Leiomyoma almost exclusively among reproductive-age women, increasing with age until menopause, after which time they are often no longer detectable by ultrasound imaging. The main consistently identified risk factors include age, black race, nulliparity, and premenopausal status. Most uterine leiomyomas are asymptomatic and 20% to 50% are clinically symptomatic. The common presenting symptom is heavy menstrual bleeding, which may lead to anemia, fatigue, and sometimes painful periods. Other symptoms include abdominal protuberance, pressure symptoms, painful intercourse and bladder or bowel dysfunction resulting in urinary incontinence or retention, pain, or constipation. Diagnosis is achieved by clinical history and physical examination, pelvic examination, pelvis ultrasonography, CT scan, and MRI. Leiomyoma can be single or multiple and can vary in size, location, and perfusion. They are commonly classified into 3 subgroups based on their location: sub serosal, intramural, and submucosal. Management can be medical hormonal or non-hormonal, open surgical, endoscopic, uterine artery embolization (UAE), magnetic resonance guided focused ultrasound surgery (MRgFUS), or myolysis. Prospective imaging studies indicate that 3% to 7% of untreated fibroids in premenopausal women regress over 6 months to 3 years. Most women experience shrinkage of fibroids and relief of symptoms at menopause. In the absence of applicable medico financial assessments of the various therapeutics, diminishing the number of hysterectomies and other surgeries performed in the USA and globally will decrease expenses. Thus, it is important to explore and assess novel therapies in contrast to surgeries particularly when fertility preservation is the objective and less invasive approach preferred.
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Prof. Samir A. Farghaly and Prof. Andrea Tinelli
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