Myome - Teil 1

Epidemiologische Aspekte

Myome des Uterus sind die häufigsten soliden Tumoren der Frau. Sie sind hormonabhängig und durch ein gutartiges Wachstum charakterisiert. Bei ca. 20 - 30 % aller Frauen über 30 Jahre finden sich Myome des Uterus. Die Zahl steigt bei 40-jährigen Frauen auf über 40 % an [[150]]. Bei 1245 durchgeführten Hysterektomien wiesen 69 % der Patientinnen Myome auf [[74]]. Durch ihre Hormonabhängigkeit

Die Hormonabhängigkeit macht die gutartigen Myome zu einem Problem der Frau im reproduktiven Alter.

stellen Myome ein Problem der Frau im reproduktiven Alter dar. Dennoch muss davon ausgegangen werden, dass die meisten Myome klein und asymptomatisch sind und keiner medizinischen Intervention bedürfen. Im Rahmen von Autopsien fanden sich Myome bei 77 % aller Frauen [[25]]. Größere Myome bzw. solche mit entsprechender Lokalisation können symptomatisch werden und sind häufig der Grund für operative Eingriffe [[166]].

Auffällige Myome sind häufig assoziiert mit folgenden Symptomen

Symptome der Myome: Schmerzen, Blutungsunregelmäßigkeiten, rezidivierende Aborte, Sterilität. Die meisten Myome sind asymptomatisch.

: Schmerzen, Blutungsunregelmäßigkeiten, rezidivierenden Aborten und Sterilität [[52], [120]]. Die Probleme, die durch Myome hervorgerufen werden, sind der häufigste Grund für die Entfernung der Gebärmutter. In den USA wie auch in Deutschland sind Myome der Grund für ein Drittel aller durchgeführten Hysterektomien. Dies entspricht jährlich ca. 200 000 Hysterektomien in den USA [[60], [200]]. Im Jahr 2000 war die Diagnose Leiomyome des Uterus mit insgesamt 94 066 auf Rang 13 aller Krankenhausdiagnosen bei Frauen in Deutschland [[175]].

Myome werden bei Schwarzen 2-mal häufiger diagnostiziert als bei Weißen, während die Häufigkeit bei Asiatinnen und Latinos mit der von Weißen vergleichbar ist. Die höchste Inzidenz wird für Weiße zwischen dem 40. und 44. Lebensjahr angegeben. Trotz der hohen durch Myome verursachten Morbidität ist über die komplexe molekulare Ätiologie der uterinen Myome bisher wenig bekannt [[166]].

Literatur

• 1 Advincula A P, Song A. Endoscopic management of leiomyomata.  Semin Reprod Med. 2004;  22 149-155
• 2 Altman D, Lopez A, Falconer C, Zetterstrom J. The impact of hysterectomy on lower urinary tract symptoms.  Int Urogynecol J Pelvic Floor Dysfunct. 2003;  14 418-423
• 3 Andrews R T, Spies J B, Sacks D, Worthington-Kirsch R L, Niedzwiecki G A, Marx M V, Hovsepian D M, Miller D L, Siskin G P, Raabe R D, Goodwin S C, Min R J, Bonn J, Cardella J F, Patel N H. Task Force on Uterine Artery Embolization and the Standards Division of the Society of Interventional Radiology . Patient care and uterine artery embolization for leiomyomata.  J Vasc Interv Radiol. 2004;  15 115-120
• 4 Arici A, Sozen I. Transforming growth factor-beta3 is expressed at high levels in leiomyomata where it stimulates fibronectin expression and cell proliferation.  Fertil Steril. 2000;  73 1006-1011
• 5 Audonnet G M, Valentini F A, Nelson P P, Breheret J. Urodynamics and uterine fibroid. Is there a specific parameter?.  Ann Readapt Med Phys. 2004;  47 51-55
• 6 Ayoubi J M, Fanchin R, Monrozies X, Imbert P, Reme L M, Pons J C. Respective consequences of abdominal, vaginal and laparoscopic hysterectomies on women's sexuality.  Eur J Obstet Gynecol. 2003;  111 179-182
• 7 Bernard G, Darai E, Poncelet C, Benifla J L, Madelenat P. Fertility after hysteroscopic myomectomy: effect of intramural myomas associated.  Eur J Obstet Gynecol. 2000;  88 85-90
• 8 Baird D D, Schectman J M, Dixon D, Sandler D P, Hill M C. African Americans at higher risk than whites for uterine fibroids: ultrasound evidence.  Am J Epidemiol. 1998;  147 S90
• 9 Benassayay C, Leroy M J, Rigourd V, Robert B, Honore J C, Mignot T M. et al . Estrogen receptors (ERalpha/ERbeta) in normal and pathological growth of the human myometrium: pregnancy and leiomyoma.  Am J Physiol. 1999;  276 E1112-E1118
• 10 Birinyi L, Kalamasz N, Juhasz A G, Major T, Borsos A, Bacsko G. Follow-up study on the effectiveness of transcervical myoma resection (TCRM).  Eur J Obstet Gynecol Reprod Biol. 2004;  113 78-82
• 11 Boehm K D, Daimon M, Gorodeski I G, Sheean L A, Utian W H, Ilan J. Expression of the insulin-like and platelet-derived growth factor genes in human uterine tissues.  Mol Reprod Dev. 1990;  27 93-101
• 12 Brandon D D, Bethea C L, Strawn E Y, Novy M J, Burry K A, Harrington M S, Erickson T E, Warner C, Keenan E J, Clinton G M. Progesterone receptor messenger ribonucleic acid and protein are overexpressed in human uterine leiomyomas.  Am J Obstet Gynecol. 1993;  169 78-85
• 13 Buttram Jr V C. Uterine leiomyomata - aetiology, symptomatology and management.  Prog Clin Biol Res. 1986;  225 275-296
• 14 Campo S, Garcea N. Laparoscopic myomectomie in premenopausal women with and without preoperative treatment using gonadotropin-releasing hormone analogues.  Human Reprod. 1999;  14 44-48
• 15 Canis M J, Wattiez A, Mage G, Bruhat M A. Results of eVALuate study of hysterectomy techniques: laparoscopic hysterectomy may yet have a bright future.  Brit Med J. 2004;  328 129
