than women without fibroids.
  8. In premenopausal women, ‘‘rapid uterine growth’’ almost never indicates the presence of uterine sarcoma. The preoperative diagnosis of leiomyosarcoma in premenopausal and postmenopausal women may be possible using total serum lactic acid dehydrogenase (LDH), LDH isoenzyme 3, and gadolinium-enhanced dynamic MRI (Gd-DTPA).
  9. The presence of submucous fibroids decreases fertility, and their removal increases fertility to baseline rates. Neither intramural nor subserosal fibroids appear to affect fertility rates, and removal has not been shown to increase fertility.
  10. Pregnancy has a variable and unpredictable effect on fibroid growth, but most fibroids do not increase in size during pregnancy. Very rarely does the presence of a fibroid during pregnancy lead to an unfavorable outcome. Uterine rupture during pregnancy or delivery as a consequence of abdominal myomectomy appears to be extremely rare.