Fibroid uterus

Fibroid uterus are benign tumors that originate in the uterus with the some smooth muscle fibres of the uterus Wall,but they are much denser than normal myometrium.Uterus fibroid are usually round.

Fibroid are the most benign solid tumors in females.

It is the most common pelvic tumors.

Most common age groups affected is 35 to 45 years.

Fibroid are most commonly seen in nulliparity female.

Structural of fibroid-

1)Fibroid is well circumscribed tumors with a pseudocapsule which is formed by compressed adjacent myometrium.

2)The blood vessels supplying the fibroid lie in the capsule and run radially so that the centre is the least vascular and peripheral is the most vascular part of the fibroid.

3)Calcification begin from the peripheral of fibroid and degeneration begin from the centre.

4)Most fibroid are slow growing.

Cause and incidence of uterine fibroid--

1)Fibroid are monoclonal tumors.

2)Genetics abnormalities

3)Alternation in growth factor

4)Abnormalities in the vascular system.

5)Tissue response to injure.

Family history.

6)Associated cause- particularly beer, uterine infection, elevated blood pressure

7)Fibroid are related to oestrogen predominantly.

8)Risk of fibroid increase as obesity increase.

Symptoms-

1)Most of the time,it is asymptomatic-75%

2)Aub-menorrhagia,or metrorrhagia

Dysmenorrhoea

3)Iron deficiency anaemia

4)Fibroid can also cause a number of symptoms depending on their size, location within the uterus and how close they are to adjacent pelvic organ.large fibroid can cause:

    1)Pelvic pain, including pain during coitus.

   2) Pressure on the bladder with frequent or even osbtructed urination.

   3) Pressure on the rectum with painful or difficult defecation.

During pregnancy,they may also be the cause of miscarriage, bleeding, premature labour, interference with the position of the fetus,IUGR.

5)Infertility 3%cases

6)Abdominal swelling.

Sign-

1)Pallor depending upon menstrual blood loss per abdominal examination.

2)If fibroid is large enough to feel per abdominal following features are noted:

   1)Firm feeling,may be cystic degeneration.

  2) Margin are well-define except the lower pole.

3) Surface is nodular.

Diagnosis-

PELVIC EXAMINATION

USG

MRI AND CT SCAN

HSG

Differential diagnosis-

Pregnancy

Adenomyosis

Ovarian tumor

Full bladder

Myohyperplasia

Tubo-ovarian mass

Treatment-

Medical treatment;

 NSAIDS

OCP

Iron supplements

Levonorgestrel intrauterine device

Cabergoline-shrink fibroid effectively

Danazol

GnRH analogue

Progesterone antagonist-mifepristone

Aromatase inhibitors-reduce fibroid

Surgical treatment;