Leiomyomas are uterine fibroids that appear on the uterus, causing pain, abnormal uterine bleeding, and urinary issues. They are screened for on bimanual pelvic exam and confirmed with ultrasound or MRI, then treated with NSAIDs, oral contraceptives, or surgery.

Pathophysiology

• Smooth muscle tumours arising from the myometrium
• Develops monoclonally from one smooth muscle cell
• Enlarges with estrogen

FIGO Classification (PALM-COEIN) for Causes of Abnormal Uterine Bleeding Subclassification

• L = leiomyoma
• Subclassification based on location relative to uterine tissue layers

Submucosal

• At surface of the uterus

Intramural

• Within the uterine wall

Other

• Subserous: at surface of uterus
• Other: cervix, broad ligament, fallopian tube, etc.

Shape Definitions

• Pedunculated: growing on a stalk
• Sessile: broad base without protrusion

Contextual Factors

Non-Modifiable

• Reproductive age
• Black race
• Early menarche
• Genetic predisposition: MED12, HMGA1, HMGA2 mutations

Modifiable

• Obesity
• Hypertension
• Consumption of red meats
• Low number of births (< 3)
  • Technically it’s modified by having more babies, but don’t actually tell patients to have more than 3 babies to decrease the risk of fibroids…

Clinical Manifestation

• Can be asymptomatic
• Abnormal uterine bleeding
• Pelvic pain or pressure
• Urinary frequency or urgency
• Constipation

Diagnosis

Screening

• Bimanual pelvic exam
  • Enlarged, irregular, mobile uterus
  • Adnexal mass
  • Tenderness

Imaging

• Ultrasonography
• Saline infusion sonography if abnormal uterine bleeding is present
  • Visualises submucosal fibroids
• MRI

Procedures

• Hyesteroscopy

Treatment

Bleeding Control

• NSAIDs
• Tranexamic acid
• Estrogen-progestin contraceptives
• Progestins

Removal

• Myomectomy: removal of just fibroids to preserve uterine function
  • Increases risk of uterine rupture during labour - cessarian section delivery required
  • Has chance of recurrence
• Hysterectomy: complete removal of uterus