Uterine fibroids (leiomyomas)
Fibroids are benign smooth-muscle tumours of the myometrium, the most common pelvic tumour in women: present in up to 70–80% by age 50, symptomatic in about a quarter. They are oestrogen- and progesterone-dependent: they grow in pregnancy and shrink after menopause.
- Risk factors: age 30–50, African ancestry, nulliparity, obesity, early menarche, family history.
Types (by location, FIGO 0–8)
Symptoms
- Many are asymptomatic. Heavy menstrual bleeding and anaemia; pressure (frequency, constipation), pelvic mass, pain; subfertility and miscarriage.
- Degeneration: hyaline (commonest), cystic, calcific (postmenopausal), red degeneration (in pregnancy: acute pain, fever; treat with analgesia), sarcomatous (rare).
Diagnosis
Enlarged irregular firm uterus; ultrasound confirms; MRI maps fibroids before surgery; hysteroscopy for submucous fibroids.
Treatment
- Asymptomatic: no treatment, follow-up.
- Medical: tranexamic acid, NSAIDs, levonorgestrel IUS, combined pill; GnRH agonists (shrink fibroids before surgery, short term); oral GnRH antagonists with add-back (relugolix combination); ulipristal acetate (restricted by liver risk).
- Surgical: hysteroscopic resection (submucous), myomectomy (laparoscopic or open, keeps fertility), hysterectomy (definitive).
- Radiological: uterine artery embolisation, MRI-guided focused ultrasound.