1. Fibromyomas of the uterus
Dr. Madhavi Karki

2. Synonyms : Leiomyomas, fibroids or simply myomas
Benign Neoplasm
Synonyms : Leiomyomas, fibroids or simply myomas
Commonly encountered in gynecological practice in the reproductive age group females

3. Hyper-estrogenic states : pregnancy pill users
Etiology
Age : years
Parity : Nulliparous
Race: Blacks
Hyper-estrogenic states : pregnancy pill users

4. Pathology
Microscopic features:-It is composed of muscle tissue although there is a variable amount of fibrous connective tissue.
Naked eye examination:-Myomas are frequently multiple and as many as 200 may be found in one uterus. More often the number is between 5-10.

5. TYPES OF FIBROID Intramural Fibroid Subserous Submucous
The tumor remains within the myometrial wall
Subserous
If the tumor grows outwards into the peritoneal cavity
Submucous
Uterine contractions can force the myoma towards the cavity where it is covered by a thin endometrium

7. Secondary Changes
Atrophy
Degenerations
Sarcomatous changes

8. Other complications of myomas
Torsion
Inversion
Infection
Endometrial carcinoma

9. Symptoms Menstrual disorders Infertility Asymptomatic (50%)
Pain
Pressure symptoms
Asymptomatic (50%)

10. Percussion:-The swelling is dull on percussion.
Signs
Abdominal examination: If the tumor is larger than 14 wks, it can be felt per abdomen
Percussion:-The swelling is dull on percussion.
Pelvic examination-Bimanual examination reveals, uterus is irregularly enlarged. Fornices will be felt free. The cervix moves with the movement of the tumor felt per abdomen.

11. Hemoglobin, blood grouping Hysterosalpingography
INVESTIGATIONS
Hemoglobin, blood grouping
USG
Hysterosalpingography
Hysteroscopy
Uterine curettage
Laparoscopy
MRI

12. Treatment
Small and asymptomatic cases do not require removal. They can be observed every 6 months.
Indications of treatment are :
Infertility and habitual abortion
Symptomatic fibroids : menorrhagia and pressure symptoms
Rapid growth in a menopausal women
When the nature of the tumor cannot be ascertained clinically then laparotomy is required.

13. MINIMALLY INVASIVE SURGERY
TREATMENT
MEDICAL
MINIMALLY INVASIVE SURGERY
SURGERY