Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Fibroid Tumor of Uterus


Medical Codes

ICD-9-CM:
218.0 - Uterine Leiomyoma; Submucous Leiomyoma of Uterus
218.1 - Uterine Leiomyoma; Intramural Leiomyoma of Uterus; Interstitial Leiomyoma of Uterus
218.2 - Uterine Leiomyoma; Subserous Leiomyoma of Uterus; Subperitoneal Leiomyoma of Uterus
218.9 - Uterine Leiomyoma, Unspecified
219.9 - Neoplasm, Uterus, Other Benign, Uterus, Part Unspecified

Related Terms

  • Fibroids
  • Fibroleiomyoma
  • Fibromyoma
  • Leiomyoma
  • Myoma
  • Uterine Leiomyoma
  • Uterine Myoma

Overview

© Reed Group
Fibroid tumors of the uterus (fibroids) are abnormal growths of smooth muscle in the uterus. They occur in about 20% to 50% of women older than 30 and represent one of the most common gynecologic conditions requiring medical intervention (Thomason). Fibroids usually do not cause symptoms and are seldom cancerous (benign). They develop as distinct, firm, round masses of fibrous connective tissue, most often occurring in groups. Fibroids can develop in the main part, or body, of the uterus or in the narrow opening to the uterus (cervix). Most occur in the body of the uterus, with about 3% occurring in the cervix (Thomason). Intraligamentous fibroids are those found within the broad ligaments attached to the uterus.

Fibroids are classified by their location. Intramural fibroids are found within the muscular wall of the uterus, subserosal fibroids develop on the outside surface of the uterus, and submucous fibroids are found within the uterine lining. Most fibroids (95%) are intramural or subserosal, but fibroids may be a combination of types. For example, a fibroid may grow on the outside surface of the uterus yet extend into the muscular wall. Subserosal and submucous fibroids sometimes attach to the uterus by a stalk (pedunculated fibroid). Pedunculated fibroids can easily become twisted, cutting off the blood supply. The tissue then begins to die and can become infected.

The growth of fibroids is associated with the female hormone estrogen. Fibroids tend to enlarge with pregnancy and shrink after menopause. If estrogen replacement therapy is used after menopause, fibroids may continue to grow. About one-third to one-half (20% to 50%) of women with fibroids have symptoms (Flynn).

Submucosal and intramural fibroid tumors may play a role in infertility, especially if they distort the uterine cavity. The role of fibroid tumors in early miscarriage is controversial.

Incidence and Prevalence: The prevalence of fibroids identified by ultrasound imaging ranges from 4% in women between ages 20 and 30, to 11% to 18% in women between ages 30 and 40, to 33% in women 40 to 60 years of age (Evans).

Source: Medical Disability Advisor



Diagnosis

History: Fibroids frequently cause no symptoms. When symptoms are present, they typically involve abnormal uterine bleeding, pain, and/or pelvic pressure. Abnormal uterine bleeding can include an increased amount and duration of menstrual bleeding (menorrhagia), bleeding between periods (metrorrhagia), or both. Pelvic pressure from growing fibroids may cause frequent or painful urination and constipation. Abdominal cramping may occur from fibroid pressure on the small intestine. Severe pain may result from a twisted pedunculated fibroid.

The individual may have a history of infertility, which has been associated with uterine fibroids. In pregnancy, fibroids may cause miscarriage (spontaneous abortion) by the second month. The individual may report a history of female relatives with fibroids.

Physical exam: Fibroids of sufficient size may be discovered during a bimanual pelvic examination (in which the physician places one hand on the abdomen during the exam and inserts the other into the vagina), or they may be discovered by pressing down on the abdomen with one or both hands (palpation). Sometimes a fibroid may be seen extending out of the cervix into the vagina (prolapsed fibroid).

Tests: The amount of blood loss from uterine bleeding may be estimated by performing a complete blood count with hematocrit (cell volume) and hemoglobin (iron-bearing protein in red blood cells). A pregnancy test may be performed to rule out pregnancy as a cause of abnormal tissue growth or bleeding. A pap smear may be done to rule out malignancy of the uterus or cervix. Other laboratory tests, such as renal function (blood urea nitrogen or BUN, creatinine) and coagulation profile (platelet count, prothrombin time, partial thromboplastin time), may be needed prior to surgery or embolization.

