Introduction

It is estimated that approximately 25% of women in the reproductive age have uterine leiomyomas. Even more convincing is that autopsy studies show an incidence as high as 75%. Uterine leiomyoma is responsible for a hysterectomy in up to 1.7 million women. Women of reproductive age who have symptomatic myomas have a number of alternative approaches of treatment available to them including abdominal myomectomy, laparoscopic myomectomy, laparoscopic assisted myomectomy, which includes a mini-laparotomy for uterine repair, and hysteroscopic resection, plus a host of other approaches such as freezing, i.e., cryomyolysis, as well as utilization of high energy sources for destruction of the myoma.

Most importantly, clinicians should be aware of current thinking regarding myomas from a number of perspectives including cytogenetics, hormonal effects, growth factor effects, and also extracellular matrix related factors.

With respect to cytogenetics, there is evidence that myomas are three to nine times more frequent in black than in white women. This information suggests a probable genetic pre-disposition. While a specific gene has not been clearly identified, chromosomal analysis of uterine myomas has revealed non-random tumor specific cytogenetic abnormalities in up to 40% of specimens evaluated. Multiple genetic loci have been proposed in the pathogenesis of leiomyomas.

Estrogen and progesterone have an effect on myoma growth following onset of menopause. More specifically, leiomyomas express increased concentrations of aromatase cytochrome P450 mRNA with an associated lower rate of conversion of estradiol to estrone.