Skip to main content

Pathophysiology of Uterine Myomas and Its Clinical Implications

  • Chapter
  • First Online:
Uterine Myoma, Myomectomy and Minimally Invasive Treatments

Abstract

Uterine leiomyomas or, as frequently called, fibroids or myomas, are the most common solid pelvic tumors of the genital tract in women. Because of their frequency and bothersome symptomatology, they represent an onerous condition for women that often need to be dealt with medically. The majority of symptomatic women may require surgical treatment, as most medical approaches available at present, have not been completely successful, particularly in the long term. The pathophysiology of these tumors needs to be carefully reviewed and understood by physicians caring for women afflicted with this condition, in order to provide the best therapeutic option. This chapter will summarize the important factors involved in the pathophysiology of these tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cramer SF, Patel A. The frequency of uterine myomas. Am J Clin Pathol. 1990;94:435–8.

    CAS  PubMed  Google Scholar 

  2. Marsh EE, Ekpo GE, Cardozo ER, et al. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18–30 years old): a pilot study. Fertil Steril. 2013;99:1951–7.

    Article  PubMed  Google Scholar 

  3. Buttram Jr VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36:433–45.

    PubMed  Google Scholar 

  4. Wallach EE, Vlahas NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004;104:393–406.

    Article  PubMed  Google Scholar 

  5. Maruo T, Matsuo H, Samoto T, et al. Effects of progesterone on uterine leiomyoma growth and apoptosis. Steroids. 2000;65:585–92.

    Article  CAS  PubMed  Google Scholar 

  6. Islam MS, Protic O, Stortoni P, et al. Complex networks of multiple factors in the pathogenesis of uterine leiomyoma. Fertil Steril. 2013;100:178–93.

    Article  CAS  PubMed  Google Scholar 

  7. Lewicka A, Osuch B, Cendrowski K, et al. Expression of vascular endothelial growth factor mRNA in human myomas. Gynecol Endocrinol. 2010;26:451–5.

    Article  CAS  PubMed  Google Scholar 

  8. Stewart EA, Morton CC. The genetics of uterine leiomyomata: what clinicians need to know. Obstet Gynecol. 2008;1007:917–21.

    Google Scholar 

  9. Brosens I, Johansson E, Dal Cin P, et al. Analysis of the karyotype and deoxyribonucleic acid content of uterine myomas in premenopausal, menopausal, and gonadotropin-releasing hormone agonist-treated females. Fertil Steril. 1996;66:376–9.

    CAS  PubMed  Google Scholar 

  10. Meloni AM, Suoti U, Contento AM, et al. Uterine myomas: cytogenetic and histologic profile. Obstet Gynecol. 1992;80:209–17.

    CAS  PubMed  Google Scholar 

  11. Brosens I, Duprest J, Cin PD, Van den Berghe H. Clinical significance of cytogenetic abnormalities in uterine myomas. Fertil Steril. 1997;69:232–5.

    Article  Google Scholar 

  12. Megine M, Kaasinen E, Makinen N, et al. Characterization of uterine myomas by hole-genome sequencing. N Engl J Med. 2013;369:43–53.

    Article  Google Scholar 

  13. Henning Y, Wanschura S, Deichert V, et al. Rearrangements of the high mobility group protein family genes and he molecular genetic origin of uterine myomas and endometrial polyps. Mol Hum Reprod. 1996;2:277–83.

    Article  Google Scholar 

  14. Fuhrmann U, Wasserfall A, Klotzbucher M. Expression of high mobility group 1 proteins in uterine myomas. In: Brosens IA, Lunenfeld B, Donnez J, editors. Uterine fibroids. New York/London: Parthenon Publishing Group; 1999. p. 61–79.

    Google Scholar 

  15. Brosens J, Campo R, Gordts S, Brosens I. Submucosal and outer myometrium myomas are two distinct clinical entities. Fertil Steril. 2003;79:1452–4.

    Article  PubMed  Google Scholar 

  16. Cohen LS, Valle RF. Role of vaginal sonography and hysterosonography in the endoscopic treatment of uterine myomas. Fertil Steril. 2000;73(2):197–204.

