Leiomyoma Treatment & Management
- Author: Kyle L Horner, MD, MS; Chief Editor: William D James, MD more...
Because all leiomyomas are tumors, medical management has a limited role in the resolution or destruction of these lesions. However, pharmacologic intervention may alleviate associated pain.
- Several investigators report that calcium channel blockers, particularly nifedipine, relieves pain associated with many cases of piloleiomyomas.
- As the name implies, drugs in this class inhibit the movement of extracellular calcium ions across the cell membrane into the smooth muscle cell, thereby inhibiting muscular contraction.
- These data support the theory that muscle contraction is somehow responsible for pain in at least some tumors.
- Phenoxybenzamine, an alpha-adrenoceptor blocker, is also reported to be helpful in alleviating pain, including cold-induced pain, in some cases.
- Gabapentin has also shown promise in alleviating pain from piloleiomyomas; however, larger randomized trials have not yet been conducted.[21, 22]
- Two case reports describe botulinum toxin therapy for relief of pain associated with leiomyoma, although one suggested a possible placebo effect.[23, 24]
In a study of 1036 randomly selected premenopausal women (age range, 35-49 y), adequate plasma levels of vitamin D (>20 ng/mL) were associated with a reduced risk of uterine leiomyomas. Only 10% of the 620 black women and 50% of the 416 white women in the study had sufficient levels of vitamin D. Compared with women with vitamin D insufficiency, those with sufficient vitamin D had about 32% lower odds of uterine leiomyomas. This relationship was similar for black and white women. There was also an association between daily sun exposure for 1 hour or more and a reduced risk of developing uterine leiomyomas.
Surgical excision or ablation may be helpful for some symptomatic individuals.
- Excision is frequently effective with a solitary leiomyoma.
- Excision of multiple piloleiomyomas is more cosmetically problematic and less effective than excision of solitary leiomyomas. The recurrence of lesions is more common with multiple piloleiomyomas than with single lesions. After excision, subsequent recurrences have been reported to occur from 6 weeks to more than 15 years. One case report described total excision of multiple leiomyomas followed by immediate artificial skin graft, with successful results.
- One report revealed promising results for pain relief with carbon dioxide laser ablation of several symptomatic leiomyomas over a follow-up of as long as 3-9 months. Only local anesthesia was required for this procedure.
Female patients with multiple leiomyomas should be referred to a gynecologist for evaluation.
- Women who have multiple cutaneous piloleiomyomas may also have uterine leiomyomas. If the latter are present, the patient most likely has a familial condition called multiple MCUL. This is also known as leiomyomatosis cutis et uteri, or Reed syndrome.
- A disease variant involving aggressive renal cancer can also occur and is termed HLRCC. Two family kindreds in Finland with uterine leiomyomas had the unusual association of unilateral papillary renal cell carcinoma. Interestingly, 7 members of 1 family had cutaneous nodules. Two of them underwent skin biopsy, which showed multiple cutaneous piloleiomyomas.
- Reed syndrome is thought to be inherited as an autosomal-dominant trait with incomplete penetrance. As such, not all women in a family are affected, and those who are may have only cutaneous, only uterine, or both cutaneous and uterine leiomyomas.
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