Leiomyoma (Fibroids)

Fibroids are benign tumors that originate from smooth muscle cells of the uterus. They are commonly associated with abnormal uterine bleeding and pain.

Classification

• Subserosal- under the outer surface of the uterus
• Intramural- in the wall of the uterus
• Submucosal- under the uterine lining
• Pedunculated- fibroid is growing on a stalk

Signs and symptoms

-It depends on the number, size, and location of the uterus

• Abdominal pain
• Abnormal uterine bleeding
• Anemia ( severe disease)
• Urinary symptoms,e.g., increased urgency and frequency- due to pressure on surrounding tissues.
• Intestinal compression -in advanced disease

Complications

• Infertility- due to blockage of fallopian tubes
• Postpartum hemorrhage
• Preterm labor
• Malpresentations and malposition of the foetus
• Spontaneous abortion

Diagnosis

-Relevant history accompanied by physical examination

-Pregnancy test- rule out any presence of a fetus

-Imaging

1. Ultrasonography- to detect any nonspecific abnormalities of the uterus
2. Sonohysterograhy- uses saline infusion
3. MRI- most accurate if the above modalities are inconclusive

Differential diagnoses

1. Adenomyosis
2. Endometriosis
3. Leiomyosarcoma
4. Pregnancy

Treatment and management

Asymptomatic

-Does not require medical or surgical interventions.

-Patients should be reevaluated once or twice annually

Symptomatic

-Medical– drugs to suppress hormone activity or production

1. GnRH agonist-goserelin
2. Progestins- medroxyprogesterone
3. Antiprogestins- mifepristone (low dose than the one used in the termination of pregnancy)
4. Estrogen receptor modulator(selective)- raloxifene
5. Tranexamic acid- has antifibrinolytic properties that reduce abnormal bleeding
6. Analgesics- NSAIDs

Surgical

Indications

• Rapid enlarging tumor
• Persistent uterine bleeding despite medical interventions
• Infertility and recurrent spontaneous abortions- when pregnancy is desired in the future
• Severe pain

-Myomectomy- done laparoscopically or hysteroscopically

-Hysterectomy- is done when pregnancy is not desired in the future.

-Morcellation- involves cutting the tumor into small pieces and then removing it laparoscopically. It poses risks of disseminating cancerous cells

Other modalities

1. Cryotherapy- entails freezing the tumor
2. Radiofrequency ablation
3. Uterine artery embolization- prevent bleeding alongside causing infarction of the tumor.