Skip to main content
SpringerLink
Log in

Uterine Leiomyomas

  • Chapter
  • First Online:
Clinical Reproductive Medicine and Surgery

  • 2098 Accesses

Abstract

Uterine leiomyomas are the most common benign pelvic tumor found in women and represent the most common indication for hysterectomy. They result in a variety of clinical concerns such as increased uterine bleeding, pain, pelvic pressure, and/or reproductive dysfunction. New findings from recent basic research have added additional clarity to the pathophysiology behind their initiation and growth. There is a clear ethnic disparity in presentation where leiomyomas (fibroids) come to clinical attention sooner and result in more interventions in African-American women. New imaging modalities allow leiomyomas to be detected before the onset of symptoms and provide more precise information regarding their size and location within the uterus. Detection of asymptomatic lesions provides an opportunity to develop and study potential preventive approaches. In addition to definitive surgery via hysterectomy, a growing list of minimally invasive and medical approaches has been developed. These approaches need to be tailored based on both the patient’s future desires and the number, size, and location of the leiomyomas. Promising avenues for future care include the use of aromatase inhibitors and selective progesterone modulators and the expansion and refinement of minimally invasive procedures, including robotic-assisted myomectomy, uterine artery embolization, and magnetic resonance imaging-guided focused ultrasound therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 209.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94:435.

    PubMed  CAS  Google Scholar 

  2. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, et al. Hysterectomy surveillance—United States, 1980–1993. MMWR CDC Surveill Summ. 1997;46:1–15.

    PubMed  CAS  Google Scholar 

  3. Stovall DW. Clinical symptomatology of uterine leiomyomas. Clin Obstet Gynecol. 2001;44:364–71.

    PubMed  CAS  Google Scholar 

  4. Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for debate? Hum Reprod. 2002;17:1424–30.

    PubMed  CAS  Google Scholar 

  5. Bulletti C, De Zieger D, Polli V, Flamigni C. The role of leiomyomas in infertility. J Am Assoc Gynecol Laparosc. 1999;6:441.

    PubMed  CAS  Google Scholar 

  6. Vercellini P, Maddalena S, De Giorgi O, Pesole A, Ferrari L, Crosignani PG. Determinants of reproductive outcome after abdominal myomectomy for infertility. Fertil Steril. 1999;72: 109–14.

    PubMed  CAS  Google Scholar 

  7. Dubuisson J-B, Chapron C, Chalet X, Gregorakis SS. Infertility after laparoscopic myomectomy of large intramural myomas: preliminary results. Hum Reprod. 1996;11:518–22.

    PubMed  CAS  Google Scholar 

  8. Coutinho EM, Maia HS. The contractile response of the human uterus, fallopian tubes and ovary to prostaglandins in vivo. Fertil Steril. 1971;22:539–43.

    PubMed  CAS  Google Scholar 

  9. Deligdish L, Loewenthal M. Endometrial changes associated with myomata of the uterus. J Clin Pathol. 1970;23:676–9.

    PubMed  CAS  Google Scholar 

  10. Farrer-Brown G, Beilby JO, Tarbit MH. Venous changes in the endometrium of myomatous uteri. Obstet Gynecol. 1971;38: 743–6.

    PubMed  CAS  Google Scholar 

  11. Ng EHY, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Hum Reprod. 2002;17:765–70.

    PubMed  Google Scholar 

  12. Katz VL, Dotters DJ, Droegemueller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol. 1989;73:593–6.

    PubMed  CAS  Google Scholar 

  13. Eldar-Geva T, Meagher S, Healy DL, MacLachlan V, Breheny S, Wood C. Effects of intramural, subserosal and submucosal uterine fibroids on the outcome of assisted reproduction technology treatment. Fertil Steril. 1988;70:687–91.

    Google Scholar 

  14. Stovall DW, Parrish SB, Van Voorhis BJ, Hahn SJ, Sparks AE, Syrop CH. Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study. Hum Reprod. 1998;13:192–7.

    PubMed  CAS  Google Scholar 

  15. Hart R, Khalaf Y, Yeong CT, Seed P, Taylor A, Braude P. A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception. Hum Reprod. 2001;16(11):2411–7.

