**3. Clinical features**

The majority of uterine myomas are asymptomatic. When symptomatic, uterine fibroids commonly present with abnormal uterine bleeding (heavy or irregular menstrual bleeding) which is the main reason for gynecologic consultations of women aged 40 to 50 years [11]. The mechanism of leiomyoma associated excessive menstrual bleeding is unknown. Increased endometrial surface area, vascular dysregulation, and interference with endometrial hemostasis have been offered as possible explanations [12]. Other less common symptoms include pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation and dyspareunia [10]. This latest situations are generally determined by large fibroids; Urinary symptoms associated with anterior fibroids, constipation with posterior ones [13]. Pain as a symptom is relatively infrequent. It's usually associated with torsion of a pedunculated myoma, cervical dilatation by a submucous myoma protruding through the uterine segment or degeneration associated with pregnancy. This conditions cause acute pain and require immediate attention [2]. With respect to reproductive prognosis, the degree to which fibroids contribute to infertility is controversial, but they seem to be implicated as the sole factor during diagnostic workup in less than 10% of infertile couples [14].
