Cervical Fibroid

A cervical fibroid is a benign smooth muscle tumour arising from the muscle of the cervix. It is an uncommon site for fibroids.

• It can distort the cervix, displace the bladder and ureters, and obstruct labour.
• Size, position and desire for fertility decide treatment.
• Surgery is technically harder than for fibroids in the uterine body.

Heavy or irregular vaginal bleeding, post-coital bleeding, pelvic pressure, urinary frequency or retention, constipation, dyspareunia and infertility; some women are asymptomatic.

• A firm, smooth cervical mass that may enlarge the cervix, displace the os and prolapse into the vagina.
• Differential diagnosis: cervical polyp, cervical cancer, leiomyosarcoma, nabothian cyst, endometrial polyp prolapse, uterine inversion, ovarian mass.
• Complications: anaemia, urinary retention, hydronephrosis, obstructed labour, infection, degeneration and rarely malignant change.

Diagnosis is by bimanual examination and imaging, with histology after removal.

• Speculum and bimanual examination.
• Transvaginal ultrasound; pelvic MRI to define the origin and the relation to the bladder, ureters and rectum.
• Full blood count and ferritin; pregnancy test; renal ultrasound if obstruction is suspected.
• Cervical screening; biopsy for atypical or rapidly growing lesions.
• Histology after removal.

Observe small asymptomatic fibroids, control bleeding medically, and remove fibroids that cause symptoms.

• Supportive: observe small asymptomatic fibroids; menstrual diary; iron-rich diet.
• Pharmacological: tranexamic acid 1 g oral 8-hourly for up to 4 days during heavy bleeding (maximum 4 g in 24 hours; reduce the dose in renal impairment and avoid in thromboembolism). Mefenamic acid 500 mg oral 8-hourly with food during menses for pain. Levonorgestrel 52 mg intrauterine system when the cavity is not distorted. Pre-operative shrinkage: leuprorelin 3.75 mg IM every 4 weeks for up to 3 months. Anaemia: ferrous sulphate 200 mg oral 8-hourly, continued for 3 months after haemoglobin normalises; iron sucrose 200 mg IV per dose for severe anaemia or intolerance (cumulative dose calculated by weight and deficit).
• Procedures: myomectomy by vaginal, hysteroscopic, laparoscopic or open approach with tranexamic acid 1 g IV before surgery and blood available; hysterectomy when fertility is complete; uterine artery embolisation in selected women; caesarean delivery if the fibroid blocks labour.
• Special groups: in pregnancy manage conservatively with paracetamol 1 g oral 6-hourly (maximum 4 g in 24 hours) for pain and avoid ibuprofen from 28 weeks; plan caesarean delivery for an obstructing cervical fibroid. In renal impairment, reduce tranexamic acid to 15 mg/kg (usually 1 g) oral 12-hourly when creatinine is 120 to 249 micromol/L.
• Red flags: rapid growth, postmenopausal growth, haemoglobin below 7 g/dL, urinary retention, hydronephrosis, fever.
• Follow-up: review at 6 weeks and 3 months after treatment; ultrasound every 6 to 12 months if observed.