Fibroids (Leiomyomas)

Benign smooth muscle tumours of the uterus

Aetiology

  • Poorly understood, growth is thought to be stimulated by oestrogen

Clinical presentation

Symptoms

  • Majority asymptomatic
  • Pressure symptoms +/- abdominal distention
    • Includes urinary frequency or chronic retention
  • Heavy menstrual bleeding
  • Subfertility
  • Acute pelvic pain (rare)

Signs

  • A solid mass or enlarged uterus may be palpable on abdominal or bimanual examination
  • The uterus is usually non-tender

Investigations

Imaging

  • Pelvic US
  • MRI (rarely required, unless sarcoma suspected)

Management

Medical

  • Tranexamic or mefanamic acid
  • Hormonal contraceptives
  • GnRH analogues
  • Selective progesterone receptor modulators

Surgical

  • Hysteroscopy and transcervical resection of fibroid (TCRF)
  • Myomectomy
  • Uterine artery embolisation
  • Hysterectomy