uterine fibroids
Summary
Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus, affecting 20-80% of reproductive-age women. They are estrogen-dependent growths that can cause abnormal uterine bleeding, pelvic pain, and reproductive complications. Most are asymptomatic but may require intervention based on size, location, and symptoms.
Detail
Uterine fibroids are monoclonal proliferations of smooth muscle cells in the myometrium, making them the most common benign gynecologic tumors. They are classified by location: intramural (within myometrium), submucosal (protruding into endometrial cavity), subserosal (extending toward serosa), and pedunculated. Pathophysiology involves estrogen and progesterone sensitivity, explaining their growth during reproductive years and regression after menopause. Risk factors include African American ethnicity, nulliparity, early menarche, and family history. Clinical manifestations depend on size and location: submucosal fibroids commonly cause menorrhagia and infertility, while large intramural/subserosal fibroids cause bulk symptoms (pelvic pressure, urinary frequency, constipation). Complications include iron-deficiency anemia from heavy bleeding, pregnancy complications (miscarriage, preterm labor, malpresentation), and rarely malignant transformation (<0.1%). Diagnosis involves pelvic examination, transvaginal ultrasound, and sometimes MRI for surgical planning. Treatment ranges from observation to medical management (GnRH agonists, hormonal therapies) to surgical options (myomectomy, hysterectomy, uterine artery embolization).
Sources
- Berek & Novak's Gynecology
- Williams Gynecology
- First Aid for the USMLE Step 1
- ACOG Practice Bulletin on Management of Symptomatic Uterine Leiomyomas
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