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BioMed Research International
Volume 2018, Article ID 2414609, 11 pages
https://doi.org/10.1155/2018/2414609
Review Article

A Comprehensive Review of the Pharmacologic Management of Uterine Leiomyoma

1Program in Adult & Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, USA
2Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
3Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA

Correspondence should be addressed to William H. Catherino; ude.shusu@onirehtac.mailliw

Received 10 October 2017; Accepted 13 December 2017; Published 28 January 2018

Academic Editor: Wan-Liang Lu

Copyright © 2018 Terrence D. Lewis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Uterine leiomyomata are the most common benign tumors of the gynecologic tract impacting up to 80% of women by 50 years of age. It is well established that these tumors are the leading cause for hysterectomy with an estimated total financial burden greater than $30 billion per year in the United States. However, for the woman who desires future fertility or is a poor surgical candidate, definitive management with hysterectomy is not an optimal management plan. Typical gynecologic symptoms of leiomyoma include infertility, abnormal uterine bleeding (AUB)/heavy menstrual bleeding (HMB) and/or intermenstrual bleeding (IMB) with resulting iron-deficiency anemia, pelvic pressure and pain, urinary incontinence, and dysmenorrhea. The morbidity caused by these tumors is directly attributable to increases in tumor burden. Interestingly, leiomyoma cells within a tumor do not rapidly proliferate, but rather the increase in tumor size is secondary to production of an excessive, stable, and aberrant extracellular matrix (ECM) made of disorganized collagens and proteoglycans. As a result, medical management should induce leiomyoma cells toward dissolution of the extracellular matrix, as well as halting or inhibiting cellular proliferation. Herein, we review the current literature regarding the medical management of uterine leiomyoma.