    PubMed  CAS  Google Scholar 

  16. Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril. 2004;81(3):582–7.

    PubMed  Google Scholar 

  17. Yarali H, Bukulmez O. The effect of intramural and subserous uterine fibroids on implantation and clinical pregnancy rates in patients having intracytoplasmic sperm injection. Arch Gynecol Obstet. 2002;266:30–3.

    PubMed  CAS  Google Scholar 

  18. Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90:967–73.

    PubMed  CAS  Google Scholar 

  19. Kjerulff HK, Langenberg P, Seidman JD, Stolley PD, Guzinski GM. Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med. 1996;41:483.

    PubMed  CAS  Google Scholar 

  20. Ross RL, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives. Br Med J (Clin Res Ed). 1986;293:359–62.

    CAS  Google Scholar 

  21. Treloar SA, Martin NG, Dennerstein L, Raphael B, Heath AC. Pathways to hysterectomy: insights from longitudinal twin research. Am J Obstet Gynecol. 1992;167:82.

    PubMed  CAS  Google Scholar 

  22. Leibman AJ, Kruse B, McSweeney MB. Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses. AJR Am J Roentgenol. 1988;151:89–92.

    PubMed  CAS  Google Scholar 

  23. Stewart EA. Uterine fibroids. Lancet. 2001;357:293–8.

    PubMed  CAS  Google Scholar 

  24. Catherino W, Salama A, Potlog-Nahari C, Leppert P, Tsibris J, Segars J. Gene expression studies in leiomyomata: new directions for research. Semin Reprod Med. 2004;22(2):83–9.

    PubMed  CAS  Google Scholar 

  25. Shimomura Y, Matsuo H, Samoto T, Maruo T. Upregulation by progesterone of proliferating cell nuclear antigen and epidermal growth factor expression in human uterine leiomyoma. J Clin Endocrinol Metab. 1998;83:2192–8.

    PubMed  CAS  Google Scholar 

  26. Brandon DD, Betheq CL, Strawn EY, Novy MJ, Burry KA, Harrington MS, et al. Progesterone receptor messenger ribonucleic acid and protein are over expressed in human uterine leiomyomas. Am J Obstet Gynecol. 1993;169:78–85.

    PubMed  CAS  Google Scholar 

  27. Brandon DD, Erickson TE, Keenan EJ, Strawn EY, Novy MJ, Burry KA, et al. Estrogen receptor gene expression in human uterine leiomyomata. J Clin Endocrinol Metab. 1995;80:1876–81.

    PubMed  CAS  Google Scholar 

  28. Folkerd EJ, Newton CJ, Davidson K, Anderson MC, James VH. Aromatase activity in uterine leiomyomata. J Steroid Biochem. 1984;20:1195–200.

    PubMed  CAS  Google Scholar 

  29. Bulun SE, Simpson ER, Word RA. Expression of the CYP19 gene and its product aromatase cytochrome p450 in human uterine leiomyoma tissues and cells in culture. J Clin Endocrinol Metab. 1994;78:736–43.

    PubMed  CAS  Google Scholar 

  30. Shozu M, Sumitani H, Segawa T, Yang HJ, Murakami K, Kasai T, et al. Over expression of aromatase p450 in leiomyoma tissue is driven primarily through promoter 14 of the aromatase p450 gene (CYP19). J Clin Endocrinol Metab. 2002;87:2540–8.

    PubMed  CAS  Google Scholar 

  31. Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol. 1995;172(1 Pt 1):14–8.

    PubMed  CAS  Google Scholar 

  32. Kettel LM, Murphy A, Morales AJ, Yen SS. Clinical efficacy of the antiprogesterone RU486 in the treatment of endometriosis and uterine fibroids. Hum Reprod. 1994;9:116–20.

    PubMed  Google Scholar 

  33. Murphy AA, Kettel L, Morales AJ, Roberts VJ, Yen SS. Regression of uterine leiomyomata in response to the antiprogesterone RU486. J Clin Endocrinol Metab. 1993;76:513–7.

    PubMed  CAS  Google Scholar 

  34. Kawaguchi K, Fujii S, Konishi I, Nanbu Y, Nonogaki H, Mori T. Mitotic activity in uterine leiomyomas during the menstrual cycle. Am J Obstet Gynecol. 1989;160:637–41.