    Article  CAS  PubMed  Google Scholar 

  17. Rogers R, Norian J, Malik M, et al. Mechanical homeostasis is altered in uterine leiomyoma. Am J Obstet Gynecol. 2008;198:474.e1–e11.

    Google Scholar 

  18. Pritts EA. Myomas and infertility; a systematic review of the evidence. Obstet Gynecol Surv. 2001;56:483–91.

    Article  CAS  PubMed  Google Scholar 

  19. Yan L, Ding L, Li C. Effect of myomas not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril. 2014;101:717–21.

    Article  Google Scholar 

  20. Rackow BM, Taylor HS. Submucosal uterine myomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril. 2010;93(6):2027–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Daftary GS, Taylor HS. Hydrosalpinx fluid diminishes endometrial cell HOXA 10 expression. Fertil Steril. 2002;78:577–80.

    Article  PubMed  Google Scholar 

  22. Daftary GS, Kayisli U, Seli E, Bukulmez ZO, Arici A, Taylor HS. Salpingectomy increases peri-implantation endometrial HOXA 10 expression in women with hydrosalpinx. Fertil Steril. 2007;87:367–72.

    Article  CAS  PubMed  Google Scholar 

  23. Klatzky PC, Tran ND, Caughey AB, Fujimoto VY. Myomas and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198:357–66.

    Article  Google Scholar 

  24. Olive DL. Role of progesterone antagonists and new selective progesterone receptor modulators in reproductive health. Obstet Gynecol Surv (Suppl). 2002;57 Suppl 4:S55–63.

    Article  Google Scholar 

  25. Stovall DW, Mikdachi HE. Treatment of symptomatic uterine myomas with selective progesterone receptor modulators. Expert Rev Obstet Gynecol. 2011;6:579–82.

    Article  Google Scholar 

  26. Murphy AA, Kettel LM, Morales AJ, et al. Regression of uterine leiomyomata in response to the antiprogesterone RU 486. J Clin Endocrinol Metab. 1993;76:513–7.

    CAS  PubMed  Google Scholar 

  27. Chwalisz K, Larsen L, Mattia-Golberg C, Edmonds A, Elger W, Winkel CA. A randomized, controlled trial of Asoprisnil, a novel selective progesterone receptor modulator, in women with uterine leiomyomata. Fertil Steril. 2001;87:1399–412.

    Article  Google Scholar 

  28. Wilkens J, Chwalisz K, Han C, et al. Effects of the selective progesterone receptor modulator Asoprisnil on uterine artery blood flow, ovarian activity, and clinical symptoms in patients with uterine leiomyomata scheduled for hysterectomy. J Clin Endocrinol Metab. 2008;93:4664–71.

    Article  CAS  PubMed  Google Scholar 

  29. Levens ED, Potlog-Nahari C, Armstrong AY. CDB-2914 for uterine leiomyomata treatment: a randomized controlled trial. Obstet Gynecol. 2008;111:1129–36.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Nieman LK, Blocker W, Nansel T, et al. Efficacy and tolerability of CDB 2914 treatment for symptomatic uterine myomas: a randomized, double blind, placebo controlled, Phase IIb study. Fertil Steril. 2011;95:767–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Shozu M, Murakami K, Inoue M. Aromatase and leiomyoma uterus. Semin Reprod Med. 2004;22:51–60.

    Article  CAS  PubMed  Google Scholar 

  32. Folkerd EJ, Newton CJ, Davidson K, Anderson MC, James VH. Aromatase activity in uterine leiomyomata. J Steroid Biochem. 1984;20:1195–200.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rafael F. Valle MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Valle, R.F., Ekpo, G.E. (2015). Pathophysiology of Uterine Myomas and Its Clinical Implications. In: Tinelli, A., Malvasi, A. (eds) Uterine Myoma, Myomectomy and Minimally Invasive Treatments. Springer, Cham. https://doi.org/10.1007/978-3-319-10305-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-10305-1_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-10304-4

  • Online ISBN: 978-3-319-10305-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics