FFinalistSouthampton · 2027
Obstetrics & gynaecology
AKT · Obstetrics & gynaecology/Menstrual & benign gynae

Fibroids

Benign uterine smooth-muscle (leiomyoma); oestrogen-dependent

Overview

Benign oestrogen-dependent smooth-muscle tumours of the uterus — the commonest pelvic tumour in women, more common in Black women. Cause heavy menstrual bleeding, bulk symptoms and subfertility; regress after menopause.

Recognise

  • Heavy/prolonged menstrual bleeding (often with iron-deficiency anaemia)
  • Bulk: pelvic pressure, urinary frequency, abdominal distension
  • Subfertility, recurrent miscarriage; enlarged firm "bulky" non-tender uterus
  • Red degeneration in pregnancy (acute pain)

Red flags

  • Rapid growth or postmenopausal growth → consider (rare) leiomyosarcoma

Differentials & how to tell them apart

Adenomyosisdiffusely enlarged tender "boggy" uterus, dysmenorrhoea, MRI distinguishes
Ovarian massseparate from uterus on USS
Endometrial/cervical cancerpostmenopausal/intermenstrual bleeding, biopsy
PregnancyβhCG

Investigations

Pelvic USS (transvaginal/abdominal) is first-line imaging; FBC for anaemia. Hysteroscopy for submucosal fibroids.

Management

Levonorgestrel IUS (if cavity not distorted) for heavy bleeding

  1. 1Heavy bleeding, fibroids <3 cm, no cavity distortion: levonorgestrel IUS first-line; tranexamic acid/NSAID or COCP as alternatives.Gate: IUS is unsuitable if the fibroid distorts the uterine cavity → use other medical/surgical options
  2. 2Larger/symptomatic: GnRH analogue (shrink pre-op), uterine artery embolisation, myomectomy (fertility-preserving) or hysterectomy.
Levonorgestrel IUS (Mirena) — first-line for bleeding if uterine cavity not distorted
Tranexamic acid / NSAID — non-hormonal bleeding control
GnRH analogues — shrink fibroids pre-op (short-term, add-back HRT)

Key points

Red degeneration: acute pain in a pregnant woman with fibroids (the fibroid outgrows its supply). GnRH analogues are short-term (bone loss) with add-back HRT.

Monitor & prognosis

Symptoms, anaemia, size on USS.

Benign; regress after menopause.

Source: NICE CKS Fibroids / Heavy menstrual bleeding (NG88)