Benign Tumors of the Female Reproductive Tract

Reproductive Age Group - Uterine Masses

 

Symptoms

Menorrhagia

Chronic pelvic pain

Acute pain

Urinary  symptoms:  Frequency,  Partial  ureteral  obstruction,  complete

urethral obstruction

Infertility

The  most  common  initial  symptom  associated  with  broids,  and  the

one that most frequently leads to surgical intervention, is menorrhagia.

Chronic pelvic pain may also be present. Pain may be characterized as

dysmenorrhea, dyspareunia, or pelvic pressure.

Acute  pain  may  result  from  torsion  of  a  pedunculated  leiomyoma  or

infarction and degeneration

The following urinary symptoms may be present:

1.Frequency, which may result from extrinsic pressure on the bladder.

2.Partial  ureteral  obstruction  may  be  caused  by  pressure  from  large

tumors  at  the  pelvic  brim.  Reports  suggest  some  degree  of  ureteral

obstruction  in  30%  to  70%  of  tumors  above  the  pelvic  brim.  Ureteral

compression is 3 to 4 times more common on the right, because the

left ureter is protected by the sigmoid colon.

3.Rarely, complete urethral obstruction, resulting from elevation of the

base  of  the  bladder  by  the  cervical  or  lower  uterine  leiomyoma  with

impingement on the region of the internal sphincter, may occur.

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4. Leiomyomas are an infrequent primary cause of infertility and have

been  reported  as  a  sole  cause  in  only  a  small  percentage  of  infertile

patients.

5. One review of myomectomies performed for all indications noted a

history of infertility in 27% of women.

6.  Pregnancy  loss  or  complications  can  occur  in  women  with

leiomyomas, although most patients have uncomplicated pregnancies

and  deliveries.  7.  One  study  calculated  a  10%  rate  of  pregnancy

complications in women with  broids.

8.  Although  growth  of  leiomyomas  may  occur  with  pregnancy,  no

demonstrable  change  in  size  (based  on  serial  ultrasonographic

examination)  has  been  noted  in  70%  to  80%  of  patients.  The  risk  of

pregnancy  complications  is  in uenced  by  both  myoma  location  and

size

。

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