The document discusses uterine fibroids, which are benign tumors that develop from the muscle tissue of the uterus. Key points include: - Fibroids are very common among women and often do not cause symptoms. When they do cause issues, common symptoms include heavy bleeding, pelvic pain, and pressure. - Risk factors include nulliparity, early menstruation, increasing age, obesity, and genetic factors. - Treatment options depend on symptoms and desire for future fertility, ranging from watchful waiting to drug therapy, myomectomy (surgical removal of fibroids), and hysterectomy (removal of the uterus).

1. FIBROIDS
1
N G E N D A I M B O E L A
D i p C l i n i c a l M e d i c a l S c i e n c e s , C e r t H I V / A I D S M a n a g e m e n t , P g D i p T e a c h i n g M e t h o d o l o g y ,
C e r t P r o j e c t M a n a g e m e n t & D i p M o n i t o r i n g & E v a l u a t i o n ( M & E )
B a c h e l o r o f S c i e n c e I n H u m a n B i o l o g y ( B S c . H B )
M a s t e r s i n B u s i n e s s A d m i n i s t r a t i o n ( F i n a n c e )
B a c h e l o r o f M e d i c i n e & B a c h e l o r o f S u r g e r y ( M B C h B ) … , I n P r o g r e s s !

2. INTRODUCTION
Fibroid is the commonest benign tumor of the uterus and also the
commonest benign solid tumor in females. Fibroids are benign tumours
arising from the smooth muscle of the myometrium. Also known as
uterine leiomyoma, myoma, fibromyoma, leiofibromyoma,
fibroleiomyoma, and fibroma. Uterine fibroids are extremely common.
Many women have uterine fibroids at some point in life.
Uterine fibroids in most cases are usually too small to cause any
problems, or even be noticed. A recent study states that by the age of 50,
70% of women will have developed uterine fibroids at some point in their
life. When fibroids develop, they are non-cancerous and in fact, do not
present fibroid symptoms in the early stages or when they are very small.
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3. INTRODUCTION
As symptoms develop, the patient may experience any of the
following: heavy bleeding, abdominal distention, frequent urination,
painful intercourse, lower back pain, and/or fertility issues. The degree
to which a patient may experience these symptoms can vary, however, it
is important that when fibroids are diagnosed that treatment is sought
as soon as possible, even if the symptoms are manageable.
Many women may delay fibroid treatment if they feel they are able to
manage the symptoms. There are many myths women will tell
themselves, but as with all medical conditions, the earlier a condition is
treated, the easier and more effective than treatment is likely to be.
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4. ETIOLOGY
The etiology still remains unclear. The prevailing hypothesis is that, it
arises from the neoplastic single smooth muscle cell of the
myometrium. The stimulus for initial neoplastic transformation is not
known. The following are implicated:
Chromosomal abnormality: In about 40% of cases, there is a varying
type of chromosomal abnormality, particularly the chromosome six or
seven (rearrangements, deletions). Somatic mutations in myometrial
cells may also be the cause for uncontrolled cell proliferation.
Role of polypeptide growth factors: Epidermal growth factor (EGF),
insulin-like growth factor-1 (IGF-1), transforming growth factor (TGF),
stimulate the growth of leiomyoma either directly or via estrogen.
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5. ETIOLOGY
It is predominantly an estrogen-dependent tumor. Estrogen and
progesterone is incriminated as the cause. Estrogen dependency is
evidenced by:
Growth potentiality is limited during childbearing period.
Increased growth during pregnancy.
They do not develop until after puberty, and usually after age 30.
They shrink or disappear after menopause, when oestrogen levels fall.
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6. RISK FACTORS
Increased risk
Nulliparity (Not having children)
Early onset of menstruation
Increasing age
Obesity
Black-American ethnicity: 2-3 fold increase
Genetic/Familial predisposition
Reduced risk
Pregnancy
Combination OCP
Depo-Provera
Tobacco use
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7. TYPES OF FIBROIDS
Classified by where they grow in the uterus
Intracavitary fibroids are inside the cavity of the uterus.
Submucous fibroids are partially in the cavity and partially in the wall
of the uterus.
Intramural fibroids are in the wall of the uterus.
Subserous fibroids are on the outside wall of the uterus.
Pedunculated fibroids are attached to the uterus by a stalk.
Pedunculated fibroids can detach from the uterus to become parasitic
fibroids.
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10. COMPLICATIONS OF FIBROIDS
Uterine fibroids frequently outgrow their blood supply and undergo
degeneration.
Hyaline degeneration: Death of tissue with loss of muscle cell
structure, which may lead to hardening of the fibroid.
Cystic degeneration: A sequel to hyaline change with subsequent
breakdown and cyst formation giving a honeycomb appearance.
Fatty degeneration: Partial cell death resulting in the development of
fatty substances which may subsequently undergo hardening.
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11. COMPLICATIONS OF FIBROIDS
Red degeneration: Swelling and distortion of structures, particularly
encountered in the 2nd trimester of pregnancy .
There is breakdown of blood supply by formation of blood clots
within the blood vessels.