    PubMed  CAS  Google Scholar 

  35. Matsuo H, Maruo T, Samoto T. Increased expression of Bcl-2 protein in human uterine leiomyoma and its upregulation by progesterone. J Clin Endocrinol Metab. 1997;82:293–9.

    PubMed  CAS  Google Scholar 

  36. Martel KM, Ko AC, Christman GM, Stribley JM. Apoptosis in human uterine leiomyomas. Semin Reprod Med. 2004;22: 91–103.

    PubMed  CAS  Google Scholar 

  37. Karasick S, Lev-Toaff AS, Toaff ME. Imaging of uterine leiomyomas. AJR Am J Roentgenol. 1992;158:799–805.

    PubMed  CAS  Google Scholar 

  38. Zawin M, McCarthy S, Scoutt LM, Comite F. High-field MRI and US evaluation of the pelvis in women with leiomyomas. Magn Reson Imaging. 1990;8:371–6.

    PubMed  CAS  Google Scholar 

  39. Weintraub JL, Romano WJ, Kirsch MJ, Sampaleanu DM, Madrazo BL. Uterine artery embolization: sonographic imaging findings. J Ultrasound Med. 2002;21:633–7.

    PubMed  Google Scholar 

  40. ACOG Technology Assessment No. 5; Sonohysterography. Obstet Gynecol. 2008;112:1467–9.

    Google Scholar 

  41. Wamsteker KEM, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol. 1993;82(5):736–40.

    PubMed  CAS  Google Scholar 

  42. Jurkovic D. Three-dimensional ultrasound in gynecology: a critical evaluation. Ultrasound Obstet Gynecol. 2002;19(2):109–17.

    PubMed  CAS  Google Scholar 

  43. Fleischer AC. Color Doppler sonography of uterine disorders. Ultrasound Q. 2003;19(4):179–83.

    PubMed  Google Scholar 

  44. Baramki TA. Hysterosalpingography. Fertil Steril. 2005;83(6): 1595–606.

    PubMed  Google Scholar 

  45. Mueller GC, Gemmete JJ, Carlos RC. Diagnostic imaging and vascular embolization for uterine leiomyomas. Semin Reprod Med. 2004;22(2):131–42.

    PubMed  Google Scholar 

  46. Lee JK, Gersell DJ, Balfe DM, Worthington JL, Picus D, Gapp G. The uterus: in vitro MR-anatomic correlation of normal and abnormal specimens. Radiology. 1985;157:175–9.

    PubMed  CAS  Google Scholar 

  47. Yamashita Y, Torashima M, Takahashi M, Tanaka N, Katabuchi H, Miyazaki K, et al. Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology. 1993;189:721–5.

    PubMed  CAS  Google Scholar 

  48. Okizuka H, Sagimura K, Takemori M, Obayashi C, Kitao M, Ishida T. MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr. 1993;17:760–6.

    PubMed  CAS  Google Scholar 

  49. Friedman AJ, Lobel SM, Rein MS, Barbieri RL. Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: the estrogen threshold hypothesis. Am J Obstet Gynecol. 1990;163(4 Pt 1): 1114–9.

    PubMed  CAS  Google Scholar 

  50. Shozu M, Sumitani H, Segawa T, Yang HJ, Murakami K, Inoue M. Inhibition of in situ expression of aromatase p450 in leiomyoma of the uterus by leuprolide acetate. J Clin Endocrinol Metab. 2001;86:5405–11.

    PubMed  CAS  Google Scholar 

  51. De Leo V, Morgante G, La Marca A, Musacchio MC, Sorace M, Cavicchioli C, et al. A benefit-risk assessment of medical treatment for uterine leiomyomas. Drug Saf. 2002;25(11):759–79.

    PubMed  Google Scholar 

  52. Stovall TG, Muneyyirici Delale O, Summitt RL, Scialli AR. GnRH agonist and iron versus placebo and iron in the anemic patient before surgery for leiomyomas: a randomized controlled trial. Leuprolide Acetate Study Group. Obstet Gynecol. 1995;86: 65–71.