• 16 Carr B R, Marshburn P B, Weatherall P T, Bradshaw K D, Breslau N A, Byrd W, Roark M, Steinkampf M P. An evaluation of the effect of gonadotropin-releasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebo-controlled, crossover trial.  J Clin Endocrinol Metab. 1993;  76 1217-1223
• 17 Chang W C, Li T C, Lin C C. The effect of physician experience on costs and clinical outcomes of laparoscopic-assisted vaginal hysterectomy: a multivariate analysis.  J Am Assoc Gynecol Laparosc. 2003;  10 356-359
• 18 Chang S D, Cooperberg P L, Wong A D, Llewellyn P A, Bilbey J H. Limited-sequence magnetic resonance imaging in the evaluation of the ultrasonographically indeterminate pelvic mass.  Can Assoc Radiol J. 2004;  55 87-95
• 19 Chiaffarino F, Parazzini F, La Vecchia C, Ricci E, Crosignani P G. Oral contraceptive use and benign gynecologic conditions. A review.  Contraception. 1998;  57 11-18
• 20 Chiaffarino F, Parazzini F, La Vecchia C, Chatenoud L, Di Cintio E, Marsico S. Diet and uterine myomas.  Obstet Gynecol. 1999;  94 395-398
• 21 Clark B M, Johnson J V. Advising postmenopausal women with fibroids on HRT options.  Contemp OB GYN. 2000;  45 86-100
• 22 Clark T J. Outpatient hysteroscopy and ultrasonography in the management of endometrial disease.  Curr Opin Obstet Gynecol. 2004;  16 305-311
• 23 Colacurci N, De Franciscis P, Cobellis L, Nazzaro G, De Placido G. Effects of hormone replacement therapy on postmenopausal uterine myoma.  Maturitas. 2000;  29; 35 167-173
• 24 Committee on Gynecologic Practice . ACOG Committee Opinion. Uterine artery embolization.  Obstet Gynecol. 2004;  103 403-404
• 25 Cramer S F, Patel A. The frequency of uterine leiomyomas.  Am J Clin Pathol. 1990;  94 435-438
• 26 Darwish A. Modified hysteroscopic myomectomy of large submucous fibroids.  Gynecol Obstet Invest. 2003;  56 192-196
• 27 de Aloysio D, Altieri P, Penacchioni P, Salgarello M, Ventura V. Bleeding patterns in recent postmenopausal outpatients with uterine myomas: comparison between two regimens of HRT.  Maturitas. 1998;  17; 29 261-264
• 28 Deligdisch L. Hormonal pathology of the endometrium.  Mod Pathol. 2000;  13 285-294
• 29 Dessolle L, Soriano D, Poncelet C, Benifla J L, Madelenat P, Darai E. Determinants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility.  Fertil Steril. 2001;  76 370-374
• 30 Donnez J, Jadoul P. What are the implications of myomas on fertility?.  Human Reprod. 2002;  17 1424-1430
• 31 Donnez J, Squifflet J, Jadoul P, Smets M. Results of eVALuate study of hysterectomy techniques: high rate of complications needs explanation.  BMJ. 2004;  328 129
• 32 Doridot V, Dubuisson J B, Chapron C, Fauconnier A, Babaki-Fard K. Recurrence of leiomyomata after laparoscopic myomectomy.  J Am Assoc Gynecol Laparosc. 2001;  8 495-500
• 33 Dragisic K G, Milad M P. Sexual functioning and patient expectations of sexual functioning after hysterectomy.  Am J Obstet Gynecol. 2004;  190 1416-1418
• 34 Dubuisson J B, Chapron C, Fauconnier A, Babaki-Fard K. Laparoscopic myomectomy fertility results.  Ann N Y Acad Sci. 2001;  943 269-275
• 35 Dubuisson J B, Fauconnier A, Chapron C, Kreiker G, Norgaard C. Second look after laparoscopic myomectomy.  Hum Reprod. 1998;  13 2102-2106
• 36 Dubuisson J B, Fauconnier A, Babaki-Fard K, Chapron C. Laparoscopic myomectomy: a current view.  Human Reprod Update. 2000;  6 558-594
• 37 Dubuisson J B, Fauconnier A, Deffarges J V, Norgaard C, Kreiker G, Charpron C. Pregnancy outcome and deliveries following laparoscopic myomectomy.  Human Reprod. 2000;  15 869-973
• 38 Dixon D, Flake G P, Moore A B, He H, Haseman J K, Risinger J I, Lancaster J M, Berchuck A, Barrett J C, Robboy S J. Cell proliferation and apoptosis in human uterine leiomyomas and myometria.  Virchows Arch. 2002;  44 53-62
• 39 El-Mowafi D, Madkour W, Lall C, Wenger J M. Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy.  J Am Assoc Gynecol Laparosc. 2004;  11 175-180
• 40 El-Toukhy T, Hefni M, Davies A, Mahadevan S. The effect of different types of hysterectomy on urinary and sexual functions: a prospective study.  J Obstet Gynaecol. 2004;  24 420-425
• 41 Emans S J, Laufer M R, Goldstein D P. Pediatric and Adolescent Gynecology. Philadelphia; Williams and Wilkins 1998
• 42 Emig R, Wallwiener D, Licht P. Wann sind präoperative GnRh-Analoga sinnvoll?.  Frauenarzt. 2004;  45 38-39
• 43 Englund K, Blanck A, Gustavsson I, Lundkvist U, Sjoblom P, Norgren A, Lindblom B. Sex steroid receptors in human myometrium and fibroids: changes during the menstrual cycle and gonadotropin-releasing hormone treatment.  J Clin Endocrinol Metab. 1998;  83 4092-4096
• 44 Ellstrom M A, Astrom M, Moller A, Olsson J H, Hahlin M. A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy.  Acta Obstet Gynecol Scand. 2003;  82 871-875
• 45 Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson J B. Recurrence of leiomyomata after myomectomy.  Hum Reprod Update. 2000;  6 595-602
