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Uterine Myoma, Epidemiology, Pathophysiologic, Reproductive,
Clinical and Therapeutic Authors Vargas-Hernndez Vctor Manuel,
Tovar-Rodrguez Jos Mara, Agustn I Rodrguez Blas, Vargas-Aguilar
Vctor Manuel Jurez Hospital of Mexico, Mexicocity, Mexico
Corresponding Author Vctor Manuel Vargas-Hernndez. Insurgentes Sur
605-1403, c.p. 03810 Npoles, Mexicocity, Mexico.Email:
[email protected]. ABSTRACT The Uterine leiomyomas are
benign smooth muscle tumors of slow growth, most patients are
asymptomatic or
discoveredduringaroutinegynecologicalexamination.Clinicalmanifestationsoccurin20-40%with
abnormaluterinebleeding,chronicpelvicpain,pelvicheavinessandoccasionallyreproductivealterations
related to the size and location of leiomyomas. The medical
management is to improve symptoms or facilitate
surgery,particularlyifconservativeavoidingthecomplicationsassociatedwithsurgery.Technological
advances in minimally invasive surgery, interventional
imagenological, new drugs and a better understanding
oftumorbiologyofleiomyomashavereplacedthetraditionaltreatmenthysterectomy.Theuterine
leiomyomas commonly found in women of reproductive age, which most
do not require treatment because of their kindness and only when it
interferes with their quality of life should be treated
individually.
Keywords:leiomyomas,genetics,reproduction,pregnancy,magneticresonanceimaging,ultrasound,
laparoscopy,hysteroscopy,myomectomy,hysterectomy,minimalinvasionsurgery,hormonetherapy,
embolization. INTRODUCTIONLeiomyomas (LM) are benign uterine
monoclonal histopathologicallyarisefromsmoothmuscle
proliferationandconnectivetissueoftheuterus,
areslow-growingandmalignantdegenerationis
lessthan1.0%andaslowas0.2%.Despitethe
factthatthecauseisunknown,thereisevidence
thatestrogensandprogestinspromotetheir
growth,astheyrarelydevelopbeforemenarche
andmenopausesubsideafterconsideringthat
dependonhormonesandareapublichealth problem [1-3].
LMTheworldwideprevalencevariesfrom5-21%, increases with age, 1.8%
in women aged 20-29yearsand14.1%olderthan40years,60%
developinwomenofreproductiveageand80%
lifetimepredominantlyinblacks,inwomen35to
49yearsofage,medicalhistoryandultrasound (US) diagnosis, the
incidence is 60%, and African Americanwomen,increasesto80%atage50,
whileCaucasianwomen,theincidencewas40% at the age of 35years and
70% at 50years of age is commonly diagnosed in 25% to 30% in women
older than 35 years and 77% reported in autopsies
ofwomenkilledbyvariouscauses.Besidesrace,
otherriskfactors(RF)areearlymenarche,
familialpredispositionandoverweightand www.jmscr.igmpublication.org
Impact Factor 3.79 ISSN (e)-2347-176x Vargas-Hernndez Vctor Manuel
et al J MSCR Volume 03 I ssue 07 J uly Page 6578 JMSCR
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multiparityandsmokingprotectagainstits development [2,3]. CLINICAL
ASPECTS LEIOMYOMASWorldwide,theaverageageatdiagnosis,varies
from34.87.6.Thefrequencyofabnormal uterinebleeding(HUA)inwomenwitha
diagnosisofLMis59.8%comparedto37.4% women without diagnosis (p
5cmandwassuperiortoGnRHanalogue
(triptorelin)toreduceitssize(45.6%vs.33.2%) after 12 weeks of
treatment, but further studies are
neededontheeffect,long-termsafetyand
reproductivefunctionaftertreatment [39].The
Gestrinoneisandrogenderivative
ethynyltestosteronepropertiesandanti-progesteroneandanti-estrogeniceffects.5mg
administration3timesaweekfor2monthsin women with leiomyomas these
