Overview

• Benign tumours (leiomyomas) arising from the myometrium (middle smooth muscle layer of uterine wall).
• Aetiology → hormone dependent (contain lots of oestrogen and progesterone receptors).
  • Develop in response to oestrogen (therefore rare before puberty).
• Different Types → intramural (within the myometrium - most common), subserosal (grow into pelvic cavity), submucosal (grow into uterine cavity), pedunculated (attached to uterine wall by a ‘stalk’).
  • Visualisation of Different Types
• Enlarge in pregancy (due to increased oestrogen) and shrink in menopause (due to decreased oestrogen).
• Affect 30% of women of reproductive age.
• Risk Factors → increasing age until menopause, early puberty, obesity, afro-carribean, FH.

Making Diagnosis

Clinical Features

• Menorrhagia → causing iron deficiency anaemia.
• Bulk-related symptoms → lower cramping abdominal pain (often during menstruation), bloating, urinary symptoms (frequency).
• Subfertility.
• O/E → ‘bulky’ uterus.

Investigations

• Diagnosis via TVUSS.
• FBC → may have iron-deficiency anaemia due to bleeding. (Correct with iron supplements - ferrous sulphate).