Snapshot A 45-year-old African American G2P2 woman presents with abnormal uterine bleeding. She reports irregular spotting between periods and pain with intercourse. Physical exam reveals a mobile, asymmetric, nontender uterus with multiple nodular abnormalities. A Transvaginal ultrasound shows hyperchoic masses within the uterine wall. She decides to undergo a hysterectomy because she does not want any more children. summary Otherwise known as fibroids Leiomyomas are smooth muscle growths of the uterine myometrium can be intramural submucosal subserosal Often present with multiple discrete tumors Epidemiology benign uterine tumor tumor in females seen in African Americans (5x more common) occurs in women 20-40 years of age Presentation Symptoms sensitive to estrogen levels login to view 2 more bullets symptoms depend on location of leiomyoma login to view 8 more bullets Physical exam uterus is login to view 6 more bullets IMAGING transvaginal ultrasound has high sensitivity (95-100%) hyperechoic, well-circumscribed round masses STUDIES Labs β-hCG to rule out pregnancy Histology whorled pattern of smooth muscle bundles Differential Diagnosis Leiomyosarcoma Adenomyosis Endometrial polyp Pregnancy Diagnosis Confirmed with sonogram Treatment If asymptomatic observation login to view 1 more bullet If symptomatic NSAIDs for dysmenorrhea OCPs for abnormal uterine bleeding GnRH analogs to shrink fibroids pre-surgery surgical management login to view 6 more bullets Complications very rarely (if at all) transforms into leiomyosarcoma infertility iron deficiency anemia Prognosis having symptomatic fibroids decreases quality of life