Uterine Fibroids

Uterine fibroids, also known as uterine leiomyomas, are benign smooth muscle tumours of the uterus. They are a common condition, affecting up to 50% of women by the age of 50.

While some women with fibroids are asymptomatic, others may experience a range of symptoms including painful or heavy periods, pelvic pain, and fertility issues.

Signs and Symptoms

Women with uterine fibroids may experience a variety of symptoms. Common signs include abdominal pain, anaemia due to increased bleeding, and pain during sexual intercourse. Fibroids can also cause pressure symptoms, such as frequent urination and rectal pressure. During pregnancy, they may lead to complications like miscarriage, bleeding, and preterm labour.

Risk Factors

Several risk factors are associated with the development of uterine fibroids. These include a family history of fibroids, obesity, and a diet high in red meat. Genetic factors play a significant role, with 50% of fibroids exhibiting genetic abnormalities. Fibroids also occur more frequently in African American women compared to white women.

Pathophysiology

Fibroids appear as well-circumscribed, solid nodules that vary in size. Microscopically, they consist of elongated, spindle-shaped cells arranged in a whorled pattern. They can be classified based on their location within the uterus:

• Intramural fibroids: Located within the muscular wall of the uterus.
• Subserosal fibroids: Located on the surface of the uterus.
• Submucosal fibroids: Located beneath the endometrium and may distort the uterine cavity.
• Cervical fibroids: Located in the wall of the cervix.

Diagnosis

Diagnosis of uterine fibroids typically involves a pelvic examination and medical imaging, such as ultrasound or MRI. MRI is particularly useful for differentiating fibroids from other uterine and extrauterine conditions.

Treatment

Treatment for uterine fibroids depends on the severity of symptoms. Asymptomatic fibroids usually do not require treatment. For symptomatic cases, several treatment options are available:

Medication

Medications like NSAIDs, oral contraceptives, and gonadotropin-releasing hormone agonists can help manage symptoms. Levonorgestrel intrauterine devices and selective progesterone receptor modulators like ulipristal acetate are also effective in reducing bleeding and shrinking fibroids.

Surgical Options

Surgical treatments include myomectomy, hysterectomy, and uterine artery embolisation. Myomectomy is preferred for women who wish to retain fertility, while hysterectomy is considered a last resort. Uterine artery embolisation is a non-invasive procedure that blocks blood flow to fibroids, causing them to shrink.

Prognosis

Fibroids often decrease in size after menopause. While most fibroids remain benign, about 1 in 1,000 may become malignant. Rapid growth after menopause can be a sign of malignancy, warranting further investigation.

Epidemiology

Uterine fibroids are more prevalent among African American women and tend to develop at a younger age compared to white women. They also grow more quickly and are more likely to cause symptoms, leading to higher rates of surgical intervention.

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Self-assessment MCQs (single best answer)

Which of the following is a common symptom of uterine fibroids?

Which type of fibroid is located within the muscular wall of the uterus?

What is one of the primary diagnostic tools used for detecting uterine fibroids?

Which medication is effective in reducing bleeding and shrinking fibroids?

Which surgical treatment is preferred for women who wish to retain fertility?

Which ethnic group has a higher prevalence of uterine fibroids?

Rapid growth of fibroids after menopause can be a sign of:

Which fibroid is located beneath the endometrium and may distort the uterine cavity?

Which of the following is NOT a risk factor for developing uterine fibroids?

What is the medical term for uterine fibroids?