OG29.1 | Fibroid Uterus — Summary & Reflection

KEY TAKEAWAYS

Fibroid uterus (leiomyoma) is the most common benign pelvic tumour, occurring in up to 70% of women by age 50. It is oestrogen-dependent, arising from monoclonal smooth-muscle proliferation. The FIGO subclassification (types 0–8) defines location and extent of intramural involvement, directly guiding surgical approach. Clinical presentation includes menorrhagia, pelvic pain, pressure symptoms, infertility, and a firm irregular pelvic mass moving with the cervix. Key degenerations are hyaline (most common), red/carneous (most clinically important — in pregnancy, always conservative), cystic, calcific, and sarcomatous (rare, <0.5%). Investigations include pelvic ultrasound (first-line), SIS (submucous subtype differentiation), MRI (surgical mapping), hysteroscopy (type 0–2), and full blood count (anaemia). Management is individualised: expectant (asymptomatic, near menopause), medical (GnRH-a to shrink pre-op, LNG-IUS for menorrhagia in non-cavity-distorting fibroids), or surgical (myomectomy for fertility preservation, hysterectomy for definitive cure, UAE for uterine preservation without pregnancy). Surgery is indicated for severe anaemia, size ≥12 weeks, pressure symptoms, infertility attributable to fibroids, or suspected malignancy.

REFLECT

Think of a woman you have seen (or imagine a 32-year-old with a type 2 submucous fibroid causing menorrhagia and one failed IVF cycle) — what was the decision-making process for choosing hysteroscopic myomectomy over other options? How would the decision change if she was 48 years old with the same fibroid? Reflect on the FIGO classification: how does knowing the type change the surgical approach and the counselling conversation? How would you explain the risk of sarcomatous change (and its rarity) to a patient anxious about cancer?