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Leiomyoma / Fibroids

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Topic updated on 04/29/15 12:30am

Snap Shot
  • A 32-year-old nulliparous woman complains of abnormal vaginal bleeding that occurs intermittently between her predictable menstrual cycles.  Her physical exam reveals an enlarged, firm uterus. A transvaginal ultrasound reveals multiple uterine fibroids.
Introduction
  • Most common benign gynecologic lesion
  • Epidemiology
    • more common in
      • black women
      • women older than 35
  • Pathophysiology
    • growth
      • growth related to estrogen production
      • change in size with menstrual cycles
    • regress after menopause
      • secondary to ↓ in estrogen
      • if a uterine mass continues to grow after menopause then it is not a leiomyoma
  • Associated conditions
    • leiomyosarcomas
      • rarely progress to leiomyosarcomas
    • infertility
    • iron deficiency anemia
Presentation
  • Symptoms
    • often asymptomatic
    • bleeding
    • dysmenorrhea
    • abdominal pain
    • menorrhagia
    • constipation (pressure on colon)
    • urinary frequency (pressure on bladder)
  • Physical exam
    • firm irregular, palpable mass on pelvic exam
Evaluation
  • Ultrasound
  • MRI
  • Histology
    • gross pathology 
Treatment
  • Conservative
    • observation
      • asymptomatic fibroids do not typically require treatment
  • Pharmacologic
    • NSAIDs for pain
    • OCPs
  • Surgical
    • uterine artery embolization
    • radiofrequency ablation
    • myomectomy
    • hysterectomy


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