Fibroid Uterus

FIBROID UTERUS
By: Arfa khan & Abiha Tariq

INTRODUCTION
★ Fibroid is a benign tumor of Uterine
smooth Muscle termed as ‘Leiomyoma
★ Gross appearance : well-demarcated

,firm,whorled tumor
★ Found in approx 40% women overall

,more common in nulliparous and obese
women as well in those with a family
history of African Decent
Intramural fibroids are most common

(appear within the muscular wall of the
Uterus)
TYPES OF FIBROIDS
POTENTIAL
CAUSES:
SYMPTOMS :
Most fibroids are small and Asymptomatic but can be associated with the following conditions
☆ Abnormal Uterine bleeding (AUB) usually heavy menstrual bleeding (HMB)and irregular
menstrual bleeding (IMB)
☆Reproductive failure
☆subfertility
☆ Recurrent pregnancy Loss
☆ Bulk effects on adjacent Structures In the pelvis
☆ Abdominal distention
NATURAL HISTORY
Benign oestrogen dependent tumors,enlarge during pregnancy in response to hyperestrogenic
state,becomes common with advancing reproductive age and shrinks after menopause when
ovarian oestrogen production ceases ,They undergo degenerative changes usually in response to
outgrowing their blood supply.
Three types of degenerative forms:
➢ Red: Hemorrhage and necrosis occurs within the fibroid typically presenting in mid second
trimester pregnancy with acute pain
➢ Hyaline: Asymptomatic softening and liquefaction of the fibroid
➢ Cystic: Asymptomatic central necrosis leaving cystic spaces at the centre .Degenerative
changes can initiate calcium deposition leading to calcification
CLINICAL FEATURES
》Fibroids are one of the commonest indication of hysterectomy
》Abdominal examination may indicate presence of firm mass arising from the pelvis
》Common presenting symptoms include : menstrual Disturbance,and pressure or bulk

symptoms ( especially Urinary frequency and infertility)
》pain is unusual except in special circumstances of acute red degeneration or torsion of a

pedunculated Fibroid
》 subfertility may result from mechanical distortion or occlusion of fallopian tubes
》Endometrial cavity grossly distorted by submucosal Fibroids may prevent implantation of a fertilised ovum
》In late pregnancy fibroids are located In cervix or lower Uterine segment and may cause Abnormal lie
》After delivery PPH may occur due to Inefficient Uterine Contractions

Examination findings suggestive of Uterine fibroids
☆ General : signs of anemia
☆ Abdominal Examination:visible/palpable Abnormal mass
☆ Bimanual Examination: enlarged, firm, smooth or irregular, non tenderous

usually palpable
DIAGNOSIS
Often the clinical features obtained from the history and examination alone will be sufficient
to establish the diagnosis. A full blood count should be taken in women with heavy menstrual
bleeding, severe anaemia associated with HMB indicates the presence of significant fibroids.
Useful tests to detect uterine fibroids:
● Transvaginal ultrasound scan (TVUSS):good for detecting and locating submucous
fibroids and small intramural fibroids.
● Transabdominal ultrasound scan ( TAUSS):good for detecting large intramural and
subserosal fibroids and excluding hydronephrosis secondary to pressure from fibroids
obstructing the ureters.
● Hysteroscopy: good for detecting submucosal polyps and endometrial polyps nd cn
remove polyps ,adhesions submucosal fibroids
● Magnetic Resonance Imaging (MRI) : good for describing the morphology and
location of fibroids
● Medical treatment OF FIBROIDS
TREATMENT
The only effective medical treatment is to use injectable gonadotropin-releasing
hormone agonists, which induce a menopausal state by shutting down ovarian
oestradiol production. However, GnRH treatment is not tolerated by all women because
of severe menopausal symptoms. More recently, the selective progesterone receptor
modulator (SPRM) ulipristal acetate has been shown, it is an oral tablet that is as
effective as GnRH treatment in reducing fibroid volume and this SPRM does not induce
a menopausal state and associated symptoms. However, neither GnRH nor SPRM
represent a viable long-term treatment option.
● Surgical treatment
Minimally invasive hysteroscopic surgery can be used to cut away a submucous fibroid or fibroid polyp, helping to resolve
HMB symptoms even in the presence of other types of fibroid.
Where a bulky fibroid uterus causes pressure symptoms or where HMB is refractory to medical interventions, the options
are myomectomy to surgically remove fibroids with uterine conservation, or hysterectomy. Myomectomy will be the
preferred option where preservation of fertility is required.
● Radiological treatment
Uterine artery embolization (UAE) is a technique performed by interventional radiologists. It involves embolization of both
uterine arteries under radiological guidance. A small incision is made in the groin under local anaesthesia and a cannula
placed into the femoral artery and guided into the uterine arteries. Embolization particles are then injected, reducing the
blood supply to the uterus, which induces infarction and degeneration of fibroids such that the overall reduction in fibroid
volume is around 50%.
Complications include fever, infection, fibroid expulsion and potential ovarian failure.
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FIBROID UTERUS

By: Arfa khan & Abiha Tariq

★ Gross appearance : well-demarcated

★ Found in approx 40% women overall

Intramural fibroids are most common

Three types of degenerative forms:

》Common presenting symptoms include : menstrual Disturbance,and pressure or bulk

》pain is unusual except in special circumstances of acute red degeneration or torsion of a

》 subfertility may result from mechanical distortion or occlusion of fallopian tubes

》After delivery PPH may occur due to Inefficient Uterine Contractions

☆ Abdominal Examination:visible/palpable Abnormal mass

☆ Bimanual Examination: enlarged, firm, smooth or irregular, non tenderous

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