1: Menstruation: Adenomyosis and Fibroids Flashcards
What are fibroids also referred to as
Uterine Leiomyomas
What are uterine leiomyomas
Benign smooth muscle tumours of the uterus
What is the incidence of leiomyomas
20-40% Women
When are fibroids more common and why
Fibroids are more common in later life as their incidence increases with oestrogen exposure. However, there are no cases following menopause
What gene is mutated in fibroids
Fumerate Hydrase
What is the fumerate hydrase gene also associated with
Renal Cell Carcinoma
What causes growth of fibroids
Oestrogen
When are fibroids worse and why
COCP or pregnancy - due to greater oestrogen
When are fibroids at there smallest
Post-menopausal
What are 5 risk factors for fibroids
Age Obesity Early menarche FH Afro-Carribean
Why are obesity, early menarche and age risk factors for fibroids
Increase oestrogen exposure
How may women with fibroids present
Asymptomatically - found incidentally on abdominal or pelvic exam
What is the most common symptom of fibroids
Menorrhagia
Explain menorrhagia in fibroids
Periods may be heavier and prolonged
What pressure symptoms may fibroids cause
- Urinary frequency and urgency, retention
- Bloating
- Oedema and varicose veins.
Why may fibroids cause subfertility
Obstruction
What is the condition when fibroids cause acute severe pain
Red degeneration
What is red degeneration
Condition during pregnancy where there is necrosis and haemorrhage of the fibroid. That presents with acute pelvic pain
What can happen to fibroids
Calcify to form womb stones
What can be found on examination in fibroids
Non-tender enlarged uterus
What are fibroids
benign smooth muscle tumours derived from myometrium
What are the 3 types of fibroids
Subserosal
Intra-mural
Submucosal
What are subserosal fibroids
- Fibroids that project from serosal surface
- Can be pedunculated
What are intramural fibroids
- Confined to myometrium
What are submucosal fibroids
- Fibroids located under endometrium
How are fibroids investigated
Pelvic US.
Gold-standard is pelvic MRI - but reserved for surgical planning
What may be used to control menorrhagia in fibroids
Tranexamic acid and mefenamic acid
What is first-line pharmacological management of fibroids
GnRH analogue
Name a GnRH analogue
Gosrelin
How is GnRH analogue given
Once-monthly SC injection
What is the maximum duration patients can be on GnRH for and why
6-months, as osteoporotic changes after this
What is the typical indication of GnRH analogues for fibroids
Often used to shrink fibroids prior to surgery
What is second-line pharmacological management for fibroids
Ulipristal acetate
What is ulipristil acetate
Selective progesterone receptor modulator (SPRM)
How long is ulipristal acetate taken for and why
3-6m - to shrink fibroids
What are indications of medical therapy for fibroids
To reduce size of fibroids prior to surgical resection
What is first-line surgery for submucosal fibroids
Hysteroscopy and transcervical resection fibroids
When can hysteroscopy and transcervical resection of fibroids only be used (TCRF)
Submucosal fibroids
What is first-line surgery for fibroids
Myomectomy
When is myomectomy indicated
Women who want to preserve their fertility
What are indications for uterine artery embolisation
Large fibroid
What is required before uterine artery embolisation
MRI to check blood supply
Who is uterine artery embolisation NOT recommended for
Women who want to preserve their fertility
What is the only definitive cure of fibroids
Hysterectomy
What is the most serious risk of fibroids
Transformation to uterine sarcoma
What is the risk of fibroids transforming to sarcoma
0.1%
How will uterine sarcoma present
Pain
Bleeding
Increase in size, despite post-menopausal
What is a complication of fibroids during pregnancy
Red degeneration
What is red degeneration
Haemorrhage and necrosis of fibroid
How will red degeneration present clinically
Occurs during pregnancy
Pain and Bleeding
Define adenomyosis
Presence of endometrial tissue in myometrium
Define fibroids
Benign smooth muscle tumours of the myometrium
When does the peak incidence of adenomyosis occur
40-50years
What causes adenomyosis
Abnormal connection between endometrial stroma and myometrium
What can cause adenomyosis
- Uterine Surgery
- C-Section
- Child birth
What are 4 risk factors for adenomyosis
Uterine surgery: Curettage, Endometrial ablation
FH
Previous C-Section
Multiparous
When may someone of had endometrial ablation
Menorrhagia
What are 3 symptoms of adenomyosis
- Menorrhagia
- Dysmenorrhoea
- Deep pareunia
Explain dysmenorrhoea in adenomyosis
Starts as cyclical pain, the progresses to dysmenorrhoea
Will adenomyosis present in post-menopausal women and why
No. As endometrial tissue is oestrogen dependent
Describe how uterus will present on examination in adneomyosis
Symmetrically enlarged tender uterus - described as ‘boggy’ uterus
In which part of the uterus does adneomyosis occur more
Posterior wall
what is adenomyoma
Collection several adenomyosis to form a node
what is the only way to definitively diagnose adenomyosis
Biopsy post-hysterectomy
what is used to diagnose adenomyosis
TVUS
MRI
what will be seen on TV-US in adenomyosis
Globular uterine configuration
Poor definition endometrium-myometrium
what will be seen on MRI in adenomyosis
Irregular thickening of endometrial-myometrial junction zone
What is pathognomic of adenomyosis
Irregular thickening of endometrial-myometrial junction zone on MRI
What is the only curative treatment for adenomyosis
hysterectomy
What does other management of adenomyosis aim to do
controlling symptoms
What is first line for adenomyosis
analgesia for dysmenorrhoea (NSAIDs)
What hormonal treatments are used to treat adenomyosis
COCP
Progesterone
GnRH analogues
Aromatase inhibitors
What is the only definitive treatment for adneomysois
Hysterectomy
How does uterine artery embolisation work for adenomyosis
It occludes blood supply to endometrial tissue in the myometrium causing shrinkage
Who is uterine artery embolisation indicated for
Temporary treatment for women who want to preserve fertility
