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Fibroid Fundus Uterus
had a scan still worried?
i have just been for an ultrasound scan im 6 wks pregnant because i am losing a slight brown discharge.luckily they found a heart beat and everything looks ok, but wat they did find as well was a fibroid at the fundus of the uterus. will this effect my pregnancy in any way and am i at any more risk then usall of misscarage?
Leiomyomas are benign tumors of the uterus.
Most leiomyomas occur in the fundus and body of the uterus; only 3% occur in the cervix. The fibroids may be solitary, multiple, or diffuse.
Most fibroids (95%) are intramural; they are located in the middle of the myometrium. Subserosal, or exophytic, fibroids are located in the subserosal layer and tend to cause a focal bulge in the exterior surface of the uterus. They can become pedunculated. Rarely, they occur in the broad ligament. Submucosal, or subendometrial, fibroids are the least common. They distort the overlying endometrium and can become extruded or pedunculated (ie, fibroid polyp) in the endometrial canal.
Clinical Details
Most women with fibroids are asymptomatic. Only 10-20% of patients require treatment.
Symptoms of fibroids are related to the location, size, and number of the tumors. Symptoms may include the following:
Bleeding: Menorrhagia, with an increased amount and duration of flow, is the most common symptom. Menorrhagia may result in severe anemia and can be life threatening, although this is rare. Menorrhagia usually results from the erosion of a submucosal fibroid into the endometrial cavity. Rarely, dilated veins on the surface of a subserosal pedunculated fibroid can cause sudden massive intraperitoneal bleeding.
Pain: Women may experience abdominal cramping. Pain usually is felt during menstruation. Less often, pain occurs intermenstrually.
Pressure: Urinary frequency, urgency, and/or incontinence result from pressure on the bladder. Constipation, difficult defecation, or rectal pain results from pressure on the colon. Abdominal cramping results from pressure on the small bowel. Generalized pelvic and/or lower abdominal discomfort may be present.
Other: Rare cases of secondary polycythemia, cured with hysterectomy, are reported. Infertility and/or complications of pregnancy may occur. Submucosal fibroids may affect fertility (see Mortality/Morbidity). An exophytic fibroid can twist on its pedicle, resulting in necrosis and pain.
Leiomyomas arise from the overgrowth of smooth muscle and connective tissue in the uterus. A genetic predisposition exists. Histologically, a monoclonal proliferation of smooth muscle cells occurs
Evidence of an apparent hormonal dependency includes the following:
Both estrogen and progestin receptors are present in fibroids.
Elevated estrogen levels may cause fibroid enlargement. During the first trimester of pregnancy, 15-30% of fibroids may enlarge then shrink in puerperium. Some fibroids may decrease in size during pregnancy.
Fibroids shrink after menopause. Some regrowth may occur with hormonal therapy.
Frequency United States
Leiomyoma is the most frequently diagnosed gynecologic tumor and occurs in 20-50% of women older than 30 years.
Mortality/Morbidity
Rarely, uterine leiomyoma may undergo malignant degeneration to become a sarcoma. The true incidence of malignant transformation is difficult to determine because leiomyomas are common, whereas malignant leiomyosarcomas are rare and can arise de novo. The incidence of malignant degeneration is less than 1.0% and has been estimated to be as low as 0.2%.
Infertility may occur as a result of narrowing of the isthmic portion of the fallopian tube or as a result of interference with implantation, especially inference caused by submucosal fibroids.
Complications during pregnancy include spontaneous abortion, intrauterine growth retardation, preterm labor, uterine dyskinesia or inertia during labor, obstruction of the birth canal, postpartum hemorrhage, and hydronephrosis.
Race Leiomyomas occur more commonly in black women than white women, with a black-to-white ratio of 3-9:1. A genetic predisposition exists.
