Causes:

1. Chromosomal abnormality: In 40% of cases, there are various types of abnormalities.
2. Polypeptide growth factors: Epidermal Insulin & transforming are the various factors.
3. A positive family history: Sometimes it is hereditary as well.

Risks:

1. The chances of risk increase in women who are obese.
2.  The risks also prevail in black women i.e. Africans or Americans.
3. It is also applicable for nulliparous women or women who have never given birth.
4. Women with PCOS or Hyper estrogenic state have a higher risk of having fibroids.

Protective factors:

1. Smoking inhibits aromatase, thus decreasing Estrogen.
2. Physical exercise.
3. Pregnancy (due to absence of ovulation).
4. Multiparity – The more the females conceive, the more is the anovulation & which is a protective factor.
5. Breastfeeding.

The use of OCP does not affect the fibroid size.

Types of Fibroid:

1. There are four types of Uterine fibroids :

• Submucosal Fibroid: It grows within the uterine cavity i.e the endometrium.
• Intramural or Interstitial Fibroid: This is the most common type & it lies within the uterus but outside the endometrial cavity i.e at the myometrium.
• Subserosal Fibroid: It lies outside the myometrium, towards the peritoneal cavity.
• Pedunculated Fibroid: A type of Subserosal fibroid which might lie inside or outside the uterus but attached to the uterine wall by a stalk-like growth Peduncle that makes it different from other fibroids.
• Broad Ligament Fibroid : 

1. There are two types of ligament fibroids :

• True broad ligament fibroid: It arises from the broad ligament & remains lateral to the uterus.
• Pseudo broad ligament fibroid: It is an SSF that grows into the broad ligament & remains medial to the uterus.

FIGO Classification: There are 8 varieties :

Submucous fibroid  Type O (completely within the cavity).

Type 1 – less than 50% in the myometrium & more than 50% in the endometrium.

Type 2 – less than 50% in the endometrium & more than 50% in the myometrium.

Type 3 – 100%. It is completely an intramural fibroid but abutting the endometrium.

Type 4 – Completely intramural without any contact with endometrium or serosa.

Type 5 – More than 50 % in the myometrium.

Type 6 – Less than 50% in the myometrium.

Type 7 – Pedunculated Subserous Fibroid.

Type 8 – Other types of fibroids like Cervical, Parasitic.

Symptoms: 

1. Most common patients are asymptomatic.
2. The most common symptom is menorrhagia.
3. In the case of submucosal fibroid, it may cause infertility, or chances of miscarriage might increase.
4. A fibroid may cause Dysmenorrhea but it can never be the chief complaint.
5. Pain in the fibroid indicates the fibroid is undergoing degeneration or torsion.

A fibroid may also cause 

• Infertility
• Miscarriage
• Pelvic pain
• Abdominal enlargement
• Sometimes a tubal blockage is due to the position of the fibroid.

Diagnosis: 

A fibroid may not be enlarged to be felt per abdomen. But if enlarged 14 weeks or more then the following features are noted:

• Palpable.
• Percussion.
• Pelvic examination

Management of Fibroid: 

Asymptomatic patients – Most of the time, it is an incidental finding.

Conditions where the asymptomatic fibroid should be removed.

Females with recurrent abortions without any cause other than a fibroid.

In case of infertility, without any cause other than a corneal fibroid or any other fibroid.

A subserous pedunculated fibroid is likely to undergo torsion.

Management of symptomatic Fibroid: 

In the case of submucosal fibroid, with heavy menstrual bleeding, it should be removed surgically.

Hysteroscopic removal in Type O & Type I fibroid.

Intramural & subserous fibroid – can be started with medical management.

Myomectomy – 

• Laparotomy in case of large SSF or intramural fibroid.
• Laparoscopic myomectomy.
• Hysteroscopic myomectomy.
• Sometimes it may be both hysteroscopic & laparoscopic myomectomy.