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What is Uterine fibroid? Definition | Cause | Types | Symptoms | Diagnosis | Treatment

Definition :

 It is benign of tumour or growth arising from the muscular layer of the uterus with intervening fibrous tissue.

 Cause :

Age : 
  • Seen after menarche to menopause.
  • Average - 30 to 35 years.
  • Rare - before puberty and after menopause.
Hereditary :
  • History of tumour in the family. 
Parity :
  • Common in nulliparous.
Mechanical stress :
  • Fibromsculor reaction of the uterus to mechanical stress. 
Ovarian function :
  • Not clear but the oestrogen is responsible for the growth of fibroid so during pregnancy fibroid increase in size and reduces after menopause. 
OCP ( Oral Contraceptive Pills )

Types of fibroid : 

 Uterine fibroid :

1. Corporeal fibroid :
  • Interstitial 
  • Subserous 
  • Submucous 
2. Cervical fibroid :

Interstitial or Intramural fibroid :
  • Growth of fibroid in myometrium may push itself to form submucous or subserous.
  • Commonest variety.
  • A posterior wall more affected than the arterial wall.
Subserous fibroid :
  • Growth below the peritoneal layer and away from the cavity. 
  • It may get attached to an abdominal organ and get blood supply from there and so detaching itself from myometrium and now it is called as wondering or parasitic fibroid. 
  • If wondering fibroid may produce in a layer of the broad ligament. It is known as ligament fibroid. 
Submucous fibroid :
  • It growing below a submucous layer of the uterus and protruding inside the uterine cavity may go to form submucous polyp with its direction towards internal os. 
Pathology :
  • Naked eye: Rarely single, frequently multiple.
  • Microscopic: Spindle shape muscle tissue, between fibrous connective tissue.
Symptoms :
  • It is mostly symptomless.
Commonest and progressive with the passage of clots due to :
  • Increase the endometrial surface.
  • Increase vascularity.
  • Haemostasis.
  • Endometrial hyperplasia.
  • Duration of period normal or prolonged.
  • Loss of blood is heaviest on 2nd and 3rd menses. 
Congestive and spasmodic dysmenorrhoea :
  • Per vaginal examination: White discharge seen in surface ulceration of submucosa and usually polypoid tumour.
  • Metrorrhagia.
Sensation as if lump and weight at the lower abdomen.

 Pressure symptoms which are very rarely seen and they are the following :
  • GIT dyspepsia. 
  • On bladder: Causing irritability with frequent urination.
  • On vein and lymphatics: It leads to oedema and varicosity. 
  • On nerve: Feel the pain.
Symptom related to pregnancy : 
  • Subfertility either is the cause or effect of fibroid.
  • Abortion or premature delivery by interfering growing embryo and initially of contracting. 
  • Malpresentation and malposition.
  • Obstructed labour. 
  • It will be predisposed to 3rd stage difficulty and PPH also can cause delayed involution. 
Signs :

General Examination :
  • Pallor in case of excessive bleeding.
Per abdominal Examination :
  • A firm lump is palpated arising out of the pelvis, the surface may be smooth or tubular.
  • Restricted mobility from above downward. 
  • Percussion: Dull sound.
Diagnosis : 
  • Pelvic examination.
  • Laparotomy confirms the diagnosis. 
  • Pelvic USG when clinically is not diagnosed or identified. 
  • Lab test: Pap smear of cervical epithelial. 
  • IVP: Uterine curettage. 
Differential diagnosis :
  • Adenomyosis.  
  • Pregnancy. 
  • Full bladder.
  • Ovarian tumour.
  • Broad ligament cyst or tumour. 
  • Tubo-ovarian mass.
Treatment :
  • No medicine for symptomless fibroid but it is required when its size increased from 10 to 12 cm.  
  • In woman, at the age of menopause as there is a cessation of oestrogen and fibroid will itself disappear.
Palliative Surgery :
  • Hormonal therapy.
  • Bed rest.
  • Blood transfusion in severe case.
  • Uterine artery embolism through femoral artery by intra-arterial catheter and polyvinyl alcohol particles are injected to block artery and degeneration of fibroid to avoid degeneration.
Surgical Treatment : 
  • Myomectomy.
  • Hysterectomy. 
  • Endoscopic resection.
  • Polypectomy. 
Complication :
  • Torsion of subserous fibroid.
  • Sarcoma 
  • Haemorrhage - Intracapsular and Intraperitoneal
Secondary changes :
  • Degeneration: Red, Hyaline, Cystic, Fatty, Calcareous. 
  • Atrophy.
  • Necrosis.
  • Infection.
  • Vascular change.
  • Sarcomatous change.
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