Illness script
Uterine Leiomyoma (Fibroids)
Reproductive-age woman with heavy menstrual bleeding, pelvic pressure, and an enlarged, irregular, firm uterus.
This illness script for Uterine Leiomyoma (Fibroids) covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Reproductive-age women, peak 30s-40s
- Higher incidence and severity in Black women
- Nulliparity, early menarche, obesity increase risk
- Estrogen/progesterone dependent — shrink after menopause
- Family history a risk factor
02
Diagnostics & workup
- History: menorrhagia, pelvic pressure, bloating, dysmenorrhea, infertility
- Exam: enlarged, firm, irregular ('lumpy-bumpy') nontender uterus
- Pelvic ultrasound (transvaginal) — first-line imaging
- MRI for mapping before surgery/procedures
- CBC to assess iron-deficiency anemia from bleeding
03
Pathophysiology
- Benign monoclonal smooth muscle tumors of myometrium
- Growth stimulated by estrogen and progesterone
- Classified by location: submucosal, intramural, subserosal, pedunculated
- Submucosal cause most bleeding; subserosal cause pressure symptoms
- Rarely undergo malignant transformation to leiomyosarcoma (<1%)
04
Treatment
- Asymptomatic: observation
- Medical: NSAIDs, tranexamic acid, hormonal contraceptives, levonorgestrel IUD
- GnRH agonists (leuprolide) shrink fibroids pre-op; short-term use
- Uterine artery embolization for fertility-sparing symptom relief
- Myomectomy preserves fertility; hysterectomy is definitive
- Iron supplementation for associated anemia
Keep reading
Full library- Urge IncontinenceSudden strong urge to void followed by involuntary urine leakage, often with frequency and nocturia.
- Vulvovaginal CandidiasisReproductive-age woman with intense vulvar itching and thick white 'cottage cheese' discharge.
Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.