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Updated: Nov 29 2021

Leiomyoma (Fibroids)

  • 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
        • tumor growth and increased symptoms during pregnancy
        • decreased symptoms during menopause
      • symptoms depend on location of leiomyoma
        • intramural
          • asymptomatic
        • submucosal
          • intermenstrual bleeding and menorrhagia
        • subserosal
          • compression of bladder, rectum, or ureter
            • pelvic pain
            • urinary or bowel issues
    • Physical exam
      • uterus is
        • enlarged
        • firm
        • mobile
        • asymmetric
        • nontender
        • multiple tumors
    • transvaginal ultrasound has high sensitivity (95-100%)
      • hyperechoic, well-circumscribed round masses
    • 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
        • fibroids can shrink substantially postpartum and after menopause
    • If symptomatic
      • NSAIDs for dysmenorrhea
      • OCPs for abnormal uterine bleeding
      • GnRH analogs to shrink fibroids pre-surgery
      • surgical management
        • myomectomy
          • preserves childbearing potential
        • uterine artery embolization
          • preserves childbearing potential if myomectomy is not an option
        • hysterectomy
          • definitive therapy
  • Complications
    • very rarely (if at all) transforms into leiomyosarcoma
    • infertility
    • iron deficiency anemia
  • Prognosis
    • having symptomatic fibroids decreases quality of life
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