1. FIBROID UTERUS (UTERINE LEIOMYOMA)
Fibroid uterus is the most common benign
tumor of the uterus and the most common solid benign tumor in females. It is a smooth muscle tumor composed of fibrous connective tissue and is also called leiomyoma, myoma,
or fibromyoma.
Etiopathogenesis
- Unknown (Idiopathic) Causes
- Chromosomal Abnormalities – Involvement of chromosomes 6, 7, and 12
- Growth Factors
- Epidermal Growth Factor
(EGF)
- Insulin-like Growth Factor
(IGF)
- Platelet-derived Growth
Factor (PDGF)
- Hormonal Dependence
- Estrogen and Progesterone
sensitive
- Increase in size during
pregnancy
- Regression after menopause
- Risk Factors
- Nulliparity
- Hyperestrogenic state
- African descent
- Smoking
Types
of Fibroids (Based on Location)
1.
Intramural Fibroid – Located within the myometrium
2.
Subserosal Fibroid – Located beneath the peritoneal
surface
3.
Submucosal Fibroid – Protrudes into the endometrial
cavity
4.
Cervical Fibroid – Located in the cervix
5.
Broad Ligament Fibroid – Extrauterine extension of fibroid
Clinical
Features
- Asymptomatic in many cases
(15%)
- Menstrual Abnormalities:
- Menorrhagia (Heavy menstrual bleeding)
- Metrorrhagia (Irregular bleeding)
- Dysmenorrhea (Painful menstruation)
- Pressure Symptoms
- Bladder compression → Increased
urinary frequency, retention
- Rectal compression → Constipation
- Infertility and Pregnancy
Complications
- Recurrent miscarriage
- Preterm labor
- Postpartum hemorrhage
Diagnosis
- Clinical Examination – Enlarged, firm, irregular uterus
- Ultrasound (USG) – First-line imaging
- MRI – To differentiate from adenomyosis
- Hysteroscopy – For submucosal fibroids
- Hysterosalpingography (HSG) – To assess tubal involvement
Complications
- Degeneration
- Hyaline degeneration (Most common)
- Cystic degeneration
- Calcific degeneration
- Red degeneration (Occurs in
pregnancy)
- Sarcomatous changes (Rare,
<1%)
- Torsion of pedunculated
fibroids
- Infection & Ulceration
Treatment
Medical Management
- NSAIDs (for pain relief)
- Tranexamic Acid (for heavy
bleeding)
- Hormonal Therapy
- GnRH Analogues – Reduce fibroid size
- Progesterone Therapy (DMPA,
Mirena IUD)
Surgical Management
- Myomectomy – Fertility-preserving surgery
- Hysterectomy – Definitive treatment for large
fibroids
- Uterine Artery Embolization
(UAE) –
Minimally invasive procedure
2. ENDOMETRIAL POLYP
An endometrial polyp is a localized overgrowth of
endometrial tissue, which may
cause abnormal bleeding.
Clinical
Features
- Intermenstrual bleeding
- Postmenopausal bleeding
- Heavy menstrual bleeding
(Menorrhagia)
Diagnosis
- Ultrasound (USG)
- Saline Infusion Sonography
(SIS)
- Hysteroscopy with biopsy
Treatment
- Hysteroscopic polypectomy
3. ADENOMYOSIS
Adenomyosis is a benign condition
where endometrial glands and stroma are present within the myometrium.
Pathophysiology
- Endometrial invasion into
myometrium →
Leads to uterine enlargement
- Myometrial hypertrophy due to chronic inflammation
Clinical
Features
- Heavy menstrual bleeding
(Menorrhagia)
- Severe dysmenorrhea (painful
menstruation)
- Enlarged, tender uterus on
examination
Diagnosis
- Transvaginal Ultrasound (TVUS)
- MRI (Gold standard for
adenomyosis diagnosis)
Treatment
- Medical Management
- NSAIDs & Tranexamic
Acid
- Hormonal Therapy (OCPs,
GnRH Analogues, Mirena IUD)
- Surgical Management
- Hysterectomy (Definitive
treatment)
Keynote Symptoms of Benign Uterine Lesions
1.
Abnormal uterine bleeding (Heavy,
prolonged, or irregular menstruation)
2.
Pelvic pain or pressure symptoms
due to enlarged fibroids or polyps
3.
Frequent urination or
constipation from pressure on the bladder or rectum
4.
Infertility or recurrent
miscarriages due to structural abnormalities
5.
Leucorrhea (profuse, thick, or
offensive vaginal discharge)
1. Calcarea Carbonica
Indications:
- Uterine fibroids with
excessive weight gain and cold sensitivity
- Prolonged, heavy bleeding
with exhaustion
Keynote Symptoms:
- Menses too early, too profuse, and last too long.
- Weakness, sweat on the head, and cold feet.
- Craving for eggs and indigestible things.
- Anxiety about health and future.
- Worse from cold, damp weather.
2. Fraxinus Americana
Indications:
- Enlarged uterus due to fibroids
or prolapse
- Chronic leucorrhea with
uterine heaviness
Keynote Symptoms:
- Enlarged uterus with bearing-down pain.
- Heavy menstrual bleeding with clots.
- Weakness and bloating sensation.
- Painful urination due to pressure on the bladder.
- Worse from overexertion and lifting.
3. Sabina
Indications:
- Fibroids or polyps with
excessive bright red menstrual bleeding
- Recurrent miscarriages due
to uterine pathology
Keynote Symptoms:
- Pain extends from the sacrum to the pubis.
- Bleeding worsens with movement.
- Large, dark clots with severe cramps.
- Worse from warmth and exertion.
- Strong bearing-down sensation in the uterus.
4. Thuja Occidentalis
Indications:
- Uterine polyps, cysts, or
warty growths in the cervix
- Profuse vaginal discharge
with offensive odor
Keynote Symptoms:
- Profuse, greenish, or offensive leucorrhea.
- Uterine growths that worsen with damp weather.
- Sensation of something alive moving in the
abdomen.
- Worse from cold air and at night.
- Better in dry, warm weather.
5. Ustilago Maydis
Indications:
- Uterine fibroids with
persistent spotting between cycles
- Menorrhagia with dark,
stringy clots
Keynote Symptoms:
- Dark, tarry blood with offensive odor.
- Bleeding with persistent dull pelvic pain.
- Clots resembling black threads.
- Weakness and anemia from blood loss.
- Worse from standing and exertion.
