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.

You can also check it out :

Homeopathic medicine for uterine fibroid