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 login to view 1 more bullet symptoms depend on location of leiomyoma intramural login to view 1 more bullet submucosal login to view 1 more bullet subserosal login to view 3 more bullets 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 login to view 1 more bullet uterine artery embolization login to view 1 more bullet hysterectomy login to view 1 more bullet Complications Very rarely (if at all) transforms into leiomyosarcoma Infertility Prognosis Having symptomatic fibroids decreases quality of life