shrinks 40% in the secondmonthoftakingsecondaryamenorrhea
developsbutcontinuousadministrationtwotimes
aweekfor1year,butandrogenicsideeffects
(acne,hirsutism,seborrhea),andweightgain symptoms recur by
suspending [39,78]. The Danazol
isaderivativeof17-alpha-ethinyltestosterone, which has multiple
effects at different levels of the
hypothalamic-pituitary-ovarythroughbindingto
intracellularestrogenreceptors,androgen,
progesteroneandglucocorticoid,theusein
patientswithLMreducedinvolumeby23.6%
anddecreaseHUA,however,importantside
effectssuchashyperandrogenism(acne, hirsutism) and weight gain,
that limit their clinical application [39]. Complementary and
Alternative Medicine Mostpublishedstudiesonalternativemedicine
treatmentsarecontroversialnon-randomized, unblinded and small. One
study reported that after 6monthsoftreatmentwithtraditionalChinese
medicine,theLMwasreducedbyU.S.59%
comparedwith8%ofcontrolsandLMunder 10cm,theHUAwasreduced95%and
dysmenorrhea improved 94% [78,79]. FUTURE MANAGEMENT LEIOMYOMAS
Medicaltreatmentisaimedatfuturecell
differentiationpathways.TheexcessLMtumors are abnormal in CM
production and modulation of
thisprocessprovidesitscontrol.Inhibitorsof
TGF-pathwayavoidstheproductionofCM
proteinsandreductioninratsLM;alsodown-regulation in the pathwayof
TGF- decreases the messengerRNAexpressionofmultiplegenesin
theCMLMandtherapydirectedatdisruptionof this process will be
therapeutic fibrotic [29,30].
TheLMpossessapathwaythroughretinoicacid and retinoids modulate
these pathways responsible
forcellproliferation,apoptosisandsurvivalof
these.Decreasedendogenousretinoicacidand
abnormalproductionofCMinhandlingLM
retinoicacidtransformsCMphenotypeto Vargas-Hernndez Vctor Manuel et
al J MSCR Volume 03 I ssue 07 J uly Page 6589 JMSCR
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simulatecloselythemyometriumbydecreased
expressionofcollagensandproteoglycansofthe
CMthroughcompoundsthatincreasethe
endogenousretinoicacidfibroidsasliarozole(an
agentthatblocksthemetabolismofretinoicacid)
withtherapeuticpotentialbyinhibitingthe
formationofabnormalCMthroughviaretinoic
acidwithoutretinoicacidpathwaywithout significantsideeffects
[30,80].Otherpromising therapeuticagentsarenutritionalsupplements.
Curcumin,withantineoplasticactivity,inhibits
cellproliferationandreducestheexpressionof proteoglycans in the CM
of LM, green tea extract inhibitscellproliferationinvitroLM.The
advantageofthesenewagentsistheirlowside effects as preventive and
therapeutic efficacy over time. Since prevention of the disease is
higher and moreprofitablethantreatment,identificationof
womenwithriskfactorsidentifiedLMgenetic
screeningwhorequirepreventativetreatment,
curcuminorgreenteaextract,slowcell
proliferationandabnormaldischargeECM developed in LM [81,82].
CONCLUSIONS TheuterineLMarecommoninwomenof
reproductiveageandmostdonotrequire
treatmentbecausetheyarebenign,isa
heterogeneousdiseaseandrecentadvancesonits
originandpathogenesisbymolecularalterations,
willadaptspecificmechanismresponsibleforits
management.Theknowledgeoftumorbiology
canprovidemedicalandsurgicaltreatmentsthat
improvesymptomsandmorbidity,the
developmentofnewdrugsandlessinvasive
procedurescanbeavoidedevenconservative
hysterectomysurgerywhentheresponseis
adequate,preservingfertilityforachieving
pregnancyandavoidlosingthemaffectstumor
growthanddigestivetractfunctionscausing
obstructivesyndromes,hysterectomyisthelast
treatmentwhennoresponsetoconservative
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