• 46 Fauconnier A, Dubuisson J B, Ancel P Y, Chapron C. Prognostic factors of reproductive outcome after myomectomy in infertile patients.  Hum Reprod. 2000;  15 1751-1757
• 47 Fayed Y M, Tsibris J C, Langenberg P W, Robertson Jr A L. Human uterine leiomyoma cells: binding and growth responses to epidermal growth factor, platelet-derived growth factor, and insulin.  Lab Invest. 1989;  60 30-37
• 48 Febo G, Tessarolo M, Leo L, Arduino S, Wierdis T, Lanza L. Surgical management of leiomyomata in pregnancy.  Clin Exp Obstet Gynecol. 1997;  24 76-78
• 49 Felberbaum R E, Germer U, Ludwig M, Riethmuller-Winzen H, Heise S, Buttge I, Bauer O, Reissmann T, Engel J, Diedrich K. Treatment of uterine fibroids with a slow-release formulation of the gonadotrophin releasing hormone antagonist Cetrorelix.  Hum Reprod. 1998;  13 1660-1668
• 50 Fernandez H, Sefrioui O, Virelizier C, Gervaise A, Gomel V, Frydman R. Hysteroscopic resection of submucosal myomas in patients with infertility.  Human Reprod. 2001;  16 1489-1492
• 51 Filicori M, Hall D A, Loughlin J S, Rivier J, Vale W, Crowley Jr W F. A conservative approach to the management of uterine leiomyoma: pituitary desensitization by a luteinizing hormone-releasing hormone analogue.  Am J Obstet Gynecol. 1983;  147 726-727
• 52 Flake P G. Etiology and pathogenesis of uterine leiomyomas: a review.  Environ Health Perspect. 2003;  111 1037-1054
• 53 Fleischer A C. Color Doppler sonography of uterine disorders.  Ultrasound Q. 2003;  19 179-189
• 54 Friedman A J, Barbieri R L, Doubilet P M, Fine C, Schiff I. A randomized, double-blind trial of a gonadotropin releasing-hormone agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri.  Fertil Steril. 1988;  49 404-409
• 55 Friedman A J, Lobel S M, Rein M S, Barbieri R L. Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: the estrogen threshold hypothesis.  Am J Obstet Gynecol. 1990;  163 1114-1119
• 56 Friedman A J, Daly M, Juneau-Norcross M, Gleason R, Rein M S, LeBoff M. Long-term medical therapy for leiomyomata uteri: a prospective, randomized study of leuprolide acetate depot plus either oestrogen-progestin or progestin ‚add-back‘ for 2 years.  Hum Reprod. 1994;  9 1618-1625
• 57 Fuchs-Young R, Howe S, Hale L, Miles R, Walker C. Inhibition of estrogen-stimulated growth of uterine leiomyomas by selective estrogen receptor modulators.  Mol Carcinog. 1996;  17 151-159
• 58 Gamage S D, Bischoff E D, Burroughs K D, Lamph W W, Gottardis M M, Walker C L, Fuchs-Young R. Efficacy of LGD1069 (Targretin), a retinoid X receptor-selective ligand, for treatment of uterine leiomyoma.  J Pharmacol Exp Ther. 2000;  295 677-681
• 59 Gambone J C, Reiter R C, Lench J B, Moore J G. The impact of a quality assurance process on the frequency and confirmation rate of hysterectomy.  Am J Obstet Gynecol. 1990;  163 545-550
• 60 Gao Z, Matsuo H, Nakago S, Kurachi O, Maruo T. p53 Tumor suppressor protein content in human uterine leiomyomas and its down-regulation by 17 beta-estradiol.  J Clin Endocrinol Metab. 2002;  87 3915-3920
• 61 Gattas G J, Quade B J, Nowak R A, Morton C C. HMGIC expression in human adult and fetal tissues and in uterine leiomyomata.  Genes Chromosomes Cancer. 1999;  25 316-322
• 62 Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, Clayton R, Phillips G, Whittaker M, Lilford R, Bridgman S, Brown J. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.  BMJ. 2004;  328 129-Epub 2004, Jan 07 BMJ. 2004;  328 494-494 (Erratum)
• 63 Goldin B R, Adlercreutz H, Gorbach S L, Warram J H, Dwyer J T, Swenson L, Woods M N. Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women.  N Engl J Med. 1982;  307 1542-1547
• 64 Gorbach S L, Goldin B R. Diet and the excretion and enterohepatic cycling of estrogens.  Prev Med. 1987;  16 525-531
• 65 Guise J M, McDonagh M S, Osterweil P, Nygren P, Chan B K, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section.  BMJ. 2004;  329 19-25
• 66 Halttunen M. Female sexuality does not need a uterine cervix: no need for subtotal hysterectomy.  Acta Obstet Gynecol Scand. 2004;  83 119-120
• 67 Harrison-Woolrych M L, Charnock-Jones D S, Smith S K. Quantification of messenger ribonucleic acid for epidermal growth factor in human myometrium and leiomyomata using reverse transcriptase polymerase chain reaction.  J Clin Endocrinol Metab. 1994;  78 1179-1184
• 68 Hart R. A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception.  Human Reprod. 2001;  16 2411-2417
• 69 Havre P A, Rice M C, Noe M, Kmiec E B. The human REC2/RAD51 B gene acts as a DNA damage sensor by inducing G1 delay and hypersensitivity to ultraviolet irradiation.  Cancer Res. 1998;  58 4733-4739
• 70 Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy.  Int J Gynaecol Obstet. 1991;  34 45-48
• 71 Havre P A, Rice M, Ramos R, Kmiec E B. HsRec2/Rad51L1, a protein influencing cell cycle progression, has protein kinase activity.  Exp Cell Res. 2000;  254 33-44
• 72 Heinberg E M, Crawford 3rd B L. Total laparoscopic hysterectomy in obese versus nonobese patients.  Obstet Gynecol. 2004;  103 674-680
