Uterine Fibroids

Question 1

Predisposing factors?

Answer 1

° Nulliparity.

° Early menarche (< 10 years old)

°Age: 25–45 years

1. Fibroids are largely found in women of reproductive age
2. Influenced by hormones (i.e., estrogen, growth hormone, and progesterone).
3. During menopause, hormone levels begin to decrease and leiomyomas begin to shrink

° Increased incidence in African individuals

°Obesity

°Family history

Question 2

Clinical features

Answer 2

Most women have small, asymptomatic fibroids. Symptoms depend on the number, size, and location of leiomyomas.

1. Abnormalmenstruation:hypermenorrhea,heavy menstrual bleeding, metrorrhagia(possibly associatedwith anemia),dysmenorrhea
2. Features ofmass effect

Enlarged,firm and irregularuterusduring bimanual pelvic examination

Back or pelvicpain/discomfort

Urinary tractor bowel symptoms (e.g.,urinary frequency/retention,constipation, features ofhydronephrosis).

2.Reproductive abnormalities

Infertility (difficulty conceiving andincreased risk ofmiscarriage)

Dyspareunia

Question 3

Complications

Answer 3

Infertility

Iron deficiency anemia(due toheavy menstrual bleeding)

Fibroid torsion

Thromboembolism

Very rare: malignant transformation to uterine leiomyosarcoma

Question 4

Differential diagnosis of Fibroids

Answer 4

1. adenomyosis
2. endometriosis
   may be present simultaneously in the same patient.
3. endometrial cancer,
4. Uterine polyps
5. Uterine leiomyosarcoma
6. benign tumors of the endometrium