The Cervical Fibroid

  • Grace LiuEmail author


A 37-year-old G0P0 patient with a cervical fibroid presents with dysfunctional uterine bleeding and anemia. She notes that over the course of the past one and a half years, her periods, while still regular, have slowly increased in amount. Her cycles are 33 days in length, and last for a total of 5 days. Days one to three are heavy, and she will change both a super tampon and overnight pad every 2 h on these days. She is otherwise completely healthy. She has no preexisting conditions and has not had any previous surgeries. She is on no medications and has no known drug allergies. Her last pap smear was 2 years ago and was normal. She has never had any history of abnormal pap smears or sexually transmitted infections. There is no family history of breast, ovarian, or colon cancer.

Supplementary material

Video S1

(MOV 277054 kb)


  1. 1.
    Shen Y, Xu Q, Xu J, Ren ML, Cai YL. Environmental exposure and risk of uterine leiomyoma: an epidemiologic surgery. Eur Rev Med Pharmacol Sci. 2013;17(23):3249–56.PubMedGoogle Scholar
  2. 2.
    Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of uterine myomas: a review. Int J Fertil Steril. 2016;9(4):424–35.PubMedGoogle Scholar
  3. 3.
    Shen Y, Wu Y, Lu Q, Ren M. Vegetarian diet and reduced uterine fibroids risk: a case-control study in Nanjing. China J Obstet Gynaecol Res. 2016;42(1):87–94. doi: 10.1111/jog. 12834.CrossRefPubMedGoogle Scholar
  4. 4.
    Parazzini F, Di Martino M, Candiani M, Vigano P. Nutr Cancer. 2015;67(4):569–79. doi: 10.1080/01635581.2015.1015746.CrossRefPubMedGoogle Scholar
  5. 5.
    Ylikorkala O, Pekonen F. Obstet Gynecol. 1986;68(1):10–2.PubMedGoogle Scholar
  6. 6.
    Lethaby A, Duckitt K, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013;(1):CD000400. doi: 10.1002/14651858.CD000400. PII: S1521-6934(15)00230-8.
  7. 7.
    Kashani BN, Centini G, Morelli SS, Weiss G, Petraglia F. Role of medical management for uterine leiomyomas. Best Pract Res Clin Obstet Gynaecol. 2016;34:85–103. doi: 10.1016/j.bpobgyn.2015.11.016.CrossRefPubMedGoogle Scholar
  8. 8.
    Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016;214(1):31–44. doi: 10.1016/j.ajog.2015.07.044.CrossRefPubMedGoogle Scholar
  9. 9.
    Peitsidis P, Koukoulomati A. Tranexamic acid for the management of uterine fibroid tumors: a systematic review of the current evidence. World J Clin Cases. 2014;2(12):893–8. doi: 10.12998/wjcc.v2.i12.893.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sangkomkamhang US, Lumbiganon P, Laopaiboon M, Mol BW. Progestogens or progestogen-releasing intrauterine systems for uterine fibroids. Cochrane Database Syst Rev. 2013;(2):CD008994. doi: 10.1002/14651858.CD008994.
  11. 11.
    Moroni RM, Martins WP, Ferriani RA, Vieira CS, Nastri CO, Candido Dos Reis FJ, Brito LG. Add-back therapy with GnRH analogues for uterine fibroids. Cochrane Database Syst Rev. 2015;(3):CD010854. doi: 10.1002/14651858. CD010854.
  12. 12.
    Gurusamy KS, Vaughan J, Fraser IS, Best LMJ, Richards T. Medical therapies for uterine fibroids—a systematic review and network meta-analysis of randomized controlled trials. PLoS ONE. 11(2):e0149631. doi: 10.1371/journal.pone.0149631.
  13. 13.
    Arendas K, Leyland NA. Use of ulipristal acetate for the management of fibroid-related acute abnormal uterine bleeding. J Obstet Gyneaecol Can. 2016;38(1):80–3. doi: 10.1016/j.jogc.2015.11.005.CrossRefGoogle Scholar
  14. 14.
    Donnez J, Tatarchuk TF, Bouchard P, Pascasiu L, Zakharenko NF, Ivanova T, Ugocsai G, Mara M, Jilla MP, Bestel E, Terrill P, Osterloh I, Loumaye E, PEARL 1 Study Group. Ulipristal acetate versus placebo for fibroid treatment before surgery. New Engl J Med. 2012;366(2):409–20. doi: 10.1056/NEJMoa1103182.CrossRefPubMedGoogle Scholar
  15. 15.
    Donnez J, Tomaszewski J, Vazquez F, Bouchard P, Lemieszczuk B, Baro F, Nouri K, Selvaggi L, Sodowski K, Bestel E, Terrill P, Osterloh I, Loumaye E, PEARL II Study Group. N Engl J Med. 2012;366(5):421–32. doi: 10.1056/NEJMoa1103180.CrossRefPubMedGoogle Scholar
  16. 16.
