Uterine leiomyoma


  • Benign, smooth muscle tumors of the uterus

  • Location:

    • intramural - 70%

    • subserous - 10%

    • submucosal - 10%

Risk Factors

Differential diagnosis

      • ovarian tumours:

        • ovarian cysts - cystic, rarely cause menstrual disturbance, and grow more rapidly

        • ovarian fibroma - often with ascites as Meig's syndrome

        • ovarian carcinoma - usually irregular

      • tubo-ovarian inflammatory mass - uterus not enlarged, mass tender, blood tests usually show leucocytosis, raised ESR

      • pregnancy - associated amenorrhoea, uterus soft, foetus detectable by ultrasound from 7th week onwards

      • uterine endometriosis - uterus only slightly enlarged, usually dysmenorrhoea

      • diverticular disease - identifiable by barium enema

      • colonic carcinoma - identifiable by sigmoidoscopy


    • Three times more common in black females, and occur at an earlier age


  • Minimal malignant potential but may grow to enormous size

  • Oestrogen dependent

  • Affect 20% of women by age 40

  • Occur with increased frequency in conjunction with endometrial hyperplasia and granulosa cell tumours of the ovary

Clinical features

    • Bloating

  • menorrhagia

  • urinary frequency/retention

  • infertility

  • dystocia



    • very large fibroids may be palpated abdominally

  • vaginal examination usually reveals a firm, irregularly enlarged uterus that is non-tender; an exception is one undergoing red degeneration which may be very tender

  • most fibroids move with the cervix - except if subserous, detached and parasitic


a) conservative

    • Majority are asymptomatic and do not require treatment

b) medical

c) surgical

    • Surgical intervention is indicated if:

      • there is heavy or prolonged bleeding

      • the tumour is large, even if asymptomatic; in young women, it will continue to grow; following the menopause, it may undergo complications

      • there is urinary symptoms

      • the tumour has undergone torsion

      • the tumour threatens to obstruct labour