UTERINE FIBROIDS

DR.HANAN A BALOBAID
.ASSIS.PROF
CONSULTANT OF OBS&GYN
 DEFINITION

Uterine fibroid is a leiomyoma (benign, smooth •

muscle neoplasms that typically originate from
the myometrium
 Incidence
The incidence among women is generally cited as 20 •
,to 25 percent
but has been shown to be as high as 70 to 80 percent •
in studies using histologic or sonographic
. examination
 CAUSES

.unknown
Family history
.Genetic alterations
Hormones.: Uterine leiomyomas are estrogen- and
progesterone-sensitive tumors
 RISK FACTORS

.Heredity
.Race
.Pregnancy and childbirth
, Nulliparity
Obesity
.Oral contraceptives
 Relationships of Patients Factors,
Leiomyoma Risk, and Steroid Hormones
Early menarche : Increased years of estrogen exposure
Elevated BMI : Increased conversion of androgens to estrogens
Affected family member : Increased Genetic differences in hormone
production or metabolism
African-American race :Increased Genetic differences in hormone
production or metabolism
PCOS : Increased Unopposed estrogen secondary to anovulation
Postmenopausal : Decreased Hypo estrogenism
Increased parity : Decreased Break in chronic estrogen
exposure
Combination oral contraceptives : Decreased or null
Exposure to estrogen opposed by progesterone
Cigarette smoking : Decreased serum estrogen levels
 TYPES

BODY OR
CORPOREAL
FIBROIDS
Intramural or-
interstitial fibroids
Subserosal fibroids-
Submucosal fibroids-
% CERVICAL FIBROIDS 1-2-
 SECONDARY CHANGES IN FIBROID
Pathogenesis

Degenerative changes
:Hyaline degeneration
:Cystic degeneration
:Calcification
:Fatty degeneration
:Red degeneration
:Septic degeneration
Infection
Atropy
Necrosis
Vascular changes
Sarcomatous changes
 CLINICAL FEATURES
remains asymptomatic % 75
Menustrual abnormalities
Menorrhagia (30%)
Metrorrhagia or irregular bleeding
Dysmenorrhea
; only 1 to 3 percent of infertiliry cases are due solely to leiomyomas Infertility
; Pain lower abdomen
seen with a degenerating, a prolapsing
;Pressure symptoms
large uterus can cause chronic pressure, urinary frequency, incontinence, or
. constipation
 Abdominal examination

Feel is firm more towards hard may be cystic in cystic

.degeneration
.Margins are well defined except the lower pole
nodular may be uniformly enlarged
Mobility is restricted from above downwards but can be
.moved from side to side
Percussion : swelling is dull
 Pelvic examination
Bimanual examination reveals uterus irregularly
enlarged
Uterus is not felt separated from the swelling and
as such a groove is not felt between the uterus
.and the mass
The cervix moves with the movement of the
.tumour felt per abdomen
 DIAGNOSIS

An abdominal, transvaginal or pelvic ultrasound

C.T scan
MRI
An endometrial biopsy
A hysteroscopy
Hysterosalpingography
Laparoscopy
 TREATMENT
For symptomatic fibroids
Medication to control symptoms
Medication aimed at shrinking tumours
Ultrasound fibroid destruction
surgically aided methods to reduce blood supply of fibroids
Myomectomy or radio frequency ablation
Hysterectomy
Treatment for infection and anemia
Embolization
 Medications

Oral contraceptive pills

GnRH agonists
The antihormonal drug RU-486
)mifepristone(
Danazol (Danocrine)
Antifibrinolytics (tranexamic acid)
Nonsteroidal anti-inflammatory agents
Progesterone receptor modulator named Ellaone
 SURGERY

Myomectomy
Hysterectomy
,Uterine artery embolization•
Uterine artery ligation

Radio frequency ablation

Endometrial ablation
 COMPLICATIONS

.Menorrhagia- Anemia-
Abdominal pains- Urinary tract infections-
Premature birth, labor- A c-section may be needed-
--problems, miscarriages Some pregnant women with-
Infertility- fibroids have heavy bleeding
Leiomyosarcoma- .immediately after giving birth
Twisting of the fibroid-
THANK YOU