    PubMed  CAS  Google Scholar 

  53. Dawood M, Lewis V, Ramos J. Cortical and trabecular bone mineral content in women with endometriosis: effect of gonadotropin-releasing hormone agonist and danazol. Fertil Steril. 1989;52: 21–6.

    PubMed  CAS  Google Scholar 

  54. Gottardis MM, Robinson SP, Satyaswaroop PG, Jordan VC. Contrasting actions of tamoxifen on endometrial and breast tumor growth in the athymic mouse. Cancer Res. 1988;48:812–5.

    PubMed  CAS  Google Scholar 

  55. Guetta V, Lush RM, Figg WD, Waclawiw MA, Cannon III RO. Effects of the antiestrogen tamoxifen on low-density lipoprotein concentrations and oxidation in postmenopausal women. Am J Cardiol. 2005;76:1072–3.

    Google Scholar 

  56. Delmas PD, Bjarnason NH, Mitlak BH, Ravoux AC, Shah AS, Huster WJ, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997;337:1641–7.

    PubMed  CAS  Google Scholar 

  57. Fuchs-Young R, Howe S, Miles R, Walker C. Inhibition of estrogen-stimulated growth of uterine leiomyomas by selective estrogen receptor modulators. Mol Carcinog. 1996;17:151–9.

    PubMed  CAS  Google Scholar 

  58. Walker CL, Burroughs K, Davis B, Sowell K, Everitt JI, Fuchs-Young R. Preclinical evidence for therapeutic efficacy of selective estrogen receptor modulators for uterine leiomyoma. J Soc Gynecol Investig. 2000;7:249–56.

    PubMed  CAS  Google Scholar 

  59. Porter KB, Tsibris JC, Porter GW, Fuchs-Young R, Nicosia SV, O’Brien WF, et al. Effects of raloxifene in a guinea pig model for leiomyomas. Am J Obstet Gynecol. 1998;179:1283–7.

    PubMed  CAS  Google Scholar 

  60. Palomba S, Sammartino A, Di Carlo C, Affinito P, Zullo F, Nappi C. Effects of raloxifene treatment on uterine leiomyomas in postmenopausal women. Fertil Steril. 2001;76:38–43.

    PubMed  CAS  Google Scholar 

  61. Palomba S, Orio F, Morelli M, Russo T, Pellicano M, Nappi C, et al. Raloxifene administration of women treated with gonadotropin-releasing hormone agonist for uterine leiomyomas: effects on bone metabolism. J Clin Endocrinol Metab. 2002;87:4476–81.

    PubMed  CAS  Google Scholar 

  62. Palomba S, Orio F, Morelli M, Russo T, Pellicano M, Zupi E, et al. Raloxifene administration in premenopausal women with uterine leiomyomas: a pilot study. J Clin Endocrinol Metab. 2002;87:3603–8.

    PubMed  CAS  Google Scholar 

  63. Palomba S, Russo T, Orio Jr F, Tauchmanovà L, Zupi E, Panici PL, et al. Effectiveness of combined GnRH analogue plus raloxifene administration in the treatment of uterine leiomyomas: a prospective, randomized, single- blind, placebo-controlled trial. Hum Reprod. 2002;17:3213–9.

    PubMed  CAS  Google Scholar 

  64. Deng L, Wu T, Chen XY, Xie L, Yang J. Selective estrogen receptor modulators (SERMs) for uterine leiomyomas. Cochrane Database Syst Rev. 2012;10:CD005287. doi:10.1002/14651858.CD005287.pub4.

    PubMed  Google Scholar 

  65. Chwalisz K, DeManno D, Garg R, Larsen L, Mattia-Goldberg C, Stickler T. Therapeutic potential for the selective progesterone receptor modulator asoprisnil in the treatment of leiomyomata. Semin Reprod Med. 2004;22(2):113–9.

    PubMed  CAS  Google Scholar 

  66. Elger W, Bartley J, Schneider B, Kaufmann G, Schubert G, Chwalisz K. Endocrine-pharmacological characterization of progesterone antagonists and progesterone receptor modulators (PRMs) with respect to PR-agonistic and antagonistic activity. Steroids. 2000;65:713–23.

