PATHOPHYSIOLOGY

OF LEIOMYOMA

Definition of the disease:

Uterine Leiomyomas are the most common pelvic
tumors of reproductive- age women (Ling & duff,
2009). They occur in up to to 50% of patients in
autopsy series, and are more common in AfricanAmerican women.
They are composed of smooth muscle cells
within a fibrous tissue matrix and are unicellular
in origin. The growth of these benign tumor tends
to be promoted by estrogen and other growth
factors

Definition of the disease:

Uterine fibroids are leimyomas of the uterine
smooth muscle.
They may vary in size and location. Leiomyomas
may be submucuous, intraligamentous,
peduncultated or parasitic.
As other Leiomyomas, they are benign, but may
lead to excessive menstrual bleeding
(menorrhagia). often cause anemia and may lead
to infertility.

Definition of the disease:

enucleation is removal of fibroids without
removing the uterus (hysterectomy), which is also
commonly performed.
Laser surgery (called myolysis) is increasingly
used, and provide a viable alternative to
traditonal surgeries.
Oral contraceptoive pills can be used to decrease
excessive menstrual bleeding and pain associated
with uterine fibroids.

CLASSIFICATION BY
LOCATION
Submucosal - lie just beneath the endometrium
Intramural - lie within the uterine wall
Subserosal - Lie in the serosal surface of the
uterus or may bulge out from the myometrium
and can become peduculate

 The tumor can become malignant in less than

0.1% of patients, which should serve as comfort
to women concerned with the possibility of
uterine malignancy in association with a fibroid
(McCann & Holmes, 2003)

PREDISPOSING FACTORS:
1. AGE is a risk factor in the disease process of the
uterine leiomyomas. this is due to the differences of
estrogen and progesterone levels in females as they
get older and undergo the processess of menopause.

2. RACE although an actual connection between the
disease process and race have yet to been validated
and affirmed, many studies have shown that particular
races such as Amercian and African American are
more susceptible to tumor growth in the endometrial
lining among premenopausal women.

PREDISPOSING FACTORS:
3. HEREDITY Women whose mothers have had
myoma themselves are more susceptible to getting
the disease that those who have no family history of
the disease.

4 EARLY MENARCHE AND NULLIPARITY Studies have
suggested that an early start of menarche (less than
the average of 13) and nulliparity contribute to the
development of a uterine leiomyoma, however, how
this connection or relationship between the risk
factors and the disease are unknown. It is beleived
that these facotors are precipitated because of the
estrogen and progesterone levels in the body.

PRECIPITATING FACTORS:
1. HIGH FAT DIET AND OBESITY is also considered
source of estrogen where as diets rich in fiber and
low in fat decreases estrogen rearbsorption. Fat has
an enzyme that converts adrenal steroids to
estrogen.

2. ANXIETY The stress levels of the individuals can

influence the production of estrogen and
progesterone in the body. Stress cause adrenal gland
exhaustion as well as reduced progesterone levels.
This tilts the estrogen to progesterone ratios in favor
of estrogen.

PRECIPITATING
FACTORS:
3. ORAL CONTRACEPTIVES promotes estrogen
domincance and eventually influence the growth of
the cells in the uterus

4. LUTEAL INSUFFICIENCY Leiomyomas formation is

also possible because of hyperestrogennism due to
progesterone difficiency that is caused by luteal
insufficiency
5. CAFFEINE OF COFFEE INTAKE increase in coffee
consuption is linked with higher estrogen levels
regardless of age, body mass index (BMI), caloric
intake, smoking, alcohol, and cholesterol intake

SIGNS AND SYMPTOMS:

1. SWELLING OF BREASTS- results from the
fluctuationof the hormones progesterone and
estrogen

2. DEPRESSION due to imbalanced levels of

estrogen in the body

3. LOSS OF SEX DRIVE due to imbalanced levels of

estrogenin the body
4. DYSMENORRHEA due to imbalanced levels of
estrogenin the body

SIGNS AND SYMPTOMS:

5. PAIN due to strecing of the uterus and the
proliferationof cells which damages the endometrial
wall
6. INCREASED PELVIC PRESSURE due to growth in
the tumor
7 HYPERMENORRHEA AND ABNORMAL BLEEDING
due to growth of the tumor as well as the
deteriorationof the surrounding tissue which may
comefrom the ischemia due to the tumor's growth