- Clinical science
Uterine leiomyomas (fibroids) are benign, hormone-sensitive uterine neoplasms. These tumors are classified as either submucosal (beneath the endometrium), intramural (within the muscular uterine wall of the uterus), or subserosal (beneath the peritoneum). Symptoms depend on the location, size, and number of myomas, and include menstrual abnormalities (menorrhagia), features of mass effects (e.g., back/abdominal/pelvic pain or bladder and bowel dysfunction), and infertility. Physical examination and sonohysterography are used to establish the diagnosis. Treatment for symptomatic patients includes surgery (myomectomy or hysterectomy) as well as interventional (uterine artery embolization) and/or medical therapy (GnRH agonists).
Most women have small, asymptomatic fibroids. Symptoms depend on the number, size, and location of leiomyomas.
- Abnormal menstruation
- Features of mass effect
- Reproductive abnormalities
- Ultrasound (best initial test)
- MRI: to evaluate the uterus and ovaries for potentially complicated surgical cases and visually differentiate between leiomyomas, adenomyomas, and adenomyosis
- Grayish-white surface
- Homogenous; tissue bundles on cross section partly in a whorled pattern
- Some leiomyomas may involve regressive changes: scar formation, calcification, and cysts
- Microscopic: Smooth muscle tissue, consisting of monoconal cells interspersed with connective tissue
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See also .
The differential diagnoses listed here are not exhaustive.
Treatment should only be considered in symptomatic patients because of the side effects of medical therapy and surgery. The goal is to relieve symptoms. Perimenopausal women warrant expectant management in most cases.
- Do not require treatment
- Frequent follow-ups (approx. every 6–12 months) are necessary to monitor any potential growth.
- Hormone therapy
- NSAIDs: to control pain
- Antifibrinolytics (e.g., tranexamic acid): reduce bleeding
- Androgenic agonists (e.g., danazol): suppress growth of fibroids but has many side effects (e.g., acne, edema, hair loss, etc.)
- In cases of uncontrollable bleeding: ergot derivatives (methylergometrine), packed red blood cells
- Indications: rapidly growing fibroid, recurrent refractory bleeding: secondary to medical therapy, severe symptoms
- Myomectomy: excision of subserosal or intramural fibroids
- Hysterectomy: definitive treatment
- Fibroid degeneration or torsion
We list the most important complications. The selection is not exhaustive.
- Fibroids seldom degenerate into a malignancy.
- Fibroids typically shrink after menopause.
- Elevated concentrations of progestin and estrogen foster the growth of leiomyomas. Pain may be caused by:
- Mass effect
- Peritoneal irritation
- Premature contractions
- Depending on location and size:
- Cervical leiomyoma: obstruction of the birth canal → indication for cesarean section
- Postpartum: atonic hemorrhages
- Puerperium: fibroid regression accompanied by calcification