Diagnosis

Myoma uteri

Etiology

Cause [wtq]

• Unknown cause

• Theories:

  • Reproductive hormones (overexpression of estrogen and progesterone receptors when compared to normal surrounding myometrium)

  • Abnormalities of the myometrium

  • Predisposing genetic variations that affect cell signaling pathways

Pathophysiology [sb3][wtq]

1. Estrogen and progestogen sensitive uterine leiomyoma (usually asymptomatic)

2. Compression of nearby structures

3. Faster growth than its blood supply can support it --> hemorrhagic infarction

4. Clinical manifestation (25-30%)

   • Pelvic and low back pain/pressure

   • Abnormal uterine bleeding

   • Anemia

   • Bladder or bowel dysfunction

Risk factors [kzw]

• High concentration of estrogen and progesterone receptors in the uterus

• Obesity

• Low number of pregnancies/infertility

• Arterial hypertension

• Genetic predisposition

• African descent

Complications [wtq]

• Nonobstetric Complications

  • Chronic pelvic pain

  • Heavy menstrual bleeding

  • Anemia

  • Infertility 

  • Sexual dysfunction

  • Constipation 

  • Urinary tract infections or urinary incontinence

  • Torsion of a pedunculated fibroid 

  • Degeneration with or without infection

• Obstetric complications:

  • Preterm labor and birth

  • Placental abruption

  • Placenta previa

  • Preterm prelabor rupture of membranes

  • Abnormal labor

  • Cesarean birth

  • Postpartum hemorrhage

Epidemiology

Prevalence per 100.000 [s9b][pou][sb3][kzw][hu9][pav][dcs]

Incidence per 100.000 [s9b][pou][sb3][kzw][hu9][pav][dcs]

Approach

• Blood test: complete blood count, TSH, prolactin

• Blood gas

• Abdominal x-ray

• Transvaginal ultrasound

• CT abdomen

• MRI pelvis

• Endometrial biopsy to rule out endometrial cancer if risk factors (obesity, chronic anovulation, and advanced age)

Treatment

1. Surveillance if asymptomatic myoma uteri [wtq]

   • Repeat imaging if change in clinical symptoms (bleeding, pain, anemia, or urinary or bowel dysfunction)

   • Pain: NSAIDs

   • Menorrhagia: Tranexamic acid

2. Medical therapy: suppress the hypothalamic-pituitary-ovarian axis

   • Oral contraceptives

   • Progestins

   • Levonorgestrel-releasing intrauterine system

   • GnRH-agonists

   • Aromatase inhibitors

3. Surgical intervention:

   • Myomectomy

   • Endometrial ablation

   • Hysterectomy

4. Uterine artery embolization

5. Radiofrequency ablation

Differential diagnoses

Adenomyosis, Braxton Hicks contraction, Endometrial cancer, Leiomyosarcoma, Lipoleiomyoma, Pregnancy