- leiomyoma that originates in the myometrium of the uterus

leimyosarcoma is extremely rare

- doesnt usually lead to infertility (unless the position physically blocks)
- round, well circumscribed (but not encapsulated) and show whorled histology
- 3 benign variants (atypical, cellular, and mitotically active)
Locations
-intramural: within wall and most common
-subserosal: underneat the peritoneal surface (can become pedunculated and detac
h from uterus -> parasitic leiomyoma)
-submucosal: muschle beneath endometrium (even small ones cause bleeding and inf
ertility) (also possible to have intracavity fibroid that can be passed through
the cervix)
-cervical: wall of cervix (neck of uterus)
Risk factors: African descent, nulliparity, obesity, polycystic ovary syndrome,
diabetes, and hypertension
Fibroid growth dependent on estrogen and progesterone - except during pregnancy

Diagnosis
- bimanual for larger ones; ultrasound for all
Treatment
-medication to control symptoms (menses - NSAIDs; bleed - OCP; anemia - Fe supp;
IUD due to low progestin release)
-medication aimed at shrinking tumors (Danazol shrinks fibroids and controls sym
ptoms; Dostinex; Temp shrinking for preop by GnRH analogs which reduce estrogen
levels)
-ultrasound fibroid destruction
-myomectomy or radio frequency ablation
-hysterectomy
-uterine artery embolization
- NEW: MRI guided focussed ultrasound (non invasive)
Epidemiology
- 80% AA women will develop fibroid by late 40's
- AA women: younger age, grow quicker, and more likely to cause symptoms
- possible relationship between hair relaxers, decreased dairy, and Ca Mg Phos