Disease Description (Causes and Symptoms)
- Definition: Uterine leiomyoma (uterine fibroid, Leiomyoma of uterus) is a hormone (estrogen)-dependent benign tumor arising from uterine smooth muscle cells. It is common in women of reproductive age; although prevalence varies depending on age and survey methods, it has been reported in approximately 25–35% of women of reproductive age and approximately 40–50% of women aged 35 and older.
- Pathophysiology: Under the influence of estrogen and progesterone, localized overgrowth of uterine smooth muscle cells forms nodules (fibroids). Depending on their location, they are classified as submucosal (toward the endometrium), intramural (within the myometrium), or subserosal (toward the outside of the uterus), which affects symptoms and treatment choices. Malignant transformation (leiomyosarcoma) is very rare (<0.3%).
- Main symptoms:
- Heavy menstrual bleeding (increased menstrual volume), worsening menstrual cramps
- Abnormal uterine bleeding
- Pelvic pressure or pain, abdominal distension (palpable mass)
- Frequent urination or constipation (due to pressure from large fibroids)
- Dyspareunia, lower back pain
- Infertility or pregnancy complications (depending on location and size)
- Often asymptomatic (approximately 50% or more)
Treatment Methods
- Conservative and medical treatment
- Observation (for small, asymptomatic fibroids): regular follow-up (such as ultrasound)
- Hormone therapy
- Progestin-based treatments (oral contraceptives, oral progestins, levonorgestrel-releasing intrauterine system [LNG-IUS, Mirena]) — help reduce menstrual bleeding
- GnRH agonists — such as leuprorelin; used to reduce uterine size for a short period (several months) (menopause-like state and side effects: decreased bone mineral density, hot flashes)
- GnRH antagonist combination therapy (e.g., relugolix + estradiol/norethindrone, etc.) — used to improve heavy menstrual bleeding and reduce size (check approval status by region)
- Local/supportive treatments: tranexamic acid (reduces bleeding during menstruation), NSAIDs (pain relief)
- Iron supplementation when anemia is present (oral or intravenous if necessary)
- Procedural/surgical treatment
- Hysteroscopic surgery (hysteroscopic myomectomy): recommended first for submucosal fibroids (corrects the uterine cavity and improves bleeding and infertility)
- Myomectomy: for those who wish to preserve the uterus or become pregnant (laparoscopic, robotic, or open surgery options)
- Uterine artery embolization (UAE): for those who wish to preserve the uterus but avoid surgery; however, its effects on future pregnancy need to be discussed
- Hysterectomy: definitive treatment with no recurrence (considered after completion of childbearing plans)
- MRI-guided focused ultrasound (MRgFUS): noninvasive treatment for selected indications
- Considerations when choosing treatment
- Severity of symptoms (bleeding, anemia, pain, pressure symptoms)
- Location, size, and number of fibroids
- Age and menopausal status
- Future pregnancy plans (conservative surgery is preferred when pregnancy is desired)
Precautions for This Disease (Precautions, Risk of Complications, Self-Care)
- Precautions
- If the fibroid suddenly increases in size or continues to grow after menopause, evaluation for possible malignancy (leiomyosarcoma) is necessary
- Long-term use of GnRH agonists (>6 months) is not recommended, and measures to prevent decreased bone mineral density are necessary
- Monitor for side effects during hormone therapy (hot flashes, weight changes, mood changes, etc.)
- Complications
- Chronic anemia (iron deficiency caused by heavy menstrual bleeding)
- Complications during pregnancy: miscarriage, preterm labor, abnormal fetal presentation, increased cesarean delivery rate, acute necrosis (red degeneration), etc.
- Rarely, malignant transformation
- Self-care
- Keep a record of menstrual volume and pain (useful when consulting a doctor)
- If symptoms of anemia (fatigue, dizziness) occur, undergo testing and take iron supplements
- Weight management and regular exercise help with hormonal balance and overall health
- Observe for side effects when taking medications and report them immediately
Outpatient Visit Checklist (Including Preparation Items and Sample Questions)
- Preparation items (recommended to bring)
- List of currently used medications and supplements (including dosage and time of administration)
- Previous test results (ultrasound, MRI, blood tests, etc.) and imaging CDs or reports
- Date of the most recent menstrual period (first day of the last menstrual period, cycle, and duration)
- Symptom records: menstrual volume (number of pads/tampons used), degree of pain (pain score), whether a pelvic mass is felt, urinary and bowel symptoms
- Whether pregnancy is planned (desired timeframe for future pregnancy)
- Information to tell the doctor in advance during the visit
- History of fainting or anemia caused by severe heavy menstrual bleeding
- Previous surgical history (especially uterine or abdominal surgery)
- Whether infertility treatment is currently underway
Examples of General Questions to Ask the Doctor
- What are the effects and expected side effects of this medication (or procedure)?
- What is the most appropriate treatment option for my case, and what are its advantages and disadvantages?
- When can I expect my symptoms to improve with treatment?
- I am planning a future pregnancy; what treatments are available?
- What is the recovery period after surgery (or a procedure), and when can I return to my daily activities?
Examples of Disease-Specific Questions
- What are the location (submucosal/intramural/subserosal) and size of my fibroid, and does its location affect infertility or miscarriage?
- If I wish to preserve my uterus (because I hope to become pregnant), what is the most appropriate procedure, and could you explain the approximate pregnancy success rate after the procedure?
(Note: The information above is general information; individual diagnosis and treatment should be decided in consultation with the attending physician.)