Snapshot A 30-year-old African American G0P0 with no significant past medical history presents with chronic pelvic pain. She denies any other symptoms. Physical exam reveals a mobile uterus that is nontender with multiple discrete nodules. A transvaginal ultrasound shows hyperechoic masses within the uteruine myometrium. She decides to undergo a myomectomy that will preserve her ability to bear children. Overview Introduction Otherwise known as fibroids Leiomyomas are smooth muscle growths of the uterine myometrium Epidemiology (most common) benign uterine tumor tumor in females seen in African Americans (5x more common) occurs in women 20-40 years of age Often present with multiple discrete tumors Presentation Symptoms sensitive to estrogen levels tumor growth and increased symptoms during pregnancy decreased symptoms during menopause may present with no symptoms abnormal uterine bleeding iron deficiency anemia miscarriage pain constipation urinary frequency Physical exam uterus is enlarged firm asymmetric nontender multiple tumors Evaluation Diagnose with clinical history and exam Confirm with sonogram transvaginal ultrasound has high sensitivity (95-100%) hyperechoic, well-circumscribed round masses Labs β-hCG to rule out pregnancy Histology whorled pattern of smooth muscle bundles Differential Diagnosis Leiomyosarcoma Adenomyosis Endometrial polyp Pregnancy Treatment If asymptomatic observation fibroids can shrink substantially postpartum and after menopause If symptomatic premenopausal OCPs NSAIDs myomectomy postmenopausal myomectomy hysterectomy Prognosis, Prevention, and Complications Prognosis having symptomatic fibroids decreases quality of life Complications very rarely (if at all) transforms into leiomyosarcoma infertility
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