uterine fibroids. bleeding. myoma pptxjj

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1. Introduction Uterine fibroids, also known as leiomyomas or myomas, are noncancerous monoclonal tumors arising from the smooth muscle cells and fibroblasts of the myometrium Most common benign tumors of the female reproductive system More common in women aged 30-40

2. Types of uterine fibroids 3 types Fibroids contain a large quantity of extracellular matrix (fibronectin, collagen, proteoglycan) and are surrounded by a pseudocapsule of compressed areolar tissue and smooth muscle cells Variable size

3. Etiology Exact cause is not yet known; however some factors play role in the formation and growth of uterine fibroids: Genetic predisposition (genetic mutations in the MED12, HMGA2, COL4A5/COL4A6, or FH genes) Hormones: estrogen and progesterone Growth factors Angiogenesis

4. Risk factors Increased risk : African American Nulliparity Early menarche Perimenopause Family history Hypertension Diabetes obesity Alcohol Decreased risk : Multiparity Oral contraception use Smoking Exercise Diet rich in green vegetables

5. Clinical presentation Asymptomatic (in 50-60% of cases) Abnormal uterine bleeding (menorrhagia, metrorrhagia, menometrorrhagia, postcoital spotting) Iron deficiency anemia: weakness, fatigue, dizziness Pelvic and lower back pain Dysmenorrhea, dyspareunia Pressure-related symptoms: frequency and retention of urine, constipation, hydronephrosis, venous stasis Abdominal distention Infertility

6. Fibroids in pregnancy Fibroids increase the risk of: - Miscarriage Preterm labor and delivery Fetal malpresentation Intrauterine growth restriction Dysfunctional labor Antepartum and postpartum hemorrhage Cesarean delivery

7. Diagnosis Bimanual examination : nontender irregularly enlarged uterus with cobblestone protrusions that feel solid on palpation Pelvic ultrasound : well defined hypoechoic lesions Hysterosalpingogram (HSG), saline infusion sonogram, hysteroscopy MRI

8. Differential diagnosis Adenomyosis Endometriosis Endometrial polyp Pregnancy; ectopic pregnancy Leiomyosarcoma Endometrial carcinoma

9. Management For asymptomatic patients: no treatment required but follow up every 6 months Medical therapies : hormonal and nonhormonal options Non-surgical alternatives Surgical interventions indicated in case of: Abnormal uterine bleeding causing anemia Severe pelvic pain or secondary amenorrhea Uterine size >12 week Urinary frequency, retention or hydronephrosis Growth after menopause Recurrent miscarriage or infertility Rapid increase in size

10. Medical therapy Nonhormonal drugs : NSAIDs (for dysmenorrhea) and tranexamic acid (to treat heavy prolonged bleeding) Hormonal drugs: Oral contraceptive pills Progestins (medroxyprogesterone acetate, Mirena) Mifepristone Androgenic steroids (danazol and gestrinone) GnRH agonists (nafarelin acetate, leuprolide acetate depot, goserelin acetate): shrink fibroids and decrease bleeding by decreasing estrogen levels

11. Non-surgical alternatives Uterine artery embolization : To decrease blood supply to the fibroid Not recommended for large and pedunculated fibroids Not used in women who are planning to become pregnant after the procedure MRI-guided high-intensity ultrasound: - Reserved for premenopausal women who wish to retain their uterus

12. Surgical therapy Myomectomy: Reserved for patients with symptomatic fibroids who wish to preserve their fertility or who choose not to have a hysterectomy Hysterectomy with or without oophorectomy