    PubMed  CAS  Google Scholar 

  67. Chwalisz K, Elger W, McCrary K, Beckman P, Larsen L. Reversible suppression of menstruation in normal women irrespective of the effect on ovulation with the novel selective progesterone receptor modulator (SPRM) J 867. J Soc Gynecol Investig. 2002;9(Suppl 1):abstract 49.

    Google Scholar 

  68. Talaulikar VS, Manyonda IT. Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids. Adv Ther. 2012;29(8):655–63.

    PubMed  Google Scholar 

  69. Donnez J, Tatarchuk TF, Bouchard P, Puscasiu L, Zakharenko NF, Ivanova T, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. 2012;366(5):409–20.

    PubMed  CAS  Google Scholar 

  70. Ishikawa H, Reierstad S, Demura M, Rademaker AW, Kasai T, Inoue M, et al. High aromatase expression in uterine leiomyoma tissues of African-American women. J Clin Endocrinol Metab. 2009;94(5):1752–6.

    PubMed  CAS  Google Scholar 

  71. Gurates B, Parmaksiz C, Kilic G, Celik H, Kumru S, Simsek M. Treatment of symptomatic uterine leiomyoma with letrozole. Reprod Biomed Online. 2008;17(4):569–74.

    PubMed  CAS  Google Scholar 

  72. Parsanezhad ME, Azmoon M, Alborzi S, Rajaeefard A, Zarei A, Kazerooni T, et al. A randomized, controlled clinical trial comparing the effects of aromatase inhibitor (letrozole) and gonadotropin-releasing hormone agonist (triptorelin) on uterine leiomyoma volume and hormonal status. Fertil Steril. 2010;93(1):192–8.

    PubMed  CAS  Google Scholar 

  73. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000;15(12):2663–8.

    PubMed  CAS  Google Scholar 

  74. Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol. 1994;83:549–55.

    PubMed  CAS  Google Scholar 

  75. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynecol Obstet. 2003;83:37–43.

    CAS  Google Scholar 

  76. Reich H, DiCaprio J, McGlynn NF. Laparoscopic hysterectomy. J Gynecol Surg. 1989;5:213–6.

    Google Scholar 

  77. American College of Obstetrics and Gynecology. Surgical alternatives to hysterectomy in the management of leiomyomas. ACOG Pract Bull 2000;(16):776–84.

    Google Scholar 

  78. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996;174(2):654–8.

    PubMed  CAS  Google Scholar 

  79. Bulletti C, Polli V, Negrini V, Giacomucci E, Flamigni C. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1996;3(4):533–6.

    PubMed  CAS  Google Scholar 

  80. Takeuchi H, Kinoshita K. Evaluation of adhesion formation after laparoscopic myomectomy by systematic second-look microlaparoscopy. J Am Assoc Gynecol Laparosc. 2002;9(4):442–6.

    PubMed  Google Scholar 

  81. Dubuisson JB, Fauconnier A, Chapron C, Kreiker G, Nörgaard C. Second look after laparoscopic myomectomy. Hum Reprod. 1998;13(8):2102–6.

    PubMed  CAS  Google Scholar 

  82. Doridot V, Dubuisson JB, Chapron C, Fauconnier A, Babaki-Fard K. Recurrence of leiomyomata after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2001;8:495–500.

    PubMed  CAS  Google Scholar 

  83. Nezhat FR, Roemisch M, Nezhat CH, Seidman DS, Nezhat CR. Recurrence rate after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1998;5(3):237–40.

    PubMed  CAS  Google Scholar 

  84. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod. 2001;16(4):770–4.

    PubMed  CAS  Google Scholar 

  85. Agdi M, Tulandi T. Minimally invasive approach for myomectomy. Semin Reprod Med. 2010;28(3):228–34, review.

    Google Scholar 

  86. Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T. Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol. 2011;117(2 Pt 1):256–65.

    PubMed  Google Scholar 

  87. Pitter MC, Gargiulo AR, Bonaventura LM, Lehman JS, Srouji SS. Pregnancy outcomes following robot-assisted myomectomy. Hum Reprod. 2013;28(1):99–108.

    PubMed  Google Scholar 

  88. Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995;346(8976):671–2.

