clinical features
Last reviewed 10/2022
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
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