Uterine Fibroids (Leiomyomas): Pathogenesis and clinical findings
Early Menarche (onset of period)
↑ estrogen exposure in
Obesity
↑ adipose tissue
↑ conversion of androgens into estrogen
Ethnicity (African)
↑ amount of aromatase enzymes
Family History
Complex chromosomal rearrangements
Myometrial Injury
Hypoxia of myometrial cells
Low Parity
Lack of protective pregnancy-induced remodeling to myometrium
Note:
Approximately three-quarters of women have fibroids. Of these, only about one-quarter become symptomatic. Fibroids generally decrease in size after menopause and symptoms improve.
Intracavitary
Fibroid projects into uterine cavity
↑ Endometrial Surface Area ↑ endometrium to proliferate and
lose during menstruation
Age 40-50
lifetime Estrogen stimulates proliferation of uterine smooth muscle cells
Benign proliferation of monoclonal myometrial (uterine wall/muscle) cells into discrete masses
Uterine Fibroids (Leiomyomas)
Benign tumours originating in and consisting of uterine muscle tissue
Fibroids can be located in different areas of the uterus, including the following locations
Authors: Emilee Anderson Reviewers: Danielle Chang Crystal Liu Yan Yu* Aysah Amath* * MD at time of publication
Subserosal
Fibroid grows adjacent to perimetrium into uterine muscle
Enlarged uterus or pelvic mass on bimanual exam
Irregularities in uterine cavity
Transformation of normal myocytes into abnormal myocytes
Submucosal
Fibroid grows adjacent to endometrium into uterine muscle
Intramural
Fibroid is within the thickness of the myometrium
Pedunculated
Fibroid extends into pelvic cavity or uterine cavity on a stalk
Spherical mass on ultrasound
Fibroid ↑ intra-abdominal pressure and puts pressure on adjacent organs
Enlarged Uterine/Pelvic Mass
Repeat shedding over time
Iron Deficiency Anemia
Pelvic Pain
Compression of stomach
Fibroid takes up space
Enlarged Abdomen
Fibroid puts pressure on the cervix
Dyspareunia
Fibroid compress the bladder
Urinary incontinence
Fibroid compress the bladder outlet
Difficulty with voiding
Fibroid compress rectum
Constipation
Embryo cannot implant
Infertility and/or recurrent pregnancy loss
Menorrhagia Dysmenorrhea
Sensation of abdominal fullness
Early Satiety
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published November 5, 2020 on www.thecalgaryguide.com