Snapshot A 33-year-old G4P4 female complains of abnormal vaginal bleeding that occurs intermittently between her predictable menstrual cycles. A transvaginal ultrasound shows suspicious hyperechoic masses within the uterine wall. A laparoscopic procedure is performed to assess the anatomy further. 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 aged 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 note, if symptoms increase after menopause, the diagnosis is likely not fibroids 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 Diagnose with clinical history and exam Confirm 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 reserves 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