Clinical features

The majority are asymptomatic or are noticed by the patient as a non-tender, non-painful abdominal swelling.

Common symptoms include:

• abnormal uterine bleeding (AUB)
  • most common symptom of uterine fibroid
  • heavy menstrual bleeding
    • associated with intramural and submucous fibroids
    • may lead to iron deficiency anaemia
  • intermenstrual bleeding is unusual
• abdominal bloating, and a sense of heaviness in the lower abdomen, due to the abdominal swelling
• pelvic pressure symptoms
  • urinary frequency, urgency
  • urinary incontinence
  • difficulty with urination
  • hydronephrosis
  • constipation
  • tenesmus
• pelvic pain
  • is not generally a feature
  • severe pain may occur during red degeneration, especially during pregnancy, or with torsion of a pedunculated subserous fibroid
  • colicky pain may occur from extrusion of a subserous fibroid through the cervix.
• infertility - submucous tumours may interfere with implantation of the blastocyst, or cause early abortion
• dystocia - tumours in the lower uterine segment may obstruct labour (1,2,3)

Signs:

• very large fibroids may be palpated abdominally
• vaginal examination usually reveals - a firm, irregularly enlarged uterus that is non-tender; an exception is one undergoing red degeneration which may be very tender
• consistency is variable - from rock hard in the calcified postmenopausal fibroid, to soft, even to cystic if degenerative changes have occurred
• most fibroids move with the cervix - except if subserous, detached and parasitic
• bruits may be heard during auscultation of large tumours; they are similar to the uterine souffle of pregnancy

Reference:

• (1) Lumsden MA et al. Fibroids: diagnosis and management. BMJ. 2015;351:h4887
• (2) Khan AT, Shehmar M, Gupta JK.Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95-114.
• (3) Vilos GA et al.The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157-81.