• 73 Hodges L C, Bergerson J S, Hunter D S, Walker C L. Estrogenic effects of organochlorine pesticides on uterine leiomyoma cells in vitro.  Toxicol Sci. 2000;  54 355-364
• 74 Howe S R, Gottardis M M, Everitt J I, Walker C. Estrogen stimulation and tamoxifen inhibition of leiomyoma cell growth in vitro and in vivo.  Endocrinology. 1995;  136 4996-5003
• 75 Howe S R, Pass H I, Ethier S P, Matthews W J, Walker C. Presence of an insulin-like growth factor I autocrine loop predicts uterine fibroid responsiveness to tamoxifen.  Cancer Res. 1996;  56 4049-4055
• 76 Hsueh A J, Peck Jr E J, Clark J H. Progesterone antagonism of the oestrogen receptor and oestrogen-induced uterine growth.  Nature. 1975;  254 337-339
• 77 Huang L Y, Cheng Y F, Chang H W, Chang S Y, Kung F T, Liang H M, Huang K H. Quantified short-term outcome of uterine artery embolization with gelatin sponge particles and lipiodol for symptomatic myoma.  Fertil Steril. 2004;  81 1375-1382
• 78 Hunter D S, Hodges L C, Eagon P K, Vonier P M, Fuchs-Young R, Bergerson J S, Walker C L. Influence of exogenous estrogen receptor ligands on uterine leiomyoma: evidence from an in vitro/in vivo animal model for uterine fibroids.  Environ Health Perspect. 2000;  108 (Suppl 5) 829-834
• 79 Hunter D S, Hodges L C, Vonier P M, Fuchs-Young R, Gottardis M M, Walker C L. Estrogen receptor activation via activation function 2 predicts agonism of xenoestrogens in normal and neoplastic cells of the uterine myometrium.  Cancer Res. 1999;  59 3090-3099
• 80 Hyder S M, Huang J C, Nawaz Z, Boettger-Tong H, Makela S, Chiappetta C, Stancel G M. Regulation of vascular endothelial growth factor expression by estrogens and progestins.  Environ Health Perspect. 2000;  108 (Suppl 5) 785-790
• 81 Ichimura T, Kawamura N, Ito F, Shibata S, Minakuchi K, Tsujimura A, Umesaki N, Ogita S. Correlation between the growth of uterine leiomyomata and estrogen and progesterone receptor content in needle biopsy specimens.  Fertil Steril. 1998;  70 967-971
• 82 Imai A, Sugiyama M, Furui T, Takahashi S, Tamaya T. Gonadotropin-releasing hormones agonist therapy increases peritoneal fibrolytic activity and prevents adhesion formation after myomectomy.  J Obstet Gynaecol. 2003;  23 660-663
• 83 Jirecek S, Lee A, Pavo I, Crans G, Eppel W, Wenzl R. Raloxifene prevents the growth of uterine leiomyomas in premenopausal women.  Fertil Steril. 2004;  81 132-136
• 84 Katz V L, Dotters D J, Droegemeuller W. Complications of uterine leiomyomas in pregnancy.  Obstet Gynecol. 1989;  73 593-596
• 85 Katzenellenbogen B S. Dynamics of steroid hormone receptor action.  Annu Rev Physiol. 1980;  42 17-13
• 86 Kettel L M, Murphy A A, Morales A J, Rivier J, Vale W, Yen S S. Rapid regression of uterine leiomyomas in response to daily administration of gonadotropin-releasing hormone antagonist.  Fertil Steril. 1993;  60 642-646
• 87 Kjerulff K H, Langenberg P, Seidman J D, Stolley P D, Guzinski G M. Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis.  J Reprod Med. 1996;  41 483-490
• 88 Kim D H, Lee Y S, Lee E S. Alteration of sexual function after classic intrafascial supracervical hysterectomy and total hysterectomy.  J Am Assoc Gynecol Laparosc. 2003;  10 60-64
• 89 Kommoss F, DeGregorio G, Strittmatter B, Pfisterer J, Karck U, Zahradnik H P, Breckwoldt M. Obstetric complications, incidence and indications of cesarean section in uterus myomatosus.  Geburtsh Frauenheilk. 1993;  53 564-567
• 90 Köhler C, Hasenbein K, Klemm P, Tozzi R, Schneider A. Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vessels.  Surg Endosc. 2003;  17 485-490
• 91 Kreiker G L, Bertoldi A, Larcher J S, Orrico G R, Chapron C. Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital.  J Am Assoc Gynecol Laparosc. 2004;  11 229-235
• 92 Kuppermann M, Varner R E, Summitt Jr R L, Learman L A, Ireland C, Vittinghoff E, Stewart A L, Lin F, Richter H E, Showstack J, Hulley S B, Washington Ms Research Group A E;. Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial.  JAMA. 2004;  291 1447-1455
• 93 Lamminen S, Rantala I, Helin H, Rorarius M, Tuimala R. Proliferative activity of human uterine leiomyoma cells as measured by automatic image analysis.  Gynecol Obstet Invest. 1992;  34 111-114
• 94 Lee B S, Stewart E A, Sahakian M, Nowak R A. Interferon-alpha is a potent inhibitor of basic fibroblast growth factor-stimulated cell proliferation in human uterine cells.  Am J Reprod Immunol. 1998;  40 19-25
• 95 Learman L A, Summitt Jr R L, Varner R E, McNeeley S G, Goodman-Gruen D, Richter H E, Lin F, Showstack J, Ireland C C, Vittinghoff E, Hulley S B, Washington A E. Total or Supracervical Hysterectomy Research Group (TOSH) . A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes.  Obstet Gynecol. 2003;  102 453-462
• 96 Lefebvre G, Vilos G, Allaire C, Jeffrey J, Arneja J, Birch C, Fortier M, Wagner M S. Clinical Practice Gynaecology Committee . The management of uterine leiomyomas.  J Obstet Gynaecol Can. 2003;  25 396-418 quiz 419-422
• 97 Li T C, Mortimer R, Cooke I D. Myomectomy: a retrospective study to examine reproductive performance before and after surgery.  Hum Reprod. 1999;  14 1735-1740
