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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