Benign smooth muscle tumours originating from the myometrium of the uterus

Aetiology

• The exact cause of fibroids is unknown but they are thought to be influenced by genetic, hormonal, and environmental factors
• Oestrogen and progesterone, the hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids
• Fibroids contain more oestrogen and progesterone receptors than normal uterine muscle cells

Clinical features

Symptoms

• Majority asymptomatic
• Pressure symptoms +/- abdominal distention
  • Includes urinary frequency or chronic retention
• Heavy menstrual bleeding
• Subfertility
• Acute pelvic pain (rare)

Signs

• A solid mass or enlarged uterus may be palpable on abdominal or bimanual examination
• The uterus is usually non-tender

Investigations

• Imaging: pelvic US, MRI (rarely required, unless sarcoma suspected)

Management

Medical

• Tranexamic or mefanamic acid