ABSTRACT
Uterine leiomyomas are the most common benign tumors of reproductive age women, affecting between 20 and 50% of these women. Thus, it is not surprising that leiomyomas are among the most commonly encountered clinical entities by gynecologists in practice.1-5 They increase in prevalence with age, and they are more common in certain ethnic populations. For example, African-American women have a threefold greater frequency of myomas than Caucasian women. Other risk factors for leiomyomas include obesity, early age of menarche, race, and nulliparity, whereas protective factors include smoking and parity.1,6
While at least 50% of women with leiomyomas are asymptomatic, uterine myomas are responsible for a large diversity of symptoms. Menstrual abnormalities occur in 30% of women with uterine myomas.7 Other symptoms include pelvic pain or pressure, menometrorrhagia, dysmenorrhea, urinary retention, bowel dysfunction, and reproductive problems ranging from infertility to preterm labor.1,2,6,8,9 An estimated 3-5 billion dollars is spent annually in the United States for the diagnosis and management of myomas,10 making them also an important public health problem. A diagnosis of uterine myomas accounts for 35% of the approximately 600 000 hysterectomies performed yearly in the United States, contributing significantly to the cost associated with this common disorder.2,11-13 While surgery is indicated in a subgroup of women with uterine myomas (Table 8.1),2
given the associated cost and morbidity, conservative management has become the preferred first line of treatment for the majority of cases (Table 8.2).