Sarcomatous change: Rare cancerous change reported in 0.2–0.4% of
fibroids examined in older women with no symptoms.
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12. CLINICAL FEATURES OF FIBROIDS
>50% asymptomatic, Approxmately 20% require treatment
Menorrhagia
Amount & duration of flow increased
Commonest symptom
Possibly due to ↑surface area & ↑PG synthesis
Other forms of abnormal PVB must be investigated
Pelvic pain
May be dysmenorrhoea or unrelated to cycle
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13. CLINICAL FEATURES OF FIBROIDS
Pressure symptoms
Urinary frequency/retention,
Ureteric obstruction,
Constipation
Subfertility
Majority are fertile, therefore investigate other causes even if woman
has fibroids
May be due to cornual occlusion or distortion of endometrial cavity,
affecting implantation
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14. FIBROIDS AND PREGNANCY
Enlarge & may present with:
Spontaneous abortion, IUGR & Preterm labour
Red degeneration
Obstructed labour especially cervical fibroids
Uterine inertia due to incoordinate contractions
Mal-presentations
High rate for operative delivery
Abruptio placentae
Uterine atony, causing PPH
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15. DIAGNOSIS
Bimanual pelvic exam or abdominal examination
Irregular enlargement of uterus
Non tender firm to hard
Mass moves with cervix.
Ultrasound
Measure size
Demonstrate pressure effects:- Hydronephrosis
D & C to exclude endometrial pathology
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16. DIAGNOSIS
Ultrasonograghy: is an useful diagnostic tool to confirm the diagnosis of
fibroid. Transvaginal ultrasound can accurately assess the myoma location,
dimensions volume and also any adnexal pathology
Hysterosalpingography (HSG): This a detailed X-ray where a contrast
material is injected first and then X-rays of the uterus are taken. This is
more often used in people who are also undergoing infertility evaluation.
MRI: highly accurate in delineating the size, location & no. of myomas ,
but not always necessary
Hysteroscopy: for identification & removal of submucous myomas
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17. DIFFERENTIAL DIAGNOSIS
Pregnancy
Uterine enlargement
Adenomyosis, endometrial Ca,
Pelvic masses
Ovarian masses, TO Masses/ abscess
Abnormal bleeding
Ca ovary, endometrium
uterine sarcoma, Polyps, adenomyosis
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18. TREATMENT
Most uterine fibroids don’t need any treatment, because they don’t
cause symptoms or problems. Uterine fibroids causing problems may
be treated with non-surgical or surgical options
Drug therapy has established a firm place in the management of
symptomatic fibroids. The drugs are used either as a temporary
palliation or may be used in rare cases, as an alternative to surgery.
Prior to drug therapy, one must be certain about the diagnosis
Watchful waiting: A minority of fibroids will naturally shrink over
time. Most uterine fibroids will either stay the same size or grow.
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19. TREATMENT
DRUG THERAPY
Oral contraceptives: These can help reduce heavy periods caused by
uterine fibroids.
GnRH agonists: This hormone treatment stops menstrual periods and
shrinks uterine fibroids. Usually used as a temporary treatment before
surgery for very huge fibroids. Drugs commonly used are goserelin,
luporelin, buserelin or nafarelin
Prostaglandin synthetase inhibitors—These are used to relieve pain
due to associated endometriosis or degeneration of the fibroid. They
cannot improve menorrhagia due to fibroids. Pain relievers: Can reduce
the pain caused by uterine fibroids.
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20. TREATMENT
DRUG THERAPY
Levonorgestrel-releasing Intrauterine System (LNG-IUS) reduces blood
loss and uterine size. However, this is not recommended when the
uterine size is >12 weeks or there is distortion of uterine cavity.
Iron: Heavy periods caused by uterine fibroids can lead to iron-
deficient anaemia.
Iron tablets can help the body replace the blood lost during
menstruation.
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21. TREATMENT
SURGICAL MANAGEMENT
Myomectomy: The enucleation of myomata from the uterus leaving
behind a potentially functioning organ capable of future reproduction.
Surgery to remove uterine fibroids while leaving the uterus in place.
Often done for women wishing to have children.
Among the contraindications few are relative rather than
absolute. Restoration of anatomy and function of the uterus, tubes
and ovaries following myomectomy are important, not only for
future reproductive function but also to avoid the future hazards
New uterine fibroids may grow after myomectomy.
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22. TREATMENT
SURGICAL MANAGEMENT
Hysterectomy: Surgery to remove the entire uterus and all uterine
fibroids. Cures uterine fibroids and prevents them from ever returning.
Hysterectomy in fact, is the operation of choice in symptomatic fibroid
when there is no valid reason for myomectomy. The patients over the
age of 40 years and in those not desirous of further child are the classic
indications.
Embolotherapy: Uterine artery embolization (UAE) causes avascular
necrosis followed by shrinkage of fibroid. Uterine arteries are occluded
by injecting polyvinyl alcohol particles through percutaneous femoral
catheterization. This may be an option to women with symptomatic
fibroid where surgery is not preferred
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