UTERINE FIBROIDS
Dr Rakhi Sardar
Assistant professor of department of Obstetrics and Gynaecology
Murshidabad Medical college and Hospital
UTERINE FIBROIDS
DEFINITION :
A uterine fibroid or leiomyomas originates from the
smooth muscle cell of the myometrium containing
varying amount of fibrous tissue.
These are commonly benign tumor.
Monoclonal origin .
They may be single or multiple and vary in size.
ETIOLOGY :
The incidence of fibroids in general population is 20-25% but that can be
higher with routine use of ultrasound .
Most common age group:35 to 45 yrs
RISK FACTORS:
Increase with age until menopause.
Family history :2.5 times increase risk
Ethnicity :African and carribens
Obesity
Diet :meat and high fat diet
Nulliparous women OR low parity
Various growth factors like TGFB,EGF,IGF-I,IGF-2,BFGF.
PROTECTIVE FACTORS :
Multiparity
Exercise
Intake of green vegetables
Progesterone only contraceptives
Cigarette smoking
TYPES OF FIBROIDS
SITE OF ORIGIN :
I. Intramural or interstitial Corporeal (97%)
II. Subserous Cervical (3%)
III. Submucosal (mc type ,70-75%)
IV. Cervical
V. Broad ligament
PATHOLOGY :
Macroscopic appearance : Microscopic appearance :
o Round to oval shaped o Smooth muscle bundles with swirled
pattern .
o Single or multiple
o Well circumscribed
o Firm and pearly white
o Pseudocapsule
CLINICAL FEATURES :
SYMPTOMS:
1. Asymptomatic :most common up to 50%
2. Menstrual dysfunction
3. Pain
4. Pressure symptoms
5. Infertility
6. Abdominal distension
7. Abortions
8. Pregnancy complications .
SIGNS: Vaginal examination :midline
enlarge uterus with free adnexa.
Anemia Movement of mass transmitted to
Abdominal mass cervix .
Speculum examination : Fibroidal Large cervical fibroid : ‘lantern on
polyp the dome of St.Paul’s cathedral’
COMPLICATIONS :
1) Atrophy Risk of malignancy
2) Necrosis 0.1 % in reproductive
3) Degeneration age group .
4) Malignancy 1.7%after age age of 60 .
5) Infection
6) Torsion
7) Incarceration
8) Inversion of uterus
SECONDARY CHANGES IN FIBROID
DEGENERATIVE CHANGES :
Hyaline degeneration
Cystic Degeneration
Fatty Degeneration
Red degeneration
Septic degeneration
Calcification
INVESTIGATIONS :
GENERAL : SPECIAL :
Hemoglobin Ultrasound :transabdominal for large
fibroid and transvaginal for small
Complete urine test fibroid .For following
features :number ,site ,size ,adnexal
Renal function test mass ,hydronephrosis .
Liver function test MRI
Saline infusion sonography
Blood sugar
Hysterosalpingography
Xray chest and abdomen
Diagnostic hysteroscopy and
Ecg laparoscopy
FIBRIOD D/D
Pregnancy
Adenomyosis
Ovarian tumour
Ectopic pregnancy
Endometriosis
T O mass
MANAGEMENT
GnRH Analogues :
Medical :
Triptorelin 3.75mg
Not a definitive treatment ,
leuprolide depot 3.75 mg I/M
for symptomatic relief
Preoperatively to decrease the size Goseraline 3.6 mg SC foe 3
months .
progesterone ,antiprogesterone
(mifepristone),androgens(danazol, Advantages :decrease size ,
gestrinone) ,GnRH analogues . blood loss ,increase HB level .
:decrease blood loss during
surgery
Surgical :
Embolization of
Hysterectomy :
abdominal
both uterine
Vaginal
arteries
LAVH,TLH
MRI guided focused
Myomectomy
ultrasound
abdominal
Vaginal
Hysteroscopic
Laparoscopic
Myomectomy is done in following :-
Infertility
Recurrent pregnancy loss
Young patients
Patient who wish to preserve their uterus
ABDOMINAL MYOMECTOMY
Minimum incision are kept –preferably single midline
vertical ,lower ,anterior wall
Removal of as many fibroids as possible through one incision and
secondary tunnelling incision .
Meticulous closure of all dead space.
Proper haemostasis.
Measures for adhesion prevention should be taken .
Hysteroscopic myomectomy Laparoscopic myomectomy
For submucus myoma causing In 3 phases :
infertility ,recurrent
excision of myoma ,repair of
pregnancy loss , AUB or pain .
myometrium and extraction .
Criteria :
Less than 5 cm in size
Suitable for subserous and
Less than 50% intramural component
intramural fibroids upto 10 cm size
Less than 12 cm uterine size
NEWER MANAGEMENT
MIRENA: MRI guided focused
Third generation IUCD.
ultrasound therapy
Contain progesterone LNG 60mg Selective progesterone
releasing 20ug. receptor
modulator :Asoprisnil
Fibroids decreases in size 6 to 12
months Somatostatin analogues