• 98 Ligon A H, Morton C C. Genetics of uterine leiomyomata.  Genes Chromosomes Cancer. 2000;  28 235-245
• 99 Lindheim S R, Adsuar N, Kushner D M, Pritts E A, Olive D L. Sonohysterography: a valuable tool in evaluating the female pelvis.  Obstet Gynecol Surv. 2003;  58 770-784
• 100 Lindner V, Reidy M A. Proliferation of smooth muscle cells after vascular injury is inhibited by an antibody against basic fibroblast growth factor.  Proc Natl Acad Sci USA. 1991;  88 3739-3743
• 101 Lumbiganon P, Rugpao S, Phandhu-fung S, Laopaiboon M, Vudhikamraksa N, Werawatakul Y. Protective effect of depot-medroxyprogesterone acetate on surgically treated uterine leiomyomas: a multicentre case - control study.  Br J Obstet Gynaecol. 1996;  103 909-914
• 102 Lyons T L, Adolph A J, Winer W K. Laparoscopic supracervical hysterectomy for the large uterus.  J Am Assoc Gynecol Laparosc. 2004;  11 170-174
• 103 Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis G B. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome.  Am J Obstet Gynecol. 1996;  174 654-658
• 104 Malzoni M, Rotond M, Perone C, Labriola D, Ammaturo F, Izzo A, Panariello S, Reich H. Fertility after laparoscopic myomectomy of large uterine myomas: operative technique and preliminary results.  Eur J Gynaecol Oncol. 2003;  24 79-82
• 105 Malzoni M, Perniola G, Perniola F, Imperato F. Optimizing the total laparoscopic hysterectomy procedure for benign uterine pathology.  J Am Assoc Gynecol Laparosc. 2004;  11 211-218
• 106 Mangrulkar R S, Ono M, Ishikawa M, Takashima S, Klagsbrun M, Nowak R A. Isolation and characterization of heparin-binding growth factors in human leiomyomas and normal myometrium.  Biol Reprod. 1995;  53 636-646
• 107 Marshall L M, Spiegelman D, Barbieri R L, Goldman M B, Manson J E, Colditz G A, Willett W C, Hunter D J. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race.  Obstet Gynecol. 1997;  90 967-973
• 108 Marshall L M, Spiegelman D, Goldman M B, Manson J E, Colditz G A, Barbieri R L, Stampfer M J, Hunter D J. A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata.  Fertil Steril. 1998;  70 432-439
• 109 Marshall L M, Spiegelman D, Manson J E, Goldman M B, Barbieri R L, Stampfer M J, Willett W C, Hunter D J. Risk of uterine leiomyomata among premenopausal women in relation to body size and cigarette smoking.  Epidemiology. 1998;  9 511-517
• 110 Mashal R D, Fejzo M L, Friedman A J, Mitchner N, Nowak R A, Rein M S, Morton C C, Sklar J. Analysis of androgen receptor DNA reveals the independent clonal origins of uterine leiomyomata and the secondary nature of cytogenetic aberrations in the development of leiomyomata.  Genes Chromosomes Cancer. 1994;  11 1-6
• 111 Maruo T, Matsuo H, Samoto T, Shimomura Y, Kurachi O, Gao Z, Wang Y, Spitz I M, Johansson E. Effects of progesterone on uterine leiomyoma growth and apoptosis.  Steroids. 2000;  65 585-592
• 112 Matsuo H, Kurachi O, Shimomura Y, Samoto T, Maruo T. Molecular bases for the actions of ovarian sex steroids in the regulation of proliferation and apoptosis of human uterine leiomyoma.  Oncology. 1999;  57 (Suppl 2) 49-58
• 113 McLucas B, Goodwin S, Adler L, Rappaport A, Reed R, Perrella R. Pregnancy following uterine fibroid embolization.  Int J Obstet Gynecol. 2001;  74 1-7
• 114 McPherson K, Metcalfe M A, Herbert A, Maresh M, Casbard A, Hargreaves J, Bridgman S, Clarke A. Severe complications of hysterectomy: the VALUE study.  BJOG. 2004;  111 688-694
• 115 Minakuchi K, Kawamura N, Tsujimura A, Ogita S. Remarkable and persistent shrinkage of uterine leiomyoma associated with interferon alfa treatment for hepatitis.  Lancet. 1999;  353 2127-2128
• 116 Murphy A A, Kettel L M, Morales A J, Roberts V J, Yen S S. Regression of uterine leiomyomata in response to the antiprogesterone RU 486.  J Clin Endocrinol Metab. 1993;  76 513-517
• 117 Narushima M, Otani T, Itoh Y, Kai S, Kondo A, Hayashi H. Clinical effects of transabdominal simple hysterectomy on micturition function.  Hinyokika Kiyo. 1993;  39 797-800
• 118 National Collaborating Centre for Women's and Children's Health .National Institute for Clinical Excellence. February/2004
• 119 Nass Duce M, Oz U, Ozer C, Yildiz A, Apaydin F D, Cil F. Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps.  Aust NZ J Obstet Gynaecol. 2003;  43 448-452
• 120 Newbold R, DiAugustine R P, Risinger K I, Everitt J I, Walmer D K, Parrot E C, Dixon D. Advances in uterine leiomyoma research: conference overview, summary, and future research recommendations.  Environ Health Perspect. 2000;  108 769-773
• 121 Obermair A, Ginbey P, McCartney A J. Feasibility and safety of total laparoscopic radical hysterectomy.  J Am Assoc Gynecol Laparosc. 2003;  10 345-349
• 122 O'Hanlan K A, Huang G S, Lopez L, Garnier A C. Selective incorporation of total laparoscopic hysterectomy for adnexal pathology and body mass index.  Gynecologic Oncology. 2004;  93 137-143
