Fibroids (Leiomyoma)

Uterine fibroids, which are benign tumours of uterine smooth muscle, are oestrogen dependent and shrink with onset of menopause. Usu. asymptomatic if small.

Symptoms

• Often asymptomatic

• Menorrhagia

• Dysmenorrhoea

• Pelvic discomfort ± pain (from pressure)

• Bladder dysfunction

• Subfertility (acts like IUCD if submucosal)

Investigation

• Transvaginal ultrasound

• FBE (?anaemia)

Management

• Consider COCP or vaginal ring for management of menorrhagia

• Levonorgestrel 52 mg IUD (preferred treatment)

• GnRH analogues, esp. >42 yrs (max. 6 mths)

• Surgical options:

  • – myomectomy (remove fibroids only)

  • – hysteroscopic resection/endometrial ablation

  • – hysterectomy