Case history
Case history #1
A 45-year-old gravida 3, para 3 black woman presents with several years of progressively heavier and prolonged menstrual periods. Over the past months she has also experienced lethargy and weakness. She recently visited her primary care physician for tiredness and was diagnosed with moderate anaemia (haemoglobin of 90 g/L [9 g/dL]). Family history is remarkable for a sister who underwent hysterectomy at age 49 for uterine fibroids. Bimanual examination discloses a 16-week enlarged, firm and irregular uterus. Adnexal and rectal examinations are normal and the stool fecal occult blood test is negative. Pelvic ultrasound shows an enlarged uterus with irregular contour and multiple intramural masses consistent with uterine fibroids. Both ovaries are visualised and normal.
Case history #2
A 38-year-old woman presents to her gynaecologist for her annual examination. She has no specific complaints. Her menstrual cycle is regular, occurring every 28 to 30 days and lasting about 5 days. She has, however, noticed that recently her periods have been heavier than usual. On pelvic examination, she has an enlarged uterus, about the size of an 8-week pregnant uterus. Urine pregnancy test is negative. Her full blood count is normal. A pelvic ultrasound shows two fibroids within the uterine wall measuring 2 cm each.
Other presentations
Most patients with uterine fibroids are asymptomatic. The site and size, as well as degenerative changes within the tumour, have a major role in determining the clinical presentation. Uterine fibroids can significantly distort the uterine cavity and therefore be discovered during evaluation of primary or secondary infertility or second trimester fetal loss. Because of the mass effect on contiguous organs such as the bladder and rectum, fibroids can be identified during evaluation of urinary symptoms such as frequency, urgency, or incontinence and, less commonly, during work-up for constipation. Evaluation of painful intercourse can uncover the presence of fibroids that impact the anterior vagina or pelvic cul-de-sac. Finally, evaluation for bloating or dyspepsia can uncover a greatly enlarged uterus secondary to fibroids that limit space in the upper abdomen, thereby causing these symptoms.
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