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Fibroids and adenomyosis

Gynaecology

Benign myometrial disease that bleeds, presses, and sometimes hurts. Location decides the symptoms and the surgery.

Transabdominal
What do you notice? Commit in the Ultrasound Lab.

Fibroids

A single fundal leiomyoma, whorled and well circumscribed, distorting the cavity.
A museum specimen of a uterus cut to show many whorled fibroids of different sizes filling the wall
  • Present in 70 to 80 percent by age 50, symptomatic in a quarter. Oestrogen and progesterone dependent: they grow in pregnancy and shrink after menopause.
  • FIGO location: 0 to 2 submucosal (bleeding, subfertility), 3 to 5 intramural, 6 to 7 subserosal (pressure, bulk), 8 other. A hybrid fibroid crosses more than one layer.
  • Symptoms: heavy menstrual bleeding, pressure, urinary frequency, constipation, pain from degeneration (red degeneration in pregnancy), subfertility with cavity distortion.
  • Ultrasound is the first investigation; MRI maps them before myomectomy or embolisation. Rapid growth after menopause raises the question of sarcoma, though it is rare and preoperative diagnosis is unreliable.
  • Treatment follows symptoms and wishes: watchful waiting; tranexamic acid, the levonorgestrel IUD, GnRH antagonists or agonists to shrink before surgery; hysteroscopic resection (types 0 to 2); myomectomy (fertility); uterine artery embolisation; hysterectomy.

Large uterine fibroid (leiomyoma)

Transabdominal. A 9 cm well-defined solid mass with a whorled, heterogeneous echotexture.

Open in the Ultrasound Lab

Subserosal fibroid

Transvaginal. A 5 cm fibroid projecting from the outer surface of the uterus.

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Small intramural fibroid

Transvaginal, sagittal. A small, round, hypoechoic, well-defined lesion within the myometrium.

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Adenomyosis

Adenomyosis on MRI: a thick posterior junctional zone with bright endometrial foci in the myometrium.
  • Endometrial glands within the myometrium; a bulky, tender, globular uterus with heavy painful periods, often in parous women in their 40s.
  • Ultrasound signs: asymmetric wall thickening, myometrial cysts, heterogeneous echotexture, linear striations from the endometrium, an indistinct junctional zone; MRI shows a thickened junctional zone.
  • Treatment: NSAIDs and tranexamic acid, the levonorgestrel IUD (very effective), combined or progestin-only hormones, and hysterectomy as the definitive option.

Adenomyosis

Transvaginal. A bright endometrial stripe.

Open in the Ultrasound Lab

On the modelBody and myometriumFundus and cornuaEndometrium

Frameworks and sources

  • FIGO: The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes (PALM-COEIN), 2018 revisions (2018).

Content reviewed 2026-09. Teaching material for students, not clinical decision support; check the current edition of the guideline your unit uses.