Uterine Disorders

what makes up the majority of the uterus by size and weight?

the uterine corpus

what are leiomyoma?

benign growths of smooth muscle class on the uterine wall "fibroids"

most common tumor of the uterine wall

who are leiomyomas more common in?

African Americans

what do s/sxs depend on with a leiomyoma?

size and location

what are main sxs of leiomyoma?

AUB, heavy menstrual bleeding, dysmenorrhea, dyspareunia with deep penetration, pelvic pressure, infertility, and recurrent pregnancy loss

what are risk factors for leiomyoma?

age, African america, 1º relative, early menarche, late menopause, obesity

what are protective factors against leiomyoma?

smoking, exercise, increased parity, late menarche, early menopause, OC use

what is leiomyoma thought to arise from?

poorly understood, but thought to arise from an alteration in a single cell

what is bulf of the fibroid due to?

expansion of the extracellular matrix

what is used to classify fibroids?

FIGO classification system

(international federation of Gynecology and Obstetrics)

classifies myomas by location

what do tx options of fibroids depend on?

vary greatly depending on the size and location of myxomas, therefore, continued efforts to improve classification modalities are vital

what are the different types of fibroids?

submucosal, intramural, subserosal, interligamentous

what is the danger of submucosal fibroids?

they create a change in the architecture of the uterine cavity

where do intramural fibroids lie and what is their danger?

lie within the myometrium

depending on their size and positioning can protrude outward to the abdominal cavity or inward which creates defects in the uterine cavity

where do subserosal myomas lie?

under the peritoneal layer covering the uterus and protrude outward to the abdominal cavity but can also alter the myometrium

where do interligamentous myomas lie?

within the broad ligament

what are parasitic or metastatic myomas?

myomas that move beyond the uterus

on gross exam, what do fibroids look like after removal?

white-grey or yellow appearance

contained within a pseudocapsule

what is the main differential for leiomyomas? why?

ovarian and colonic masses because they can mimic the appearance of uterine myomas on imaging

what do uterine related differentials of leiomyomas include?

adenomyosis, ovarian cysts, endometriosis, polyps, grossly proliferative endometrium, endometrial hyperplasia or malignancy, ovarian malignancy, or leiomyosarcoma

what are the clinical findings of leiomyomas?

they can be asymptomatic!

if symptomatic: there is notable decrease in qoL

most common presenting symptoms are AUB (abnormal uterine bleeding), HMB, pelvic pressure and pain, infertility and spontaneous abortion

what is the most common presenting complaint of myomas? which myoma is it most associated with?

AUB

pts often present with heavy or prolonged menses

most frequently seen in submucosal fibroids

fixed retroverted uterus******* endometriosis

what is myoma related pelvic pain and pressure related to?

directly related to size and location

myomas >5cm are associated with increased pain

how do myomas create pain?

- through infarction and increasing local inflammatory response ~ (local ischemia creates pain and can even present as an acute abdomen )

- they also cause increased production of cytokines, resulting in increased inflammatory response that contributes to pain ~ (especially in those with dysmenorrhea 2º fibroids)

- submucosal myomas can create HMB and clots that create worsening dysmenorrhea

what causes fibroids to mess with fertility?

structural problem

- submucosal or intramural disrupt the endometrial cavity

-cant really undertsand 15

what will physical exam findings reveal in myomas?

vary depending on size and location

- can present as distended abdomen like pt w advanced gestation