( Uterine fibroids)
Done by :- Hamad Emad Thuhayr
Supervisor by :- Dr. mamoon
Introduction of Uterine fibroids
Signs and symptoms
Diagnosis and investigations
Ibtisam is 27 years old, from Unaizah , married for 4 months, not have children but she is
pregnant for 11 weeks and Housewife. She has fever and 4 times vomiting in one day duration
3 days. low level of education.
T 38.1 C
A uterine myoma is a benign growth of smooth muscle in the wall of the uterus.
A uterine myoma is a solid tumor made of fibrous tissue, hence it is often called a
most often slow-growing and usually cause no symptoms.
Myomas are the most frequently diagnosed tumor of the female pelvis and the most
common reason for a woman to have a hysterectomy. Although they are often referred to
as tumors, they are not cancerous.
They are the most common pelvic tumors.It is found in 25% of white women &
50% of black women.
More common in nulliparous and low parity women
More common in women with positive family history (mother and sister)
More common in obese women
Conversion of circulating androgens to estrone (E1) by excess adipose tissue.
• Early Menarche
• Late menopause
• Use of synthetic oestrogens such as Tamoxifen in treatment for CA breast
myoma may cause no signs or symptoms. Symptomatic in only 35-50% of Pt
Symptoms depend on location, size, changes & pregnancy status
• Heavy and prolonged bleeding.
• Pelvic pain or pressure.
• Weight gain or an abnormally enlarged abdomen.
• Pressure on the bladder or bowel.
• Pain in the back of the legs.
• Pain during sexual intercourse.
Diagnosis and investigations
• Most myoma are discovered on routine bimanual pelvic exam or abdominal examination
• Retroflexed retroverted uterus obscure the palpation of myomas .
• Depletion of iron reserve
• Rarely erythrocytosis pressure on the ureters back pressure on the kidneys
• Acute degeneration & infection ESR, leucocytosis, & fever
• Pelvic U/S is very helpful in confirming the Dx & excluding pregnancy / Particularly in
Saline hysterosonography can identify submucous myoma that may be missed on U/S
HSG will show intrauterine leiomyoma
MRI highly accurate in delineating the size, location & no. of myomas , but not always
IVP will show ureteral dilatation or deviation & urinary anomalies HYSTROSCOPY
for identification & removal of submucous myomas
• Nonsurgical treatment:
• Inhibit prostaglandin synthesis
• Reduce menstrual flow (25-35%)
• Relieve dysmenorrhea
• Given for 21 days
• Significant reduction in menstrual blood loss
• Synthetic steroid
suppress estrogen and progesterone receptor in endometrium
thinning of lining of endometrium
reduction of blood loss
• Disadvantage: masculinizing effect
• Tranexamic acid
Synthetic derivative of amino acid lysine
Reversible blockage on plasminogen
50% reduction of menstrual blood loss
• Levonorgestrel intrauterine system
• Reduces blood loss by 80%
• Not applicable to all type of fibroid
• GnRH agonist
• Induce a reversible hypoestrogenic state
• Reduce uterine volume
• Pre-operative use
• 3-4 months course prior surgery
• Reduce fibroid size and uterine volume
• Midline vertical laparotomy incision lower transverse abdominal incision
• Improve pre-operative haemoglobin level
• Reduce perioperative blood loss and transfusion requirement