    PubMed  CAS  Google Scholar 

  89. Worthington-Kirsch RL, Popky GL, Hutchins Jr FL. Uterine ­arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response. Radiology. 1998;208: 625–9.

    PubMed  CAS  Google Scholar 

  90. Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J. Uterine artery embolization for uterine leiomyoma. Obstet Gynecol. 2001;98:29–34.

    PubMed  CAS  Google Scholar 

  91. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008;112(2 Pt 1):387–400.

    Google Scholar 

  92. Burn PR, McCall JM, Chinn RJ, Vashisht A, Smith JR, Healy JC. Uterine fibroleiomyoma: MR imaging appearances before and after embolization of uterine arteries. Radiology. 2000;214: 729–34.

    PubMed  CAS  Google Scholar 

  93. deSouza NM, Williams AD. Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome. Radiology. 2002;222:367–74.

    PubMed  Google Scholar 

  94. Jha RC, Ascher SM, Imaoka I, Spies JB. Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine arterial embolization. Radiology. 2000;217:228–35.

    PubMed  CAS  Google Scholar 

  95. Toor SS, Jaberi A, Macdonald DB, McInnes MD, Schweitzer ME, Rasuli P. Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas: a systematic review and meta-analysis. Am J Roentgenol. 2012;199(5): 1153–63.

    Google Scholar 

  96. Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2012;5:CD005073, review.

    Google Scholar 

  97. Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG. 2002;109:1262–72.

    PubMed  CAS  Google Scholar 

  98. Watson GM, Walker WJ. Uterine artery embolisation for the treatment of symptomatic fibroids in 114 women: reduction in size of the fibroids and women’s views of the success of the treatment. BJOG. 2002;109:129–35.

    PubMed  CAS  Google Scholar 

  99. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril. 2010;94(1):324–30.

    PubMed  Google Scholar 

  100. Freed MM, Spies JB. Uterine artery embolization for fibroids: a review of current outcomes. Semin Reprod Med. 2010;28(3):235–41.

    PubMed  Google Scholar 

  101. Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008;31(1):73–85.

    PubMed  Google Scholar 

  102. Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy-Skrynarz K. Complications after uterine artery embolization for leiomyomas. Obstet Gynecol. 2002;100:873–80.

    PubMed  Google Scholar 

  103. Goodwin SC, Wong GC. Uterine artery embolization for uterine fibroids: a radiologist’s perspective. Clin Obstet Gynecol. 2001;44:412–24.

    PubMed  CAS  Google Scholar 

  104. Chrisman HB, Saker MB, Ryu RK, Nemcek Jr AA, Gerbie MV, Milad MP, et al. The impact of uterine fibroid embolization on resumption of menses and ovarian function. J Vasc Interv Radiol. 2000;11:699–703.

    PubMed  CAS  Google Scholar 

  105. Frigerio LF, Patelli G, DiTolla G, Spreafico C. A fatal complication of percutaneous transcatheter embolization for the treatment of fibroids. In: Second international symposium on embolization of uterine myomata/Society for Minimally Invasive Therapy, 11th international conference, Boston, MA; 1999.

    Google Scholar 

  106. de Blok S, de Vries C, Prinssen HM, Blaauwgeers HL, Jorna-Meijer LB. Fatal sepsis after uterine artery embolization with microspheres. J Vasc Interv Radiol. 2003;14:779–83.

    PubMed  Google Scholar 

  107. Wingo PA, Huezo CM, Rubin GL, Ory HW, Peterson HB. The mortality risk associated with hysterectomy. Am J Obstet Gynecol. 2000;152:803–8.

    Google Scholar 

  108. Hurst BS, Stackhouse DJ, Matthews ML, Marshburn PB. Uterine artery embolization for symptomatic uterine myomas. Fertil Steril. 2000;74:855–69.

    PubMed  CAS  Google Scholar 

  109. Hesley GK, Gorny KR, Woodrum DA. MR-guided focused ultrasound for the treatment of uterine fibroids. Cardiovasc Intervent Radiol. 2013;36(1):5–13.

