Leiomyoma

Fibroids are benign smooth muscle tumours of the uterus. They are thought to occur in around 20% of white and around 50% of black women in the later reproductive years.

Associations

• more common in Afro-Caribbean women
• rare before puberty, develop in response to oestrogen

Features

• may be asymptomatic
• menorrhagia
  • may result in iron-deficiency anaemia
• bulk-related symptoms
  • lower abdominal pain: cramping pains, often during menstruation
  • bloating
  • urinary symptoms, e.g. frequency, may occur with larger fibroids
• subfertility
• rare features:
  • polycythaemia secondary to autonomous production of erythropoietin

Diagnosis

• transvaginal ultrasound

Management

Asymptomatic fibroids

• no treatment is needed other than periodic review to monitor size and growth

Management of menorrhagia secondary to fibroids

• levonorgestrel intrauterine system (LNG-IUS)
  • useful if the woman also requires contraception
  • cannot be used if there is distortion of the uterine cavity
• NSAIDs e.g. mefenamic acid
• tranexamic acid