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Definition of the Disease Uterine Leiomyomas are the most common pelvic tumors of reproductive-age women (Ling & Duff, 2009). They occur in up to 50 % of patients in autopsy series, and are more common in African-American women. They are composed of smooth muscle cells within a fibrous tissue matrix and are unicellular in origin. The

growth of these benign tumor tends to be promoted by estrogen and other growth factors. Uterine fibroids are leiomyomata of the uterine smooth muscle. They may vary in size and location. Leiomyomas may be submucous, subserous, intraligamentous, peduncultated or parasitic (Ling & Duff, 2009) As other leiomyomata, they are benign, but may lead to excessive menstrual bleeding (menorrhagia), often cause anemia and may lead to infertility. Enucleation is removal of fibroids without removing the uterus (hysterectomy), which is also commonly performed. Laser surgery (called myolysis) is increasingly used, and provides a viable alternative to traditional surgeries. Oral contraceptive pills can be used to decrease excessive menstrual bleeding and pain associated with uterine fibroids. Uterine leiomyomas originate in the myometrium and are classified by location: Submucosal lie just beneath the endometrium. Intramural lie within the uterine wall.

Subserosal lie at the serosal surface of the uterus or may bulge out from the myometrium and can become pedunculated.

The tumors become malignant in less that 0.1 % of patients, which should serve as comfort to women concerned with the possibility of uterine malignancy in association with a fibroid. (McCann & Holmes, 2003) The actual cause of uterine myomas/ leiomyomas are unknown, however, they are seen to be increased with the presence of the following factors. The incidence is higher on women during the reproductive years where estrogens and other hormones are actively produced by the body. Many women opt to use oral contraceptives as a birth control method. Oral contraceptives promote estrogen dominance and eventually influence the growth of the cells in the uterus. High-fat diet is also considered a source of estrogen where as diets rich in fiber and low in fat decreases estrogen reabsorption. Leimyoma formation is also possible because of hyperestrogenism due to progesterone deficiency that is caused by luteal insufficiency. Apart from estrogen stimulation, heredity is a factor in the occurrence of leimyomas. Fibroids formation is 4.2 times more common in first-degree relatives than with fibroids without genetic influence. Estrogen is vital in the regulation the menstrual cycle. Presence of this hormone during the first phase influences the proliferation of smooth muscle cells in the uterine walls. Overstimulation increases the size of the uterine lining and further develops into a fibroid. During menstruation, the excessively thickened endometrium does not desquamate (shed its lining) easily (or even completely) at the end of the cycle, resulting in prolonged and/or excessive menstrual bleedings. Following the degeneration of the interior part of the fibroid, are the degenerative changes that eventually replace smooth muscle cells by fibrous connective tissue. The fibroid continually grows and its size puts pressure on the adjacent organs, the bladder and rectosigmoid. Urinary frequency and constipation, respectively, are the results of the compression of these organs.