Fibroid Uterus – Sign Symptoms Complications and Treatment

Fibroid Uterus:

Fibroid Uterus is the Commonest benign tumor of the uterus. Histologically this tumor is composed of smooth muscle and fibrous tissue –
Leiomyoma / Myoma / Fibromyoma.

Incidence Of Fibroid Uterus:

• Very rare before 20
• Black women – 
• More common in nulliparous or having one child infertility.
• Highest between 35-45 years.

Types of Fibroid Uterus

Fibroid Uterus Symptoms:

Majority of fibroids remain asymptomatic 75%

Menorrhagia 30%

1. – Increased surface area of the endometrium
2. – Interference uterine contractility
3. – Congestion of endometrial venous plexuses
4. – Endometrial hyperplasia

Irregular bleeding may be due to:
– Ulceration of sub mucous fibroid or fibroid polyp
– Associated endometrial carcinoma
Dysmenorrhea:
– Congestion variety
Infertility:

1. – Distortion and or elongation of the uterine
2. cavity → difficult sperm ascent
3. – Defective nidation
4. – Anovulation
5. – Endometriosis

Pain lower abdomen:

1. – Due to degeneration
2. – Torsion
3. – Extrusion of polyp

Pressure symptoms:
– Kidney, Intestine, Bladder

Signs Of Fibroid Uterus

General examination – Anemia
Abdominal examination
– If enlarged to 14 weeks or more
Palpation – feel is firm
Margins are well-defined
Surface is nodular
Mobility is restricted
Bimanual examination: < 14 weeks
– Uterus is not felt separated
– Cervix moves with the movement of the tumor

Effect Of fibroid uterus on Pregnancy

• 
  

  Abortion

• Malpresentation

• Preterm labor

• Intrauterine growth retardation

• Obstructed labor

• Retained placenta

• 
  

  PPH

Pregnancy Effect on Fibroid uterus

Rapidly growing
Degeneration

1. Red
2. Hyaline
3. Cystic
4. Fatty
5. Calcareous

Complications of Fibroid uterus

1. Degeneration
2. Necrosis
3. Infection
4. Torsion
5. Sarcomatous changes
6. Hemorrhage
7. Polycythemia – due to erythropoietic function by the tumor.

Medical Management of Fibroid uterus:

For reducing size and blood loss

– Danazol 400 to 800 mg daily for 3 to 6 months
– Progesterone
– GnRH analogues

Surgical Management of Fibroid uterus:

If Family not complicated:

1. – Myomectomy
2. – Laparoscopic Myomectomy
3. – Hysteroscopic Myomectomy

Hysterectomy is indicated over 40 multiparous women:
– Laparoscopic Hysterectomy
– Total abdominal Hysterectomy
– Lecture Courtesy: Dr. Shipra – Rajshahi Medical College