Uterine fibroids

Last reviewed: 2 Sep 2022
Last updated: 15 Jun 2022

Summary

Definition

History and exam

Key diagnostic factors

  • asymptomatic
  • heavy menstrual bleeding
  • irregular firm central pelvic mass
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • ultrasound
  • endometrial biopsy
More 1st investigations to order

Investigations to consider

  • sonohysterography
  • hysteroscopy
  • MRI
  • laparoscopy
More investigations to consider

Emerging tests

  • sonoelastography
  • MR elastography

Treatment algorithm

ONGOING

fertility desired

fertility not desired

Contributors

Authors

Ayman Al-Hendy, MD PhD FRCSC FACOG CCRP

Professor (visiting) and Director

Translational Research

Department of Obstetrics and Gynecology

University of Illinois

Chicago

IL

Disclosures

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

IL

Disclosures

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

Disclosures

VLB declares that she has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Everett Magann, MD

Chairman

Department of Obstetrics and Gynecology

Naval Medical Center

Portsmouth

VA

Disclosures

EM declares that he has no competing interests.

Amy Niederhauser, MD

Doctor

Department of Obstetrics and Gynecology

Naval Medical Center

Portsmouth

VA

Disclosures

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

UK

Disclosures

AM declares that he has no competing interests.

  • Uterine fibroids images
  • Differentials

    • Adenomyosis
    • Endometrial polyp
    • Endometrial hyperplasia
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: fibroids
    • Management of symptomatic uterine leiomyomas
    More Guidelines
  • Patient leaflets

    Fibroids

    Fibroids: questions to ask your doctor

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer