Updated: 12/27/2021

Leiomyoma (Fibroids)

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  • Snapshot
    • A 33-year-old G4P4 female complains of abnormal vaginal bleeding that occurs intermittently between her predictable menstrual cycles. A transvaginal ultrasound shows suspicious hyperechoic masses within the uterine wall. A laparoscopic procedure is performed to assess the anatomy further.
  • Introduction
    • Otherwise known as fibroids
    • Leiomyomas are smooth muscle growths of the uterine myometrium can be
      • intramural
      • submucosal
      • subserosal
    • Often present with multiple discrete tumors
    • Benign uterine tumor
  • Epidemiology
    • Demographics
      • tumor in females
      • seen in African Americans (5x more common)
      • occurs in women aged 20-40 years of age
  • Presentation
    • Symptoms
      • sensitive to estrogen levels
        • tumor growth and increased symptoms during pregnancy
        • decreased symptoms during menopause
          • note, if symptoms increase after menopause, the diagnosis is likely not fibroids
      • 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
  • imaging
    • Sonogram
      • 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
    • Diagnose with clinical history and exam
      • can confirm 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
          • reserves 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
  • Prognosis
    • Having symptomatic fibroids decreases quality of life
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