Clinical Presentation of Uterine Fibroids

Abstract

Uterine fibroids are common benign tumours that occur in women of reproductive age. Over half appear to be asymptomatic although it is not clear why some are associated with symptoms and others not. In some instances it may be related to their position in the myometrium and it is assumed that those that distort the uterine cavity are more likely to be associated with menstrual disorder and sub-fertility than those that are intra-mural or sub-serosal although this is certainly not always the case. Fibroids are frequently associated with symptoms that impact on quality of life and require treatment although symptom severity does vary from one woman to another. Women with fibroids commonly present with menstrual problems, particularly heavy menstrual bleeding. Since the bleeding can be extremely heavy, anaemia can also occur. Intracavity lesions can also lead to unscheduled bleeding. Not all women present with menstrual problems, some have symptoms related purely to the size. This includes abdominal swelling or discomfort, hydronephrosis and other urinary symptoms. A pelvic mass may also be an incidental finding when imaging is performed for another reason. The relationship of fibroids with fertility is uncertain. Data from assisted conception suggest that implantation is affected by sub-mucosal fibroids and possibly intra-mural. They may also increase the risk of miscarriage and problems during later pregnancy. However, fibroids are commoner in older women in whom fertilisation rates and the likelihood of a successful pregnancy will already have decreased. Erroneous conclusions can also be drawn from case studies where successful pregnancy occurs after the fibroids have been treated, e.g. by myomectomy or uterine artery embolisation. Fibroids are an increasing problem since women are delaying pregnancy until their 30s and 40s. Consequently it is incumbent on us to continue to try and identify the cause of the clinical symptoms and develop means of preventing fibroid development.