Uterine fibroids

Uterine fibroids are the most common benign uterine tumour and most common pelvic tumour in women.

Most are asymptomatic; however, can present with excessive uterine bleeding, symptoms secondary to pressure on bladder and rectum, and, less often, distortion of the uterine cavity, leading to miscarriage or infertility.

An enlarged irregular uterus may be found on examination and the woman may be anaemic because of heavy menstrual bleeding.

Pelvic ultrasound usually shows well-circumscribed uterine tumours.

No treatment required if asymptomatic, but follow-up should be scheduled annually.

If symptomatic, definitive treatment is surgical, including hysterectomy if fertility is not desired or myomectomy to preserve fertility.

Non-surgical treatments include uterine artery embolisation, gonadotrophin-releasing hormone agonists, hormones (birth control oral contraceptives pills or other delivery forms of hormones i.e.such as a transdermal patch, or implant), gonadotrophin-releasing hormone antagonists plus hormonal add-back therapy, or symptomatic management with non-steroidal anti-inflammatory drugs.

Uterine fibroids (leiomyomata) are benign tumours of the uterus primarily composed of smooth muscle and fibrous connective tissue.[1]Bulun SE. Uterine fibroids. N Engl J Med. 2013 Oct 3;369(14):1344-55. http://www.ncbi.nlm.nih.gov/pubmed/24088094?tool=bestpractice.com [2]Bradley LD, Falcone T. Myomectomy. In: Handa VL, Van Le L, eds. Te Linde's operative gynecology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:325-47. They range in size from seedlings to large uterine tumours. Grossly, these tumours are round, firm, and well-circumscribed nodules located just under the uterine serosa (subserosal), within the myometrium (intramural) or just below the endometrium (submucosal). There are often multiple tumours in a single uterine specimen.[1]Bulun SE. Uterine fibroids. N Engl J Med. 2013 Oct 3;369(14):1344-55. http://www.ncbi.nlm.nih.gov/pubmed/24088094?tool=bestpractice.com Microscopically, these nodules are made up of spindle-shaped cells with no mitotic activity or remarkable nuclear atypia.[3]Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990 Oct;94(4):435-8. http://www.ncbi.nlm.nih.gov/pubmed/2220671?tool=bestpractice.com