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 login to view 3 more bullets Often present with multiple discrete tumors Benign uterine tumor Epidemiology Demographics login to view 3 more bullets Presentation Symptoms login to view 13 more bullets Physical exam login to view 7 more bullets imaging Sonogram login to view 2 more bullets studies Labs login to view 1 more bullet Histology login to view 1 more bullet Differential Diagnosis Leiomyosarcoma Adenomyosis Endometrial polyp Pregnancy diagnosis Diagnose with clinical history and exam login to view 1 more bullet Treatment If asymptomatic login to view 2 more bullets If symptomatic login to view 10 more bullets Complications Very rarely (if at all) transforms into leiomyosarcoma Infertility Prognosis Having symptomatic fibroids decreases quality of life