Uterine fibroids

Most common benign uterine tumor.

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 menorrhagia.

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 when fertility is not desired or myomectomy to preserve fertility.

Nonsurgical treatments include uterine artery embolization, gonadotropin-releasing hormone agonists, or symptomatic management with nonsteroidal anti-inflammatory drugs (NSAIDs).

Uterine fibroids (leiomyomata) are benign tumors of the uterus primarily composed of smooth muscle and fibrous connective tissue.[1]Breech LL, Rock JA. Leiomyomata uteri and myomectomy. In: Rock JA, Jones III HW, eds. Te Linde's operative gynecology, 9th edition. Philadelphia, PA: JB Lippincott Co.; 2003:753-98. 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.[2]Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990 Oct;94(4):435-8. http://www.ncbi.nlm.nih.gov/pubmed/2220671?tool=bestpractice.com [3]Droegemueller W. Benign gynecologic conditions. In: Mishell Jr DR, Stenchever MA, Droegemueller W, et al, eds. Comprehensive gynecology, 3rd edition. St. Louis, MO: Mosby-Yearbook Inc.; 1997:467-516. Microscopically, these nodules are made up of spindle-shaped cells with no mitotic activity or remarkable nuclear atypia.[2]Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990 Oct;94(4):435-8. http://www.ncbi.nlm.nih.gov/pubmed/2220671?tool=bestpractice.com