• 123 O'Hanlan K A, Lopez L, Dibble S L, Garnier A C, Huang G S, Leuchtenberger M. Total laparoscopic hysterectomy: body mass index and outcomes.  Obstet Gynecol. 2003;  102 1384-1392
• 124 Olive D L. Review of the evidence for treatment of leiomyomata.  Environ Health Perspect. 2000;  108 841-843
• 125 Oliveira F G, Abdelmassih V G, Diamond M P, Dozortsev D, Melo N R, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection.  Fertil Steril. 2004;  81 582-587
• 126 Ostrzenski A, Radolinski B, Ostrzenska K M. A review of laparoscopic ureteral injury in pelvic surgery.  Obstet Gynecol Surv. 2003;  58 794-799
• 127 Otubu J A, Buttram V C, Besch N F, Besch P K. Unconjugated steroids in leiomyomas and tumor-bearing myometrium.  Am J Obstet Gynecol. 1982;  143 130-133
• 128 Palomba S, Affinito P, Tommaselli G A, Nappi C. A clinical trial of the effects of tibolone administered with gonadotropin-releasing hormone analogues for the treatment of uterine leiomyomata.  Fertil Steril. 1998;  70 111-118
• 129 Palomba S, Sammartino A, Di Carlo C, Affinito P, Zullo F, Nappi C. Effects of raloxifene treatment on uterine leiomyomas in postmenopausal women.  Fertil Steril. 2001;  76 38-43
• 130 Pambuccian C A, Oprea G M, Lakatua D J. Reduced expression of early growth response-1 gene in leiomyoma as identified by mRNA differential display.  Gynecol Oncol. 2002;  8 431-436
• 131 Pansky M, Feingold M, Bahar R, Neeman O, Asiag O, Herman A, Sagiv R. Improved patient compliance using pediatric cystoscope during office hysteroscopy.  J Am Assoc Gynecol Laparosc. 2004;  11 262-264
• 132 Parazzini F, Negri E, La Vecchia C, Rabaiotti M, Luchini L, Villa A, Fedele L. Uterine myomas and smoking. Results from an Italian study.  J Reprod Med. 1996;  41 316-320
• 133 Parazzini F, Vercellini P, De Giorgi O, Pesole A, Ricci E, Crosignani P G. Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: literature review.  Hum Reprod. 1998;  13 2592-2597
• 134 Pelage J P, Guaou N G, Jha R C, Ascher S M, Spies J B. Uterine fibroid tumors: long-term MR imaging outcome after embolization.  Radiology. 2004;  230 803-809
• 135 Pelage J P, Le Dref O, Soyer P, Kardache M, Dahan H, Abitbol M, Merland J J, Ravina J H, Rymer R. Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow up.  Radiology. 2000;  215 428-431
• 136 Pellicano M, Bramante S, Cirillo D, Palomba S, Bifulco G, Zullo F, Nappi C. Effectiveness of autocrosslinked hyaluronic acid gel after laparoscopic myomectomy in infertile patients: a prospective, randomized, controlled study.  Fertil Steril. 2003;  80 441-444
• 137 Perrone G, DeAngelis C, Critelli C, Capri O, Galoppi P, Santoro G, Nofroni I, Zichella L. Hysteroscopic findings in postmenopausal abnormal uterine bleeding: a comparison between HRT users an non users.  Maturitas. 2002;  43 251-255
• 138 Phelan J P. Myomas and pregnancy.  Obstet Gynecol Clin North Am. 1995;  22 801-805
• 139 Piazze Garnica J, Gallo G, Marzano P F, Vozzi G, Mazzocco M, Anceschi M M, Rolfini G. Clinical and ultrasonographic implications of uterine leiomyomatosis in pregnancy.  Clin Exp Obstet Gynecol. 1995;  22 293-297
• 140 Polatti F, Viazzo F, Colleoni R, Nappi R E. Uterine myoma in postmenopause: a comparison between two therapeutic schedules of HRT.  Maturitas. 2000;  37 27-32
• 141 Pritts E A. Fibroids and Infertility: A systematic Review of the Evidence.  Obstet Gynecol Survey. 2001;  56 483-491
• 142 Prollius A, de Vries C, Loggenberg E, Nel M, du Plessis A, Van Rensburg D J, Wessels P H. Uterine artery embolization for symptomatic fibroids.  Int J Gynaecol Obstet. 2004;  84 236-240
• 143 Prollius A, de Vries C, Loggenberg E, du Plessis A, Nel M, Wessels P H. Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome.  BJOG. 2004;  111 239-242
• 144 Reed S D, Cushing-Haugen K L, Daling J R, Scholes D, Schwartz S M. Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas.  Menopause. 2004;  11 214-222
• 145 Rein M S, Powell W L, Walters F C, Weremowicz S, Cantor R M, Barbieri R L, Morton C C. Cytogenetic abnormalities in uterine myomas are associated with myoma size.  Mol Hum Reprod. 1998;  4 83-86
• 146 Rein M S. Advances in uterine leiomyoma research: the progesterone hypothesis.  Environ Health Perspect. 2000;  108 (Suppl 5) 791-793
• 147 Richards P A, Tiltman A J. Anatomical variation of the oestrogen receptor in the non-neoplastic myometrium of fibromyomatous uteri.  Virchows Arch. 1996;  428 347-351
• 148 Ribeiro S C, Reich H, Rosenberg J, Guglielminetti E, Vidali A. Laparoscopic myomectomy and pregnancy outcome in infertile patients.  Fertil Steril. 1999;  71 571-574
• 149 Ribiero S C, Ribeiro R M, Santos N C, Pinotti J A. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy.  Int J Gynecol Obstet. 2003;  83 37-43
• 150 Robboy S J, Bentley R C, Butnor K, Anderson M C. Pathology and pathophysiology of uterine smooth-muscle tumors.  Environ Health Perspect. 2000;  108 779-784
• 151 Roemisch M, Nezhat F R, Nezhat A. Pregnancy after laparoscopic myomectomy.  J Am Assoc Gynecol Laparosc. 1996;  3 (Suppl 4) S42
• 152 Romagnolo B, Cluzeaud F, Lambert M, Colnot S, Porteu A, Molina T, Tomasset M, Vandewalle A, Kahn A, Perret C. Tissue-specific and hormonal regulation of calbindin-D9 K fusion genes in transgenic mice.  J Biol Chem. 1996;  271 1682-1686
• 153 Roovers J P, van der Bom J G, van der Vaart C H, Heintz A P. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy.  BMJ. 2003;  327 774-778
• 154 Rose D P, Cohen L A, Berke B, Boyar A P. Effect of a low-fat diet on hormone levels in women with cystic breast disease. II. Serum radioimmunoassayable prolactin and growth hormone and bioactive lactogenic hormones.  J Natl Cancer Inst. 1987;  78 627-631
• 155 Rose D P, Goldman M, Connolly J M, Strong L E. High-fiber diet reduces serum estrogen concentrations in premenopausal women.  Am J Clin Nutr. 1991;  54 520-525
• 156 Ross R K, Pike M C, Vessey M P, Bull D, Yeates D, Casagrande J T. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives.  Br Med J (Clin Res Ed) 1986; 293: 359 - 362, Erratum in: Br Med J (Clin Res Ed). 1986;  293 1027
• 157 Roussis N P, Waltrous L, Kerr A, Robertazzi R, Cabbad M F. Sexual response in the patient after hysterectomy: total abdominal versus supracervical versus vaginal procedure.  Am J Obstet Gynecol. 2004;  190 1427-1428
• 158 Ryu J A, Kim B, Lee J, Kim S, Lee S H. Comparison of transvaginal ultrasonography with hysterosonography as a screening method in patients with abnormal uterine bleeding.  Korean J Radiol. 2004;  5 39-46
• 159 Samadi A R, Lee N C, Flanders W D, Boring 3rd J R. Risk factors for self-reported uterine fibroids: a case-control study.  Am J Public Health. 1996;  86 858-862
• 160 Salvador E, Bienstock J, Blakemore K J, Pressman E. Leiomyomata uteri, genetic amniocentesis, and the risk of second-trimester spontaneous abortion.  Am J Obstet Gynecol. 2002;  186 913-915
• 161 Sato F, Nishi M, Kudo R, Miyake H. Body fat distribution and uterine leiomyomas.  J Epidemiol. 1998;  8 176-180
• 162 Sato F, Miyake H, Nishi M, Mori M, Kudo R. Early normal menstrual cycle pattern and the development of uterine leiomyomas.  J Womens Health Gend Based Med. 2000;  9 299-302
• 163 Saxena S P, Khare C, Farooq A, Murugesan K, Buckshee K, Chandra J. DDT and its metabolites in leiomyomatous and normal human uterine tissue.  Arch Toxicol. 1987;  59 453-455
• 164 Schoenmakers E F, Huysmans C, Van de Ven W J. Allelic knockout of novel splice variants of human recombination repair gene RAD51 B in t(12; 14) uterine leiomyomas.  Cancer Res. 1999;  59 19-23
• 165 Schwartz L B, Zawin M, Carcangiu M L, Lange R, McCarthy S. Does pelvic magnetic resonance imaging differentiate among the histologic subtypes of uterine leiomyomata?.  Fertil Steril. 1998;  70 580-587
• 166 Schwartz S M, Marshall L M, Baird D D. Epidemiologic contributions to understanding the etiology of uterine leiomyomata.  Environ Health Perspect. 2000;  108 (Suppl 5) 821-827
• 167 Sculpher M, Manca A, Abbott J, Fountain J, Mason S, Garry R. Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial.  BMJ. 2004;  DOI: 10.1136/bmj.37942.601331.EE
• 168 Segaloff A, Weed J C, Sternberg W H, Parson W. The progesterone therapy of human uterine leiomyomas.  J Clin Endocrinol Metab. 1949;  9 1273-1291
• 169 Seracchioli R, Colombo F M, Bagnoli A, Govoni F, Missiroli S, Venturoli S. Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?.  BJOG. 2003;  110 236-240
• 170 Shaw R W. New approaches to the management of fibroids.  Curr Opin Obstet Gynecol. 1991;  3 859-864
• 171 Shimomura Y, Matsuo H, Samoto T, Maruo T. Up-regulation by progesterone of proliferating cell nuclear antigen and epidermal growth factor expression in human uterine leiomyoma.  J Clin Endocrinol Metab. 1998;  83 2192-2198
• 172 Shozu M, Sumitani H, Segawa T, Yang H J, Murakami K, Kasai T, Inoue M. Overexpression of aromatase P450 in leiomyoma tissue is driven primarily through promoter I. 4 of the aromatase P450 gene (CYP19).  J Clin Endocrinol Metab. 2002;  87 2540-2548
• 173 Soriano D, Dessolle L, Poncelet C, Benifla J L, Madelenat P, Darai E. Pregnancy outcome after laparoscopic and laparoconverted myomectomy.  Eur J Obstet Gynecol. 2003;  108 194-198
• 174 Sozen I, Arici A. Interactions of cytokines, growth factors, and the extracellular matrix in the cellular biology of uterine leiomyomata.  Fertil Steril. 2002;  78 1-12
• 175 Statistisches Jahrbuch. Stuttgart; Metzler-Poeschel 2000
• 176 Stewart E A. Uterine fibroids.  Lancet. 2001;  357 293-298
• 177 Stewart E A, Nowak R A. Leiomyoma-related bleeding: a classic hypothesis updated for the molecular era.  Hum Reprod Update. 1996;  2 295-306
• 178 Stewart E A, Nowak R A. New concepts in the treatment of uterine leiomyomas.  Obstet Gynecol. 1998;  92 624-627
• 179 Strobelt N, Ghidini A, Cavallone M, Pensabene I, Ceruti P, Vergani P. Natural history of uterine leiomyomas in pregnancy.  J Ultrasound Med. 1994;  13 399-401
• 180 Surrey E S. Impact of intramural leiomyomata on in-vitro fertilization-embryo transfer cycle outcome.  Curr Opin Obstet Gynecol. 2003;  15 239-242
• 181 Takahashi T, Nagai N, Oda H, Ohama K, Kamada N, Miyagawa K. Evidence for RAD51L1/HMGIC fusion in the pathogenesis of uterine leiomyoma.  Genes Chromosomes Cancer. 2001;  30 196-201
• 182 Takeuchi H, Kinoshita K. Evaluation of adhesion formation after laparoscopic myomectomy by systematic second-look microlaparoscopy.  J Am Assoc Gynecol Laparosc. 2002;  9 442-446
• 183 Taylor A H, Al-Azzawi F. Immunolocalisation of oestrogen receptor beta in human tissues.  J Mol Endocrinol. 2000;  24 145-155
• 184 Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy.  N Engl J Med. 2002;  347 1318-1325
• 185 Thi M T, Baulieu E E, Milgrom E. Comparison of the characteristics and of the hormonal control of endometrial and myometrial progesterone receptors.  J Endocrinol. 1975;  66 349-356
• 186 Thiel J, Gamelin A. Outpatient total laparoscopic hysterectomy.  J Am Assoc Gynecol Laparosc. 2003;  10 481-483
• 187 Tiltman A J. The effect of progestins on the mitotic activity of uterine fibromyomas.  Int J Gynecol Pathol. 1985;  4 89-96
• 188 Timor-Tritsch I E, Masch R J, Goldstein S R, Ng E, Monteagudo A. Transvaginal ultrasound-assisted gynecologic surgery: evaluation of a new device to improve safety of intrauterine surgery.  Am J Obstet Gynecol. 2003;  189 1074-1079
• 189 Townsend D E, Sparkes R S, Baluda M C, McClelland G. Unicellular histogenesis of uterine leiomyomas as determined by electrophoresis by glucose-6-phosphate dehydrogenase.  Am J Obstet Gynecol. 1970;  15 (107) 1168-1173
• 190 Tropeano G, Di Stasi C, Litwicka K, Romano D, Draisci G, Mancuso S. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years.  Fertil Steril. 2004;  81 1055-1061
• 191 Ugur M, Turan C, Mungan T, Aydogdu T, Sahin Y, Gokmen O. Laparoscopy for adhesion prevention following myomectomy.  Int J Gynaecol Obstet. 1996;  53 145-149
• 192 Vercellini P, Zaina B, Yaylayan L, Pisacreta A, De Giorgi O, Crosignani P G. Hysteroscopic myomectomy: long-term effects on menstrual pattern and fertility.  Obstet Gynecol. 1999;  94 341-347
• 193 Vercellini P, Maddalena S, De Giorgi O, Pesole A, Ferrari L, Crosignani P G. Determinants of reproductive outcome after abdominal myomectomy for infertility.  Fertil Steril. 1999;  72 109-114
• 194 Viville B, Charnock-Jones D S, Sharkey A M, Wetzka B, Smith S K. Distribution of the A and B forms of the progesterone receptor messenger ribonucleic acid and protein in uterine leiomyomata and adjacent myometrium.  Hum Reprod. 1997;  12 815-822
• 195 Vollenhoven B J, Lawrence A S, Healy D L. Uterine fibroids: a clinical review.  Br J Obstet Gynaecol. 1990;  97 285-298
• 196 Vollenhoven B J, Herington A C, Healy D L. Messenger ribonucleic acid expression of the insulin-like growth factors and their binding proteins in uterine fibroids and myometrium.  J Clin Endocrinol Metab. 1993;  76 1106-1110
• 197 Walker C L. Role of hormonal and reproductive factors in the etiology and treatment of uterine leiomyoma.  Recent Prog Horm Res. 2002;  57 277-294
• 198 Walker C L, Burroughs K D, Davis B, Sowell K, Everitt J I, Fuchs-Young R. Preclinical evidence for therapeutic efficacy of selective estrogen receptor modulators for uterine leiomyoma.  J Soc Gynecol Investig. 2000;  7 249-256
• 199 Watson A, Vandekerckhove P, Lilford R. Liquid and fluid agents for preventing adhesions after surgery for subfertility.  Cochrane Database Syst Rev. 2000;  3 CD001298
• 200 Wilcox L S, Koonin L M, Pokras R, Strauss L T, Xia Z, Peterson H B. Hysterectomy in the United States, 1988 - 1990.  Obstet Gynecol. 1994;  83 549-555
• 201 Yamamoto T, Takamori K, Okada H. Estrogen biosynthesis in leiomyoma and myometrium of the uterus.  Horm Metab Res. 1984;  16 678-679
• 202 Zobbe V, Gimbel H, Andersen B M, Filtenborg T, Jakobsen K, Sorensen H C, Toftager-Larsen K, Sidenius K, Moller N, Madsen E M, Vejtorp M, Clausen H, Rosgaard A, Gluud C, Ottesen B S, Tabor A. Sexuality after total vs. subtotal hysterectomy.  Acta Obstet Gynecol Scand. 2004;  83 191-196
• 203 Zollner U, Classen V, Steck T, Dietl J. Fertilität und Schwangerschaftsverlauf nach Myomektomie.  Geburtsh Frauenheilk. 2001;  61 213-219
• 204 Nowak R A, Mora S, Diehl T, Rhoades A R, Stewart E A. Prolactin is an autocrine or paracrine growth factor for human myometrial and leiomyoma cells.  Gynecol Obstet Invest. 1999;  48 127-132
• 205 Daly D C, Walters C A, Prior J C, Kuslis S T, Chapitis J, Andreoli J, Riddick D H. Prolactin production from proliferative phase leiomyoma.  Am J Obstet Gynecol. 1984;  15 (148) 1059-1063
• 206 Hornung D, Licht P, Wallwiener D. Endometriose: Bewährte und innovative Therapiestrategien bei Schmerzen und Infertilität.  Geburtsh Frauenheilk. 2004;  64 584-588
• 207 Rice J P, Kay H H, Mahony B S. The clinical significance of uterine leiomyomas in pregnancy.  Am J Obstet Gynecol. 1989;  160 1212-1216
• 208 Di Gregorio A, Maccario S, Raspollini M. The role of laparoscopic myomectomy in women of reproductive age.  Reprod Biomed Online. 2002;  4 (Suppl 3) 55-58
• 209 Aharoni A, Reiter A, Golan D, Paltiely Y, Sharf M. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study.  Br J Obstet Gynaecol. 1988;  95 510-513