WHAT IS IT? ▪ Uterine leiomyomas, also known as a uterine fibroids ▪ Common benign tumors of smooth muscle cells or myometrium. ▪ Composed of smooth muscle that is replaced by fibrous (collagen and fibronectin) connective tissue ▪ Growth is promoted by estrogen ▪ Estrogen is the most important stimulus for leiomyoma growth ▪ Recent findings suggest that volume and growth of myomas are also heavily progesterone dependent ▪ Distinct, firm and round ▪ Often occur in groups ▪ Classified according to location ▪ Intramural - within the muscular wall of uterus ▪ Subserous –on the outside surface of uterus ▪ Submucosal – on the inside of the uterus lining ▪ May be attached by stem, increased risk to torsion or infection) ▪ Can be located in cervix, or within ligaments ▪ Can detach from uterus, feeds of blood supply from abdominal organs RISK FACTORS ▪ 30 to 50 % of women over 30 years old have leiomyomas ▪ African Americans have 3 to 4 times higher chances of development when compared to Caucasian women, in AA women, fibroids develop at earlier ages ▪ Family history has a three fold risk ▪ Obesity, which is possibly due to the association between obesity and high circulating estrogen levels ▪ Hypertensive women have a fivefold increase for diagnosis ▪ Intake of food additives and soybean increase risk; soybean has a 2.5 fold increase ▪ Consumption of red meat increases risk for fibroids ▪ Higher parity is associated with a reduced risk (80% reduction with 3 or more deliveries) ▪ 3 to 5x more common in premenopausal women than postmenopausal women ▪ Women who began taking oral contraceptives before the age of 16 are at a greater risk ▪ However, using progestin-only contraceptives is associated with a reduced risk of fibroids.