    PubMed  Google Scholar 

  110. Stewart E, Gedroyc W, Tempany C, Quade BJ, Inbar Y, Ehrenstein T, et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive themoablative technique. Am J Obstet Gynecol. 2003;189(1):48–54.

    PubMed  Google Scholar 

  111. Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol. 2009;34(5): 584–9.

    PubMed  CAS  Google Scholar 

  112. Gorny KR, Woodrum DA, Brown DL, Henrichsen TL, Weaver AL, Amrami KK, et al. Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 2011;22(6):857–64.

    PubMed  Google Scholar 

  113. Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA. MRgFUS Study Group. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril. 2010;93(1):199–209.

    PubMed  Google Scholar 

  114. Qin J, Chen JY, Zhao WP, Hu L, Chen WZ, Wang ZB. Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids. Int J Gynaecol Obstet. 2012;117(3):273–7.

    PubMed  Google Scholar 

  115. Zupi E, Sbracia M, Marconi D, Munro MG. Myolysis of uterine fibroids: is there a role? Clin Obstet Gynecol. 2006;49(4):821–33.

    PubMed  Google Scholar 

  116. Zupi E, Piredda A, Marconi D, Townsend D, Exacoustos C, Arduini D, et al. Directed laparoscopic cryomyolysis: a possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas. Am J Obstet Gynecol. 2004;190(3):639–43.

    PubMed  Google Scholar 

  117. Cowan BD. Myomectomy and MRI-directed cryotherapy. Semin Reprod Med. 2004;22(2):143–8.

    PubMed  Google Scholar 

  118. Zreik TG, Rutherford TJ, Palter SF, Troiano RN, Williams E, Brown JM, et al. Cryomyolysis, a new procedure for the conservative treatment of uterine fibroids. J Am Assoc Gynecol Laparosc. 1998;5(1):33–8.

    PubMed  CAS  Google Scholar 

  119. Ciavattini A, Tsiroglou D, Piccioni M, Lugnani F, Litta P, Feliciotti F, et al. Laparoscopic cryomyolysis: an alternative to myomectomy in women with symptomatic fibroids. Surg Endosc. 2004;18(12):1785–8.

    PubMed  CAS  Google Scholar 

  120. Zupi E, Marconi D, Sbracia M, Exacoustos C, Piredda A, Sorrenti G, et al. Directed laparoscopic cryomyolysis for symptomatic leiomyomata: one-year follow up. J Minim Invasive Gynecol. 2005;12(4):343–6.

    PubMed  Google Scholar 

  121. Ciavattini A, Tsiroglou D, Litta P, Vichi M, Tranquilli AL. Pregnancy outcome after laparoscopic cryomyolysis of uterine myomas: report of nine cases. J Minim Invasive Gynecol. 2006;13(2):141–4.

    PubMed  Google Scholar 

  122. Park KH, Kim JY, Shin JS, Kwon JY, Koo JS, Jeong KA, et al. Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma. Yonsei Med J. 2003;44(4):694–702.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Austin Fertility and Reproductive Medicine—Westlake IVF, Austin, TX, USA

    Shahryar K. Kavoussi MD, MPH

  2. Cedars Sinai Medical Center, Labor and Delivery, Los Angeles, CA, USA

    Layne Kumetz MD, FACOG

  3. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, 100294, 1600 S.W. Archer Road, Room M302L, Gainesville, FL, 32610, USA

    Gregory M. Christman MD

Authors
  1. Shahryar K. Kavoussi MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Layne Kumetz MD, FACOG
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory M. Christman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory M. Christman MD .

Editor information

Editors and Affiliations

  1. Cleveland Clinic, Ob/Gyn & Women's Health Institute, Euclid Ave 9500, Cleveland, 44195, Ohio, USA

    Tommaso Falcone

  2. Duke University Medical Center, Duke University School of Medicine, Department of Obstetrics and Gynecology, Erwin Rd 2301, Durham, 27705, North Carolina, USA

    William W. Hurd

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kavoussi, S.K., Kumetz, L., Christman, G.M. (2013). Uterine Leiomyomas. In: Falcone, T., Hurd, W. (eds) Clinical Reproductive Medicine and Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6837-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6837-0_18

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6836-3

  • Online ISBN: 978-1-4614-6837-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation