Uterine leiomyomas are benign tumors. Since histological confirmation of the clinical diagnosis is not necessary in most cases, asymptomatic uterine leiomyomas can usually be followed without intervention . Women with leiomyomas whose physicians prescribed "watchful waiting" experienced no significant change in symptoms or decline in quality of life, thereby providing some reassurance to women who are asymptomatic or have mild symptoms and choose to avoid intervention .
Prophylactic therapy to avoid potential future complications from myomas or their treatment is not recommended . Possible exceptions include women with significant submucosal leiomyomas who are contemplating pregnancy and women with ureteral compression leading to moderate or severe hydronephrosis. In these women, prophylactic treatment may prevent miscarriage or urinary tract obstruction.
Relief of symptoms (eg, abnormal uterine bleeding, pain, pressure) is the major goal in management of women with significant symptoms . The type and timing of any intervention should be individualized, based upon factors such as :
- Type and severity of symptoms
- Size of the myoma(s)
- Location of the myoma(s)
- Patient age
- Reproductive plans and obstetrical history
An overview of the treatment of uterine leiomyomas will be presented here. The clinical manifestations, diagnosis, and natural history of these tumors are reviewed elsewhere. (See "Epidemiology, clinical manifestations, diagnosis, and natural history of uterine leiomyomas (fibroids)".)