Uterine fibroids

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Aug 2025

Last updated: 21 Jun 2024

Uterine fibroids are the most common benign uterine tumor and most common pelvic tumor in women.

Most are asymptomatic; however, can present with excessive uterine bleeding, symptoms secondary to pressure on bladder and rectum, and, less often, distortion of the uterine cavity, leading to miscarriage or infertility.

An enlarged irregular uterus may be found on examination and the woman may be anemic because of heavy menstrual bleeding.

Pelvic ultrasound usually shows well-circumscribed uterine tumors.

No treatment required if asymptomatic, but follow-up should be scheduled annually.

If symptomatic, definitive treatment is surgical, including hysterectomy if fertility is not desired or myomectomy to preserve fertility.

Nonsurgical treatments include uterine artery embolization, gonadotropin-releasing hormone agonists, hormones (birth control oral contraceptives pills or other delivery forms of hormones i.e.such as a transdermal patch, or implant), gonadotropin-releasing hormone antagonists plus hormonal add-back therapy, or symptomatic management with nonsteroidal anti-inflammatory drugs.

Definition

Uterine fibroids (leiomyomata) are benign tumors of the uterus primarily composed of smooth muscle and fibrous connective tissue.[1][2] They range in size from seedlings to large uterine tumors. Grossly, these tumors are round, firm, and well-circumscribed nodules located just under the uterine serosa (subserosal), within the myometrium (intramural) or just below the endometrium (submucosal). There are often multiple tumors in a single uterine specimen.[1] Microscopically, these nodules are made up of spindle-shaped cells with no mitotic activity or remarkable nuclear atypia.[3]

História e exame físico

Principais fatores diagnósticos

asymptomatic
heavy menstrual bleeding
irregular firm central pelvic mass

Detalhes completos

Outros fatores diagnósticos

pelvic pain
pelvic pressure
dysmenorrhea
bloating
fatigue and loss of productivity in working
infertility
urinary complaints
constipation
enlarged uterus (regular contour)
dyspareunia

Detalhes completos

Fatores de risco

increased patient weight
age in the 40s
black ethnicity
hypovitaminosis of vitamin D
hypertension
early menarche (under 10 years)
use of oral contraceptives (if started before age 16 years)
nulliparity
younger age at first birth
poor vitamin A intake
dietary intake high in beef and other red meat
sex hormone exposure
menstrual history
smoking
alcohol consumption

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

ultrasound
endometrial biopsy

Detalhes completos

Investigações a serem consideradas

sonohysterography
hysteroscopy
MRI
laparoscopy

Detalhes completos

Novos exames

sonoelastography
MR elastography

Algoritmo de tratamento

CONTÍNUA

fertility desired

fertility not desired

Colaboradores

Autores

Ayman Al-Hendy, MD PhD FRCSC FACOG CCRP

Professor (visiting) and Director

Translational Research

Department of Obstetrics and Gynecology

University of Illinois

Chicago

Declarações

AAH serves on the external advisory board of Bayer, AbbVie, Myovant, Pfizer, ObsEva and Allergan, and has received research funding from the National Institutes of Health. AAH is an author of references cited in this topic.

Obianuju Sandra Madueke-Laveaux, MD MPH

Assistant Professor of Obstetrics and Gynecology

Department of Obstetrics and Gynecology

University of Illinois

Chicago

Declarações

OSML declares that she has no competing interests. OSML is an author of references cited in this topic.

Vuslat Lale Bakir, MD

Assistant Professor of Obstetrics and Gynecology

Department of Obstetrics and Gynecology

Haseki Training and Research Hospital

Health Sciences University

Istanbul

Turkey

Declarações

VLB declares that she has no competing interests.

Agradecimentos

Dr Al-Hendy, Dr Madueke-Laveaux, and Dr Bakir would like to gratefully acknowledge Dr Mohamed Mitwally, Dr Intisar Elnahhas, and Dr Robert J. Fischer, the previous contributors to this topic.

Declarações

MM, IE, and RJF declare that they have no competing interests.

Revisores

Everett Magann, MD

Chairman

Department of Obstetrics and Gynecology

Naval Medical Center

Portsmouth

Declarações

EM declares that he has no competing interests.

Amy Niederhauser, MD

Doctor

Department of Obstetrics and Gynecology

Naval Medical Center

Portsmouth

Declarações

AN declares that she has no competing interests.

Adam Magos, BSc, MB, BS, MD, FRCOG

Consultant Gynaecologist

University Department of Obstetrics and Gynaecology

Royal Free Hospital

London

Declarações

AM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Stewart EA, Cookson CL, Gandolfo RA, et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017 Sep;124(10):1501-12.Texto completo Resumo

Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997 Dec;90(6):967-73. Resumo

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 228: management of symptomatic uterine leiomyomas. Jun 2021 [internet publication].Texto completo

Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016 Mar;59(1):2-24.Texto completo Resumo

American College of Radiology. ACR Appropriateness Criteria®. Fibroids. 2022 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Adenomyosis
- Endometrial polyp
- Endometrial hyperplasia
Mais Diagnósticos diferenciais
Diretrizes
- ACR appropriateness criteria: clinically suspected adnexal mass
- ACR appropriateness criteria: fibroids
Mais Diretrizes
Folhetos informativos para os pacientes
Fibroids
Fibroids: questions to ask your doctor
Mais Folhetos informativos para os pacientes
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Uterine fibroids

Summary

Definition

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

fertility desired

fertility not desired

Colaboradores

Autores

Ayman Al-Hendy, MD PhD FRCSC FACOG CCRP

Declarações

Obianuju Sandra Madueke-Laveaux, MD MPH

Declarações

Vuslat Lale Bakir, MD

Declarações

Agradecimentos

Declarações

Revisores

Everett Magann, MD

Declarações

Amy Niederhauser, MD

Declarações

Adam Magos, BSc, MB, BS, MD, FRCOG

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice