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UTERINE FIBROIDS (LEIOMYOMAS) - Coggle Diagram
UTERINE FIBROIDS (LEIOMYOMAS)
Definition
Benign smooth muscle tumors of the uterus arising from the myometrium.
DIAGNOSIS
Clinical examination: enlarged, irregular uterus
Ultrasound (USG): well-defined hypoechoic mass
MRI: to assess number, size, location
Hysteroscopy / Sonohysterography: for submucosal fibroids
CBC: check for anemia
ETIOLOGY / RISK FACTORS
Hormonal factors (↑ Estrogen & Progesterone)
Genetic predisposition (family history, MED12 mutation)
African descent
Nulliparity
Early menarche, late menopause
Obesity
PATHOPHYSIOLOGY
Arise from monoclonal proliferation of smooth muscle cell
Excessive extracellular matrix (ECM) deposition → firm consistency
Growth influenced by sex hormones and growth factors (TGF-β, IGF, EGF)
CLASSIFICATION
Intramural – within myometrium (most common)
Submucosal – beneath endometrium → affects menstrual flow & fertility
Subserosal – beneath serosa → may project outward, become pedunculated
Cervical – arise from cervix
COMPLICATION
Anemia (from heavy bleeding)
Infertility
Degeneration (red, hyaline, cystic, calcific)
Torsion (of pedunculated fibroid)
Rare malignant transformation → Leiomyosarcoma (<1%)
CLINICAL FEATURES
Menorrhagia, metrorrhagia
Urinary frequency, constipation
Due to degeneration, torsion (in pedunculated types)
Infertility, recurrent pregnancy loss, preterm labor
Asymptomatic in many cases
MANAGEMENT
Observation if asymptomatic
GnRH agonists (reduce size temporarily)
Selective progesterone receptor modulators (e.g., ulipristal)
NSAIDs for pain
Myomectomy (for fertility preservation)
Hysterectomy (definitive, for completed family)