fibroid

Fibroids, also known as uterine leiomyomas, are benign tumors composed of smooth muscle and fibrous tissue that arise from the uterus. They are the most common benign pelvic tumors in women of reproductive age, and many fibroids cause no symptoms. Prevalence rises with age during the reproductive years, and fibroids are more common in people of African descent and in those with a family history.

Fibroids are classified by location: intramural (within the uterine wall), submucosal (into the uterine cavity), subserosal (on the outer surface), and pedunculated. They are estrogen- and progesterone-sensitive and tend to grow during reproductive years and shrink after menopause. Genetic and environmental factors are also thought to contribute.

Symptoms vary; many fibroids are asymptomatic. When present, common signs include heavy menstrual bleeding, prolonged periods, pelvic pressure or pain, urinary frequency, constipation, and fertility or pregnancy problems. Large fibroids may distort the uterus and cause bulk-related symptoms.

Diagnosis typically starts with a pelvic exam and ultrasound. MRI may be used for complex cases. Treatment depends on symptoms, size, location, age, and fertility desire. Options range from observation to medical therapies (eg, GnRH agonists, antifibrinolytics, hormonal treatments) and procedures such as myomectomy or hysterectomy, uterine artery embolization, or MR-guided focused ultrasound. Endometrial ablation is sometimes used for heavy bleeding but not for most fibroids; fertility considerations are important.

Prognosis is generally favorable; fibroids often shrink after menopause. Recurrence after treatment is possible, and fibroids can impact fertility and pregnancy outcomes depending on their size and location.