Uterine Leiomyomas (Fibroids)
Leiomyomas are the most common benign pelvic tumors in reproductive-age women, arising from the smooth muscle cells of the myometrium. They are estrogen-dependent and typically regress after menopause.
Anatomic Classification
- Submucosal: Projecting into the uterine cavity (most likely to cause abnormal uterine bleeding/AUB).
- Intramural: Within the wall of the uterus (can cause bulk symptoms).
- Subserosal: Projecting from the serosal surface (can cause pressure/bulk symptoms).
Clinical Presentation & Diagnosis
| Presentation | Key Features |
|---|---|
| Symptoms | Heavy menstrual bleeding (HMB), pelvic pressure, urinary frequency, or constipation. |
| Diagnosis | Pelvic ultrasound (Transvaginal) is the initial imaging modality of choice. |
High-Yield Exam Pearl:
- Management: Medical therapy (e.g., OCPs, progestins, GnRH agonists/antagonists) targets symptoms. Definitive surgical management includes myomectomy (for those desiring future pregnancy) or hysterectomy.
- Pregnancy Impact: Large fibroids can lead to increased risk of malpresentation, FGR, and increased risk of cesarean delivery.