Fibroids

Also known as leiomyomata, fibroids are the most common gynecological tumour.

They occur in approximately half of women >35years, though decrease following menopause. They are more common in black women.

Fibroids rarely become malignant (0.1% of cases).

 

 

Causes and Risk Factors

 

 

 

 

 

 

 

Signs, Symptoms, and Diagnosis

 

 

  • history
  • physical exam
  • lab investigations
  • diagnostic imaging

History

Over half of fibroids are asymptomatic and are discovered incidentally on ultrasound.

  • abnormal uterine bleeding (dysmenorrhea or menorrhagia) in 30%
  • pelvic pressure
  • increased abdominal girth
  • urinary frequency, urgency, retention
  • constipation
  • bloating

Fibroid degeneration or torsion can lead to acute pelvic pain

Infertility

Physical Exam

Bimanual exam can reveal asymmetrically enlarged, mobile uterus

Lab Investigations

CBC (anemia)

endometrial biopsy recommended to rule out endometrial cancer

Diagnostic Imaging

  • Sonohystogram
  • saline infusion hystography

 

 

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Pathophysiology

Fibroids are monoclonal, arising from single smooth muscle cells.

Apoptosis is decreased.

 

Growth in enhanced via progesterone. Estrogen appears to play minimal role.

 

 

 

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Treatments

Treat only if symptomatic or if rapidly growing.

Treat anemia if present.

 

Medications

 

 

Non-medications

 

 

 

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Consequences and Course

 

 

 

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Resources and References