 Uterinefibroids (leiomyomas or myomas) are extremely common benign neoplasms of theuterus. The lifetime prevalence is about 70-80%. Increasing age up to menopause and black raceare the major risk factors for fibroids. Fibroidscan cause heavy or prolonged menstrual bleeding and resultant anemia. Largefibroids and an enlarged uterus can also result in “bulk” symptoms, includingbowel and bladder dysfunction and abdominal protrusion. Painful menses,noncyclic pelvic pain, infertility, and recurrent miscarriage can also besymptoms of fibroids, but many fibroids remain asymptomatic. Ultrasonography is the standard confirmatory test becauseit can easily and inexpensively differentiate a fibroid from a pregnant uterusor an adnexal mass. As for the treatment, the choice among uterine-sparing options is guidedby the size, number, and location of fibroids, the woman’s symptoms, and whereshe is in her reproductive life span. There is no evidence to support routinetreatment of asymptomatic fibroids. （N Engl J Med 2015; 372:1646-1655） There are several first-line treatments foruterine fibroids.   Hysterectomy remains a treatment option for women who have completed childbearing. It is theonly treatment that prevents the common problem of new fibroid formation andalso treats concomitant diseases, including adenomyosis and cervical neoplasia.
On the other hand, uterine-conserving therapy, including myomectomy, medical and interventionaltreatment, should be an available option for women even if there is no plan forchildbearing. The severity of symptoms caused by fibroids must first beassessed before appropriate alternatives to hysterectomy can be determined. In most women in whom submucosal fibroids are found to bethe cause of bleeding, hysteroscopic myomectomy is first-line therapy andresults in rapid recovery with a beneficial effect on future pregnancy. In women with heavy menstrual bleeding who do not havesubmucosal fibroids, effective medical therapies include hormonalcontraceptives (including the levonorgestrel-releasing intrauterine device), tranexamic acid, and nonsteroidal antiinflammatory drugs. In women with symptoms related to leiomyoma bulk, interventional treatments that are alternatives to hysterectomy include myomectomy, uterine-artery embolization, focused ultrasound surgery and radio frequency ablation.
录音：Tazo 编辑：紫花苜蓿 参考文献： 1. Stewart EA. Uterine Fibroids. N Engl J Med 2015;372:1646-1655. |
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