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For further information, see CMDT Part 18-03: Leiomyoma of the Uterus (Fibroid Tumor)

Key Features

Essentials of Diagnosis

  • Irregular enlargement of the uterus (may be asymptomatic)

  • Heavy or irregular uterine bleeding

  • Pelvic pain, dysmenorrhea, and pressure

General Considerations

  • Uterine leiomyomas are discrete, round, firm, often multiple uterine tumors, composed of smooth muscle and connective tissue

  • They may be the most common benign neoplasm of the female genital tract

  • The most commonly used classification is by anatomic location

    • Intramural

    • Submucous

    • Subserous

    • Cervical

  • Submucous myomas may become pedunculated and descend through the cervix into the vagina

Clinical Findings

Symptoms and Signs

  • Frequently asymptomatic in nonpregnant women

  • The most common symptoms are abnormal uterine bleeding and pelvic pain or pressure

  • Occasionally, degeneration occurs, causing intense pain

  • The risk of miscarriage is increased if the myoma significantly distorts the uterine cavity and interferes with implantation

  • Fibroids rarely cause infertility by leading to bilateral tubal blockage; more commonly, they cause miscarriage and pregnancy complications, such as preterm labor, preterm delivery, and malpresentation

  • Torsion of subserosal pedunculated fibroids may lead to necrosis and pain

Differential Diagnosis

  • Pregnancy

  • Adenomyosis

  • Ovarian tumors

  • Leiomyosarcoma

    • Unusual tumor occurring in 0.5% of women who undergo surgery for symptomatic myomas

    • Rare under the age of 40 but increases in incidence thereafter


Laboratory Findings

  • Iron deficiency anemia may result from blood loss

  • Polycythemia is rare but may result from production of erythropoietin


  • Ultrasonography

    • Confirms presence of uterine myomas

    • Can be used sequentially to monitor growth

  • MRI

    • Can delineate intramural and submucous myomas accurately

    • Necessary prior to uterine artery embolization to assess blood flow to the fibroids

Diagnostic Procedures

  • Hysterography or hysteroscopy can also confirm cervical or submucous myomas


Emergency measures

  • Emergency surgery may be required for acute torsion of a pedunculated myoma

  • If the patient is markedly anemic as a result of long, heavy menstrual periods, preoperative treatment with following medications will slow or stop bleeding

    • DMPA, 150 mg intramuscularly every 3 months

    • Depot leuprolide, 3.75 mg intramuscularly monthly

    • Nafarelin, 0.2–0.4 mg intranasally twice daily

  • Then, anemia can be treated before surgery

  • Hormonal IUDs have also been used to decrease the bleeding associated with fibroids; however, an IUD cannot be used by patients with a distorted cavity or cavity length > 10 cm

  • The only emergency indication for myomectomy during pregnancy is torsion of a pedunculated fibroid

Specific Measures

  • Women who have small asymptomatic myomas can be managed expectantly and evaluated annually

  • In patients wishing to ...

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