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Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history

Elizabeth A Stewart, MD
Shannon K Laughlin-Tommaso, MD
Section Editors
Robert L Barbieri, MD
Deborah Levine, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Uterine leiomyomas (also referred to as fibroids or myomas) are the most common pelvic tumor in women [1,2]. They are benign monoclonal tumors arising from the smooth muscle cells of the myometrium. They arise in reproductive-age women and typically present with symptoms of abnormal uterine bleeding and/or pelvic pain/pressure. Uterine fibroids may also have reproductive effects (eg, infertility, adverse pregnancy outcomes).

The epidemiology, diagnosis, and natural history of uterine leiomyomas are reviewed here. Leiomyoma histology and pathogenesis, management of uterine leiomyomas, differentiating leiomyomas from uterine sarcomas, and leiomyoma variants are discussed separately. (See "Overview of treatment of uterine leiomyomas (fibroids)" and "Histology and pathogenesis of uterine leiomyomas (fibroids)" and "Differentiating uterine leiomyomas (fibroids) from uterine sarcomas" and "Variants of uterine leiomyomas (fibroids)".)


Uterine fibroids are described according to their location in the uterus although many fibroids have more than one location designation (figure 1 and picture 1A-B). The International Federation of Gynecology and Obstetrics (FIGO) classification system for fibroid location is as follows (figure 2) [3]:

Intramural myomas (FIGO type 3, 4, 5) – These leiomyomas are located within the uterine wall. They may enlarge sufficiently to distort the uterine cavity or serosal surface. Some fibroids may be transmural and extend from the serosal to the mucosal surface.

Submucosal myomas (FIGO type 0, 1, 2) – These leiomyomas derive from myometrial cells just below the endometrium (lining of the uterine cavity). These neoplasms protrude into the uterine cavity. The extent of this protrusion is described by the FIGO/European Society of Hysteroscopy classification system and is clinically relevant for predicting outcomes of hysteroscopic myomectomy (figure 3) [4] (see "Hysteroscopic myomectomy", section on 'Leiomyoma characteristics'):


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