Pelvic ultrasound is the imaging test of choice for diagnosis fibroids and can exclude pregnancy as the cause of uterine enlargement. Transvaginal ultrasound (in which an ultrasound probe is inserted into the vagina) is a useful, noninvasive initial test to provide information about intrauterine fibroids that may be used in combination with abdominal ultrasound. Abnormal tissue may be examined in more detail if the uterus is filled with saline before the ultrasound procedure (sonohysterography), but this more invasive test is not commonly used. MRI is used when precise detail is required, such as prior to surgery.

Source: Medical Disability Advisor



Treatment

Small, asymptomatic fibroids are usually not treated but are monitored for growth by having pelvic examinations and ultrasounds every 6 months. If treatment for fibroids becomes necessary, surgery and hormone therapy are two common options.

Surgery is considered when bleeding is so significant that it causes anemia, if pain is severe or chronic, if there is evidence of a twisted deteriorating pedunculated fibroid, if the fibroid is extending (prolapsed) through the cervix, if the fibroid is causing urinary symptoms, or if the fibroid is growing significantly.

Surgical options include hysterectomy or myomectomy. A hysterectomy is the removal of the entire uterus. This is the only procedure that removes current fibroids and prevents the development of fibroids in the future. Fibroids are the most common reason for hysterectomy; studies have shown that this surgery improves symptoms and quality of life in women with symptomatic fibroids when compared to nonsurgical treatment (Evans). Myomectomy removes only the fibroids, leaving the uterus intact. Hysterectomy and myomectomy can be performed either through open abdominal surgery or a less invasive laparoscopic procedure performed vaginally. Because the entire uterus is removed, pregnancy is not an option after hysterectomy. In contrast, myomectomy preserves fertility.

Uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE), may sometimes be used to shrink fibroid tumors rather than to remove them. This method involves making a peripheral incision to access the uterine arteries via the femoral artery under fluoroscopic guidance. Embolic agents such as polyvinyl alcohol (PVA) particles are injected directly into one or both uterine arteries to decrease the blood supply to the fibroid, stopping fibroid growth.

Gonadotropin-releasing hormone (GnRH) agonists are sometimes given to simulate menopause. The decreased estrogen level that results will then stop the growth of fibroids while also stopping menstrual bleeding. The result, however, is generally short-term, and fibroids may recur. Side effects of GnRH agonists include hot flashes, vaginal dryness, and bone demineralization. GnRH agonists are used only for limited time periods, usually not longer than 6 months. They are taken to control fibroid growth in women who want to preserve their fertility, to control blood loss and correct anemia before surgery, and to shrink a large fibroid before surgery. They are also used as an option for women who are near menopause and for whom surgery is not indicated.

Hormone therapy using oral contraceptives (cyclic or noncyclic estrogen-progestin combinations) has not been shown to alleviate or reduce symptoms of fibroids. Androgenic drugs and progestins have been used to control menstrual bleeding. They do not, however, consistently decrease uterine or fibroid size.

A combination of MRI and ultrasonography has been FDA-approved as a noninvasive treatment for fibroids. The treatment involves focusing high-intensity sound waves on the fibroids to induce coagulation necrosis, interrupting blood supply to the fibroids and stopping their growth. Although this is a safe, convenient outpatient procedure with a short recovery period, more studies with long-term follow-up are needed to determine who will benefit from the procedure (Evans).

Source: Medical Disability Advisor



Prognosis

Most fibroids are asymptomatic and do not require treatment. For fibroids that do cause symptoms, surgical removal of the uterus (hysterectomy) is the only certain cure. Surgical removal of the fibroids only (myomectomy) is performed endoscopically for many women with consistently good results, and hysteroscopic myomectomy is performed successfully for women with symptomatic submucosal fibroid tumors (Evans). Use of the UFE/UAE procedure significantly improves or resolves symptoms in 81% to 96% of individuals (Siskin). Gonadotropin-releasing hormone (GnRH) agonists bring about a 40% to 60% decrease in fibroid size after 3 months of treatment. Half the fibroids regrow, however, after treatment is discontinued. Fibroids typically stop appearing and growing once a woman reaches menopause.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Gynecologist
  • Reproductive Endocrinology Gynecologist

Source: Medical Disability Advisor



Complications

Fibroids can result in excessive bleeding and pain. Submucous fibroids develop infection at a greater rate than other types of fibroids. Pedunculated fibroids have a tendency to become twisted, which cuts off their blood supply and can lead to tissue death (necrosis), severe pain, and infection. Fibroids are also associated with infertility and pelvic or urinary obstructive symptoms.

