Uterine fibroids - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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.

Solitary intramural fibroid as shown by transvaginal pelvic ultrasound (TVUS) demonstrating posterior intramural mass lying between a normal-appearing trilaminar endometrial stripe and posterior uterine serosa

From the personal collection of Dr M.F. Mitwally and Dr R.J. Fischer; used with permission

Quick Reference

History & Exam
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

FIGO leiomyoma subclassification system
Solitary intramural fibroid as shown by transvaginal pelvic ultrasound (TVUS) demonstrating posterior intramural mass lying between a normal-appearing trilaminar endometrial stripe and posterior uterine serosa
Transvaginal pelvic ultrasound (TVUS) shows a midline posterior fundal fibroid greatly distorting the endometrial cavity
Sonohysterography shows several small intracavitary masses suspicious for polyps
Hysteroscopic examination of the uterine cavity demonstrates the presence of two contiguous submucous uterine fibroids in this patient with persistent heavy menstrual bleeding
Hysteroscopic image of a large pedunculated submucous uterine fibroid
Multiple polyps are identified on hysteroscopic examination of the uterine cavity in this patient with persistent vaginal spotting
Sonohysterography demonstrates a posterior submucous uterine fibroid deforming the posterior endometrial cavity
Laparoscopy shows the presence of a large right posterolateral subserosal fibroid; note the close proximity of this uterine fibroid to the right ovary (potential for misdiagnosis as an adnexal mass)

Citations

Key Articles

Stewart EA, Cookson CL, Gandolfo RA, et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017 Sep;124(10):1501-12.[Abstract][Full Text]
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.[Abstract]
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 228: management of symptomatic uterine leiomyomas. Jun 2021 [internet publication].[Full Text]
Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016 Mar;59(1):2-24.[Abstract][Full Text]
American College of Radiology. ACR Appropriateness Criteria®. Fibroids. 2022 [internet publication].[Full Text]

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