# Fibroid Uterus

> NEET-PG OBG notes on fibroid uterus covering types, degeneration, presentation, imaging and treatment options with exam points.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/fibroid-uterus
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Fibroid Uterus", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/fibroid-uterus

## Direct answer

Uterine leiomyomas (fibroids) are benign monoclonal smooth-muscle tumours — the commonest benign tumours of the uterus — that grow under oestrogen influence and shrink after menopause. Many are silent, but they commonly present with heavy or prolonged menstrual bleeding, pressure symptoms, or infertility and recurrent miscarriage when a submucous fibroid distorts the cavity. Treatment spans observation, medical suppression, myomectomy and hysterectomy.

## What you must remember

- Types by position — intramural (commonest), submucous (most symptomatic, causing abnormal bleeding, infertility and miscarriage), subserosal (which may be pedunculated) and cervical.
- In the PALM-COEIN classification of abnormal uterine bleeding, fibroids form the L of the structural causes — polyp, adenomyosis, leiomyoma, malignancy.
- Degenerations — hyaline (commonest), cystic, fatty, calcific in older women, red or carneous in pregnancy (acute painful infarction), and rarely sarcomatous change.
- Fibroids are enclosed in a pseudocapsule of compressed myometrium, which allows enucleation at myomectomy; torsion of a pedunculated subserosal fibroid causes acute abdomen.
- Diagnosis — transvaginal ultrasound is first line; saline infusion sonography and hysteroscopy assess submucous lesions; MRI best maps multiple or complex fibroids before surgery.
- Management — asymptomatic fibroids are observed; medical options include tranexamic acid, the levonorgestrel intrauterine system for cycle control, and GnRH agonists which shrink fibroids for about three to six months (used pre-operatively, with hypo-oestrogenic side effects and regrowth on stopping).
- Surgery — hysteroscopic resection for submucous fibroids, myomectomy to preserve fertility, and hysterectomy as the definitive treatment when the family is complete; uterine artery embolisation suits selected women. Rapid enlargement after menopause should raise suspicion of rare sarcomatous change.

## Common confusion

Fibroids and adenomyosis present with similar heavy bleeding and are frequently interchanged. Fibroids are discrete, capsulated masses that enlarge the uterus asymmetrically and are palpable as knobbed enlargement; adenomyosis is a diffuse, globular, often tender uterus with dysmenorrhoea and myometrial cysticity on ultrasound. Red degeneration in pregnancy is another trap — it presents with acute pain, tenderness and low-grade fever, mimicking torsion or appendicitis, and is managed conservatively.

## Exam-focused takeaway

Type-versus-symptom matching is the standard stem — submucous with bleeding and infertility, subserosal with pressure or a palpable mass. Degeneration one-liners (hyaline commonest, red in pregnancy, calcific postmenopausal) recur, as does the PALM-COEIN "L" and the choice between myomectomy and hysterectomy based on fertility wishes.

## Frequently asked questions

### Which fibroids cause the most symptoms?

Submucous fibroids, because they distort the endometrial cavity — producing heavy or prolonged menstrual bleeding, infertility and pregnancy loss, often even when small.

### What is red degeneration?

Acute ischaemic infarction of a fibroid, typically in pregnancy, causing sudden pain, tenderness and mild fever. It is managed conservatively with analgesia, and usually settles.

### How are fibroids investigated?

Transvaginal ultrasound is the first-line imaging test. Hysteroscopy or saline infusion sonography evaluates submucous fibroids, and MRI maps complex or multiple fibroids before surgery.

### When is myomectomy preferred over hysterectomy?

When the woman desires fertility or wishes to retain the uterus — understanding that fibroids can recur. Hysterectomy is definitive for women with severe symptoms who have completed their family.

### Do fibroids turn cancerous?

Malignant transformation into leiomyosarcoma is rare. Rapid growth, postmenopausal enlargement or bleeding warrants careful evaluation to exclude it.