UTERINE FIBROIDSHazem Al-Mandeel, M.DCourse 481Obstetrics and Gynecology Rotation

Introduction

Uterine fibroids (leiomyomas) are benign tumors derived from the smooth cells of the myometrium

It’s the most common neoplasm of the uterus (40-50%)

Most fibroids are asymptomatic It’s one of the most common indication for

hysterectomy (with or without abnormal bleeding)

It’s malignant potential is minimal (< 1/1000)

Pathogenesis

Initiation factors are unknown ? Uterine fibroids grow under the effect of

ovarian hormones (E & P) rarely develop before menarche and seldom enlarge after menopause

Leiomyomas has increased levels of estrogen, progesterone, and growth factors

Fibroids can enlarge during pregnancy

Risk Factors

Increasing age during reproductive years Ethnic (Black > Caucasian) Nulliparity Family History Higher BMI

Oral contraceptive pills reduced Depot medroxyprogesterone acetate

risk

Clinical Findings

The majority of uterine fibroids cause no symptoms

Symptoms may include: o Pressure symptoms: pelvic pressure, feeling a

heaviness in the lower abdomen, lower backache, bladder/bowel sx

o Abnormal uterine bleeding: menorrhagia, metrorrhagia, and/or intermenstrual bleeding

o Severe pain: secondary to degenerative changes in the fibroids (mostly during pregnancy), Types: ……………….

o Pregnancy-related: ?difficulty in conception, or recurrent abortions

Clinical Findings

Uterine leiomyomas may be palpated as a hard, non-tender mass (abdominally or by bimanual exam)

Differential Diagnosis: Endometrial poly Ovarian tumors (benign or malignant) Uterine malignant tumors (e.g. sarcoma) Pelvic kidney Tubo-ovarian mass Diverticular or inflammatory bowel mass Colon cancer

Diagnosis

Ultrasonography

CT scan of the pelvis

MRI of the pelvis

Endometrial Biopsy (by aspiration or by dilatation and curettage)

Management

If uterine fibroid is asymptomatic and small(found by USS) repeat ultrasound in 6 months

Medical management: mainly to treat abnormal uterine bleedingo Combined hormonal contraceptive pillso Progestin-only therapy (pills, injection, or IUCD)o GnRH agonists therapy (can reduce the size of

fibroid)o Mifepristone (RU 486) (can reduce the size of

fibroid)

Surgical Management

• Desired infertility: embolization or myomectomy

• Desired uterine preservation or poor surgical candidate: endometrial ablation or embolization

• No desired fertility or uterine preservation: endometrial ablation or hysterectomy

• Rapidly growing uterus: hysterectomy