CLINICAL PRESENTATION OF UTERINE FIBROIDS

It is often accepted that fibroids cause a variety of female reproduct ive problems, such as menorrhagia, pain, infertility, pregnancy loss a nd pregnancy complications. Understandably, therefore, many 'successfu l' medical or surgical interventions have been proposed. However, whil e fibroids are certainly commonly associated with these conditions, it remains unclear whether this is coincidental, because of the high pre valence of fibroids, or causal. In particular, this chapter explores t he roles of fibroids in menorrhagia, discussing possible pathophysiolo gical mechanisms and the utility of medical and surgical management. S imilarly, the relationship between fibroids and infertility is examine d, concluding that fibroids are not causative in the vast majority of cases and thereby questioning the effectiveness of myomectomy as a tre atment for infertility. The use of hormone replace ment therapy in pos t-menopausal women with existing fibroids is also discussed, concludin g that this is generally safe and appropriate. In pregnancy, it is a c ommonly held tenet that uterine fibroids enlarge and that they are ass ociated with various adverse outcomes such as miscarriage, placental a bruption, fetal growth retardation and Caesarean section. This chapter evaluates the available evidence for this and concludes that, as with infertility, the role of fibroids has been exaggerated. Nonetheless, pregnancy management options are discussed.