Heavy Menstrual Bleeding, Improving Knowledge, Improving Lives
Leiomyoma as cause for Heavy Men-strual Bleeding



  • Benign smooth muscle tumors of the myometrium, also known as fibroids. Uterine fibroids are the most common gynecological tumor and leading cause for hysterectomy1,2,3
  • Can be submucous, subserous or intramural4



  • Women are often asymptomatic5
  • Around 25 to 50% of women have symptoms: HMB, pelvic pain or pressure3
  • May lead to subfertility, miscarriage and obstetric complications6



  • Transvaginal ultrasound6
  • For submucosal fibroids: ultrasound and hysteroscopy4



  • Treatment should be individualized, depending on symptom severity, distortion of the uterine cavity and desire for future children2
  • Medical treatment: Oral contraceptives, oral progestins, levonorgestrel intrauterine system. Selective progesterone receptor modulators and GnRH analogues can be used pre surgery, to reduce fibroid size2
  • Minimally invasive procedures: uterine artery embolization, MRI guided focused ultrasound surgery, endometrial ablation, hysteroscopic myomectomy2
  • Surgical treatment: laparoscopic or abdominal myomectomy, hysterectomy2

Leiomyoma Library

Find more information and download materials on leiomyoma in the teaching and resources library.


  1. Stewart EA. N Engl J Med 2015;372:1646–55.
  2. Vilos GA, et al. J Obstet Gynaecol Can 2015;37:157–78.
  3. Borah BJ, et al. Am J Obstet Gynecol 2013;209;319e1–319e20.
  4. Munro MG, et al. Int J Gynaecol Obstet,2011; 113, 3–13.
  5. Brito L, et al. Reprod Health 2014;11:10.
  6. Van den Bosch T, et al. Ultrasound Obstet Gynecol 2015;46:284–98.

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