Pathophysiology of Uterine Myoma

Uterus

Etiology: Predisposing Factors:

- Unknown - Advancing Age
- Genetics
- Race
- Stress
Precipitating Factors:
- Over Weight
Disease Process - Hyperestrogenic State
- Hypertension
- Nulliparity
- Multiparity
- Menopause
- Contraceptives
- Smoking

Benign tumors originating in the smooth muscular uterine tissue, though sometimes they
originate in the smooth muscle of the uterine vessels

Stress within the myometrium

(Due to physical and mental means resulting from uterine contractions.
Multiple fibroids)

Simple proliferation (monoclonal) of smooth muscle cells

(Continuous development of group of cells from a single ancestral cell by repeated cellular
replication; cell formation)

Development of Leiomyomas ( fibroid )

Fibroid Growth Increase

• Estrogen-dependent tumors, their growth is related to their exposure to circulating
estrogens
• Express maximal growth during the generativeage of a female, when estrogen secretion is
at its highest, and growth curve is especially slope in the decade preceding menopause
(probably as the consequence of anovulatory cycles with unopposed circulatory estrogen)
• sometimes grow during pregnancy, which is probably related to estrogen, as well as an
increased blood flow in pregnancy and edema. Estrogen receptors are present in a higher
concentration within myomas than in the adjacent myometrium.
• Hormonal therapy
 Fibroid Growth Decrease
• decrease during menopause and other hypoestrogenic conditions

Endometrial Distention

Signs and Symptoms

• Abdominal fullness, gas
• Bleeding between periods or very prolonged bleeding with periods
• Increase in urinary frequency
• Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots
• Pelvic cramping or pain with periods
• Sensation of fullness or pressure in lower abdomen
• Sudden, severe pain due to a pedunculated fibroid

Complications

• Large fibroids may cause infertility by:

- Impairing the uterine lining, Blocking the fallopian tubes, Distorting the shape of the
uterine cavity, Altering the position of the cervix and preventing sperm from reaching the
uterus
• Pregnancy complications and delivery risks:
- Cesarean section delivery, Breech presentation, Preterm birth, Placenta previa, Postpartum
hemorrhage
• Anemia
• Pressure on the ureters may cause urinary obstruction and kidney damage.
• Pain can also develop if the blood supply is cut off from the fibroid tissue. In such cases,
the cells blacken and die (a process called necrosis) from lack of oxygen
- A very large fibroid outgrows its own blood supply, A pedunculated fibroid (one that grows
on a stem from the uterine wall) becomes twisted, thus cutting off its blood supply, Pregnancy
occurs in which the risk for fibroid cell degeneration and necrosis increases
• Fibroid breaks away from the uterus and develops in other locations. They are typically
one of the following:
- Benign Metastasizing Leiomyoma, or BML (which usually spreads to thelung)
- Disseminated Peritoneal Leiomyomatosis (which spreads to the abdominal wall
• Uterine Cancer
- Fibroids are nearly always noncancerous, even if they have abnormal cell shapes. Cancer of
the uterus nearly always develops in the lining of the uterus (endometrial cancer).