Preface

This book introduces an important subject, and aims to explore one of the most common pathologic abnormalities of the female genital tract: leiomyoma of the uterus, which is a benign tumor of the smooth muscle.

The occurrence of uterine leiomyoma increases with age, is found in 20–50% of women older than 30 years, but is rare in children and post-menopausal women.

Uterine leiomyoma results in masses associated with a variety of gynecologic problems, the most prominent of which are asymptomatic pelvic mass and abnormal vaginal bleeding.

The majority of women are asymptomatic, but may suffer pain and heavy vaginal bleeding, or have other urinary symptoms. Uterine fibroids can also cause sexual dysfunction and dyspareunia, infertility, and recurrent pregnancy loss.

The etiology of uterine fibroids is unclear, but may be a hormone-related or estrogen-dependent disease. Risk factors include race, age, genetics, and high BMI (obesity), and may be related to diet especially eating meat.

Diagnosis by clinical history and physical examination, pelvic examination, ultrasound pelvis and CT scan, and MRI are helpful.

Major complications can occur if the uterine fibroids are caused by iron deficiency due to heavy monthly blood loss, which can cause fatigue, and sometimes transfusion is needed due to severe anemia.

Fibroids may or may not interfere with fertility and pregnancy. However, submucosal fibroids could cause infertility or recurrent pregnancy loss.

Fibroids may also raise the risk of pregnancy complications, such as fetal growth restriction, preterm delivery, and placental abruption. Red degeneration of fibroids during pregnancy can cause severe abdominal pain.

Can fibroids be prevented? Researchers have admitted that little scientific evidence is available on how to prevent fibroids. Uterine fibroids may be prevented, and only a small percentage of these tumors require treatment.

Healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, may be able to decrease the risk of having fibroids.

Research suggests that using hormonal contraceptives may be associated with a lower risk of fibroids.

Management can be medical hormonal or non-hormonal, open surgical, endoscopic, or uterine artery embolization.

> **Hassan Abduljabbar** King Abdul Aziz University, Saudi Arabia

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Section 1

Clinical Presentation

Section 1