In pregnancy, a fibroid may cause miscarriage (spontaneous abortion), premature labor, pain, prolonged labor, obstructed labor, failure of the head to engage the birth canal, and postpartum hemorrhage. Depending upon where it is located within the uterus, a fibroid may necessitate a cesarean section rather than a vaginal birth.

Although fibroids are usually benign, cancerous changes do occur in rare cases (0.2% to 1.0% of fibroids) (Thomason).

Source: Medical Disability Advisor



Factors Influencing Duration

Fibroid size and location, the extent of pain and bleeding, the individual’s nearness to menopause, the need for surgery, and individual’s response to treatment will influence the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Pain and excessive blood loss may interfere with work and require a less strenuous workload or time off from work. If surgery is performed, a recovery period must be allowed. Hysterectomy requires a longer recovery period than myomectomy, up to a total of 6 weeks. Laparoscopic procedures have a shorter recovery period than open abdominal surgeries. Medical treatment may effectively manage the condition but may precede rather than preclude surgical treatment.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is individual of reproductive age?
  • Is there a history of infertility? Is there a family history of fibroids?
  • Is the individual obese?
  • Does individual have high blood pressure?
  • Is individual nulliparous (never having given birth) or multiparous (having given birth five or more times)?
  • Does individual report excessive menstrual bleeding (menorrhagia) or bleeding between periods (metrorrhagia)?
  • Does individual report frequent or painful urination or constipation?
  • Does individual report severe pelvic or abdominal pain, possibly suggesting twisted pedunculated fibroid?
  • Was pelvic ultrasound done to exclude pregnancy as the cause of uterine enlargement? Was transvaginal ultrasound done?
  • Was MRI performed?
  • Was a complete blood count (CBC), pregnancy test, or Pap smear done?
  • Was diagnosis of uterine fibroid(s) confirmed?

Regarding treatment:

  • If fibroids are small and without symptoms (asymptomatic), does individual undergo pelvic examinations every 6 months?
  • Does individual require surgery for bleeding that has caused anemia, chronic or severe pain, a twisted deteriorating pedunculated fibroid, or a fibroid extending (prolapsed) through the cervix?
  • If surgery is required, will just the fibroid be removed (myomectomy) or the entire uterus (hysterectomy)? If hysterectomy is required, does individual understand this will eliminate all possibility of future pregnancies?
  • Is UFE/UAE procedure an option to shrink size of fibroid(s)?
  • Are gonadotropin-releasing hormone (GnRH) agonists a treatment option?

Regarding prognosis:

  • Is this an initial diagnosis, or has the fibroid recurred?
  • If surgical intervention was required, was a myomectomy or hysterectomy performed? Was UFE performed?
  • Did postsurgical complications occur? If so, what were they, and what is the expected recovery time?
  • Is individual nearing menopause, when fibroids generally stop appearing and growing?
  • Has individual experienced excessive bleeding, pain, or infection?
  • If individual was pregnant, did the fibroid cause miscarriage (spontaneous abortion), premature labor, pain, prolonged labor, obstructed labor, failure of the head to engage the birth canal, or postpartum hemorrhage? Did individual require cesarean section rather than a vaginal birth?
  • Has fibroid caused infertility? If so, would individual benefit from counseling to cope with the impact of this condition?

Source: Medical Disability Advisor



References

Cited

Evan, P., and S. Brunsell. "Uterine Fibroid Tumors: Diagnosis and Treatment." American Family Physician 75 10 (2007): 1503-1508.

Flynn, M., et al. "Health Care Resource Use for Uterine Fibroid Tumors in the United States." American Journal of Obstetrics and Gynecology 195 4 (2006): 955-964.

Siskin, Gary P. "Uterine Fibroid Embolization." eMedicine. Eds. Harris L. Cohen, et al. 2 Dec. 2005. Medscape. 7 Oct. 2008 <http://emedicine.medscape.com/article/421734-overview>.

Thomason, P. "Leiomyoma, Uterus (Fibroid)." eMedicine. Eds. Christopher L. Sistrom, et al. 6 May. 2008. Medscape. 7 Oct. 2008 <http://emedicine.medscape.com/article/405676-overview>.

Source: Medical Disability Advisor