 Introduction/Background Uterine fibroids (leiomyomas or myomas) are the most common neoplasm of the uterus. They are composed of benign smooth muscle cells embedded in an extracellular matrix of collagen, fibronectin, and proteoglycan [1]. The prevalence of fibroids varies with race. Black women have an estimated incidence of fibroids by age 50 exceeding 80%, whereas White women have an incidence approaching 70% [2]. Although incompletely understood, fibroid etiology is multifactorial. A combination of genetic alterations and endocrine, autocrine, environmental, and other factors such as race, age, parity, and body mass index all play a role in fibroid development. Black women are more likely to develop clinically significant disease at an earlier age and are subject to racial disparities, including higher rates of surgical intervention when compared with medical therapy, as well as lower rates of minimally invasive approaches [3-6]. Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause. Menorrhagia is the most frequent symptom and often results in iron deficiency anemia. Other common symptoms include dysmenorrhea, pelvic pain and pressure, urinary urgency and frequency, and constipation. Fibroids may also impair fertility and/or cause obstetric complications [7]. Despite the high prevalence and protean symptoms, there are few randomized trials to guide therapy. Patient preferences and symptom severity help inform treatment choice with options ranging from medical therapy to surgery. Hysterectomy is curative. One-half to one-third of the approximately 600,000 hysterectomies performed annually in the United States are for symptomatic fibroids [1,4]. Uterine sparing therapies include medical therapy (eg, GnRH agonists, levonorgestrel-releasing intrauterine devices, contraceptive steroid hormones, and tranexamic acid), myomectomy, endometrial ablation, uterine fibroid embolization (UFE), MR-guided focused ultrasound (MRgFUS), and laparoscopic radiofrequency ablation.
Fibroids.  Introduction/Background Uterine fibroids (leiomyomas or myomas) are the most common neoplasm of the uterus. They are composed of benign smooth muscle cells embedded in an extracellular matrix of collagen, fibronectin, and proteoglycan [1]. The prevalence of fibroids varies with race. Black women have an estimated incidence of fibroids by age 50 exceeding 80%, whereas White women have an incidence approaching 70% [2]. Although incompletely understood, fibroid etiology is multifactorial. A combination of genetic alterations and endocrine, autocrine, environmental, and other factors such as race, age, parity, and body mass index all play a role in fibroid development. Black women are more likely to develop clinically significant disease at an earlier age and are subject to racial disparities, including higher rates of surgical intervention when compared with medical therapy, as well as lower rates of minimally invasive approaches [3-6]. Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause. Menorrhagia is the most frequent symptom and often results in iron deficiency anemia. Other common symptoms include dysmenorrhea, pelvic pain and pressure, urinary urgency and frequency, and constipation. Fibroids may also impair fertility and/or cause obstetric complications [7]. Despite the high prevalence and protean symptoms, there are few randomized trials to guide therapy. Patient preferences and symptom severity help inform treatment choice with options ranging from medical therapy to surgery. Hysterectomy is curative. One-half to one-third of the approximately 600,000 hysterectomies performed annually in the United States are for symptomatic fibroids [1,4]. Uterine sparing therapies include medical therapy (eg, GnRH agonists, levonorgestrel-releasing intrauterine devices, contraceptive steroid hormones, and tranexamic acid), myomectomy, endometrial ablation, uterine fibroid embolization (UFE), MR-guided focused ultrasound (MRgFUS), and laparoscopic radiofrequency ablation.