Uterine fibroids are noncancerous tumors that arise from the smooth muscle cells of the uterus. They are the most common benign tumors of the female reproductive system. The exact cause is unknown but factors like genetics, hormones, growth factors, and angiogenesis play a role. Diagnosis involves examinations and imaging tests. Treatment depends on symptoms and may include medical therapy with hormones or procedures like uterine artery embolization or surgery.

1. Introduction
•Uterine fibroids, also known as leiomyomas or
myomas, are noncancerous monoclonal
tumors arising from the smooth muscle cells
and fibroblasts of the myometrium
•Most common benign tumors of the female
reproductive system
•More common in women aged 30-40

2. Types of uterine fibroids
•3 types
•Fibroids contain a large quantity of
extracellular matrix (fibronectin, collagen,
proteoglycan) and are surrounded by a
pseudocapsule of compressed areolar tissue
and smooth muscle cells
•Variable size

3. Etiology
Exact cause is not yet known; however some factors play role in the formation and
growth of uterine fibroids:
-Genetic predisposition (genetic mutations in the MED12, HMGA2, COL4A5/COL4A6,
or FH genes)
-Hormones: estrogen and progesterone
-Growth factors
-Angiogenesis

4. Risk factors
Increased risk:
African American
Nulliparity
Early menarche
Perimenopause
Family history
Hypertension
Diabetes
obesity
Alcohol
Decreased risk:
Multiparity
Oral contraception use
Smoking
Exercise
Diet rich in green vegetables

5. Clinical presentation
Asymptomatic (in 50-60% of cases)
Abnormal uterine bleeding (menorrhagia, metrorrhagia, menometrorrhagia, postcoital spotting)
Iron deficiency anemia: weakness, fatigue, dizziness
Pelvic and lower back pain
Dysmenorrhea, dyspareunia
Pressure-related symptoms: frequency and retention of urine, constipation, hydronephrosis,
venous stasis
Abdominal distention
Infertility

6. Fibroids in pregnancy
Fibroids increase the risk of:
- Miscarriage
-Preterm labor and delivery
-Fetal malpresentation
-Intrauterine growth restriction
-Dysfunctional labor
- Antepartum and postpartum hemorrhage
- Cesarean delivery

7. Diagnosis
•Bimanual examination: nontender
irregularly enlarged uterus with
cobblestone protrusions that feel solid on
palpation
•Pelvic ultrasound: well defined
hypoechoic lesions
•Hysterosalpingogram (HSG), saline
infusion sonogram, hysteroscopy
•MRI

8. Differential diagnosis
Adenomyosis
Endometriosis
Endometrial polyp
Pregnancy; ectopic pregnancy
Leiomyosarcoma
Endometrial carcinoma

9. Management
•For asymptomatic patients: no treatment required but follow up every 6 months
•Medical therapies: hormonal and nonhormonal options
•Non-surgical alternatives
•Surgical interventions indicated in case of:
-Abnormal uterine bleeding causing anemia
-Severe pelvic pain or secondary amenorrhea
-Uterine size >12 week
-Urinary frequency, retention or hydronephrosis
-Growth after menopause
-Recurrent miscarriage or infertility
-Rapid increase in size

10. Medical therapy
Nonhormonal drugs: NSAIDs (for dysmenorrhea) and tranexamic acid (to treat heavy
prolonged bleeding)
Hormonal drugs:
-Oral contraceptive pills
-Progestins (medroxyprogesterone acetate, Mirena)
-Mifepristone
-Androgenic steroids (danazol and gestrinone)
-GnRH agonists (nafarelin acetate, leuprolide acetate depot, goserelin acetate): shrink
fibroids and decrease bleeding by decreasing estrogen levels

11. Non-surgical alternatives
Uterine artery embolization:
-To decrease blood supply to the fibroid
-Not recommended for large and pedunculated fibroids
-Not used in women who are planning to become pregnant
after the procedure
MRI-guided high-intensity ultrasound:
- Reserved for premenopausal women who wish to retain
their uterus

12. Surgical therapy
Myomectomy:
-Reserved for patients with
symptomatic fibroids who wish to
preserve their fertility or who choose
not to have a hysterectomy
Hysterectomy with or without
oophorectomy