    Czuczwar P, Wozniak S, Szkodziak P, Wozniakowska E, Paszkowki M, Wrona W, Milart P, Paszkowski T, Popajewki M. Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease. Prz Menopauzalny. 2014;13(4):247–52. doi: 10.5114/pm.2014.45001.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Firouznia K, Ghanaati H, Sanaati M, Jalali AH, Shakiba M. Uterine artery embolization in 101 cases of uterine fibroids: do size, location, and number of fibroids affect therapeutic success and complications? Cardiovasc Intervent Radiol. 2008;31(3):521–6. doi: 10.1007/s00270–007-9288-y.CrossRefPubMedGoogle Scholar
  18. 18.
    Wang X, Zhang Z, Pan J, Zhang W. Effects of embolic agents with different particle sizes on interventional treatment of uterine fibroids. Pak J Med Sci. 2015;31(6):1490–5. doi: 10.12669/pjms.316.7955.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kaump GR, Spies JB. The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol. 2013;24(4):459–67. doi: 10.1016/j.jvir.2012.12.002.CrossRefPubMedGoogle Scholar
  20. 20.
    Tropeano G, Di Stasi C, Litwicka K, Romano D, Draisci G, Mancuso S. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil Steril. 2004;81(4):1055–61.CrossRefPubMedGoogle Scholar
  21. 21.
    McLucas B, Danzer H, Wambach C, Lee C. Ovarian reserve following uterine artery embolization in women in reproductive age: a preliminary report. Minim Invasive Ther Allied Technol. 2013;22(1):45–9. doi: 10.3109/13645706.2012.743918.CrossRefPubMedGoogle Scholar
  22. 22.
    McLucas B, Voorhees WD, Chua KJ. Anti Mullerian hormone levels before and after uterine artery embolization: a preliminary report. Minim Invasive Ther Allied Technol. 2015;24(4):242–5. doi: 10.3109/13645706.2015.1012084.CrossRefPubMedGoogle Scholar
  23. 23.
    Arthur R, Kachura J, Liu G, Chan C, Shapiro H. Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve. J Obstet Gynaeol Can. 2014;36(3):240–7.CrossRefGoogle Scholar
  24. 24.
    Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2001;(2):CD000547.Google Scholar
  25. 25.
    Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2011;11:CD005355. doi: 10.1002/14651858.CD005355.Google Scholar
  26. 26.
    Fletcher H, Frederick J, Hardie M, Simeon D. A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynaecol. 1996;87(6):1014–8.CrossRefGoogle Scholar
  27. 27.
    Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. Intramyometrial vasopressin as a hemostatic agent during myomectomy. Br J Obstet Gynaecol. 1994;101(5):435–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Kwon YS, Jung DY, Lee SH, Ahn JW, Roh HJ, Im KS. Transient occlusion of uterine arteries with endoscopic vascular clip preceding laparoscopic myomectomy. J Laparoendosc Adv Surg Tech A. 2013;23(8):679–83. doi: 10.1089/lap.2012.0540.CrossRefPubMedGoogle Scholar
  29. 29.
    Kwon YS, Roh HJ, Ahn JW, Lee SH, Im KS. Transient occlusion of uterine arteries in laparoscopic uterine surgery. JSLS. 2015;19(1):e2014.00189. doi: 10.4294/JSLS.2014.00189.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Discepola F, Valenti DA, Reinhold C, Tulandi T. Analysis of arterial blood vessels surrounding the myoma: relevance to myomectomy. Obstet Gynecol. 2007;110(6):1301–3.CrossRefPubMedGoogle Scholar
  31. 31.
    Ngichabe S, Obura T, Stones W. Intravenous tranexamic acid as an adjunct haemostat to ornipressin during open myomectomy. A randomized double blind placebo controlled trial. Ann Surg Innov Res. 2015;9:10. doi: 10.1186/s13022-015-0017-y.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Shaaban MM, Ahmed MR, Farhan RE, Dardeer HH. Efficacy of tranexamic acid on myomectomy-associated blood loss in patients with multiple myomas: a randomized controlled clinical trial. Reprod Sci. 2016;23(7):908–12. doi: 10.1177/1933719115623646.CrossRefPubMedGoogle Scholar
  33. 33.
    Ikechebelu JI, Ezeama CO, Obiechina NJ. The use of tourniquet to reduce blood loss at myomectomy. Niger J Clin Pract. 2010;13(2):154–8.PubMedGoogle Scholar
  34. 34.
    Alptekin H, Efe D. Effectiveness of pericervical tourniquet by foley catheter reducing blood loss at abdominal myomectomy. Clin Exp Obstet Gynecol. 2014;41(4):440–4.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologySunnybrook Health Sciences CentreTorontoCanada

Personalised recommendations