Snapshot A 45-year-old African American G2P2 woman presents with abnormal uterine bleeding. She reports irregular spotting between periods and pain with intercourse. Physical exam reveals a mobile, asymmetric, nontender uterus with multiple nodular abnormalities. A Transvaginal ultrasound shows hyperchoic masses within the uterine wall. She decides to undergo a hysterectomy because she does not want any more children. Introduction Otherwise known as fibroids Leiomyomas are smooth muscle growths of the uterine myometrium can be intramural submucosal subserosal Epidemiology (most common) benign uterine tumor tumor in females seen in African Americans (5x more common) occurs in women 20-40 years of age Often present with multiple discrete tumors Presentation Symptoms sensitive to estrogen levels tumor growth and increased symptoms during pregnancy decreased symptoms during menopause symptoms depend on location of leiomyoma intramural asymptomatic submucosal intermenstrual bleeding and menorrhagia subserosal compression of bladder, rectum, or ureter pelvic pain urinary or bowel issues Physical exam uterus is enlarged firm mobile asymmetric nontender multiple tumors Evaluation Diagnosed with clinical history and exam Diagnosis confirmed with sonogram transvaginal ultrasound has high sensitivity (95-100%) hyperechoic, well-circumscribed round masses Labs β-hCG to rule out pregnancy Histology whorled pattern of smooth muscle bundles Differential Diagnosis Leiomyosarcoma Adenomyosis Endometrial polyp Pregnancy Treatment If asymptomatic observation fibroids can shrink substantially postpartum and after menopause If symptomatic NSAIDs for dysmenorrhea OCPs for abnormal uterine bleeding GnRH analogs to shrink fibroids pre-surgery surgical management myomectomy preserves childbearing potential uterine artery embolization preserves childbearing potential if myomectomy is not an option hysterectomy definitive therapy Prognosis, Prevention, and Complications Prognosis having symptomatic fibroids decreases quality of life Complications very rarely (if at all) transforms into leiomyosarcoma infertility iron deficiency anemia