Uterine fibroids are the most common benign uterine tumour and most common pelvic tumour 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 anaemic because of heavy menstrual bleeding.
Pelvic ultrasound usually shows well-circumscribed uterine tumours.
No treatment required if asymptomatic, but follow-up should be scheduled annually.
If symptomatic, definitive treatment is surgical, including hysterectomy when fertility is not desired or myomectomy to preserve fertility.
Non-surgical treatments include uterine artery embolisation, gonadotrophin-releasing hormone agonists, hormones (birth control oral contraceptives pills or other delivery forms of hormones i.e.such as a transdermal patch, or implant), gonadotrophin-releasing hormone antagonists plus hormonal add-back therapy, or symptomatic management with non-steroidal anti-inflammatory drugs.
Uterine fibroids (leiomyomata) are benign tumours of the uterus primarily composed of smooth muscle and fibrous connective tissue. They range in size from seedlings to large uterine tumours. Grossly, these tumours 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 tumours in a single uterine specimen. Microscopically, these nodules are made up of spindle-shaped cells with no mitotic activity or remarkable nuclear atypia.
History and exam
Key diagnostic factors
- presence of risk factors
- heavy menstrual bleeding
- irregular firm central pelvic mass
Other diagnostic factors
- pelvic pain
- pelvic pressure
- fatigue and loss of productivity in working
- urinary complaints
- enlarged uterus (regular contour)
- increased patient weight
- age in the 40s
- black ethnicity
- hypovitaminosis of vitamin D
- early menarche (under 10 years)
- use of oral contraceptives (if started before age 16 years)
- younger age at first birth
- poor vitamin A intake
- dietary intake high in beef and other red meat
- sex hormone exposure
- menstrual history
- alcohol consumption
1st investigations to order
- endometrial biopsy
Investigations to consider
- MR elastography
fertility not desired
- Endometrial polyp
- Endometrial hyperplasia
- ACR appropriateness criteria: fibroids
- Management of symptomatic uterine leiomyomas
Fibroids: questions to ask your doctorMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer