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Gynaecology > 1: Menstruation: Adenomyosis and Fibroids > Flashcards

1: Menstruation: Adenomyosis and Fibroids Flashcards

1
Q

What are fibroids also referred to as

A

Uterine Leiomyomas

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2
Q

What are uterine leiomyomas

A

Benign smooth muscle tumours of the uterus

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3
Q

What is the incidence of leiomyomas

A

20-40% Women

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4
Q

When are fibroids more common and why

A

Fibroids are more common in later life as their incidence increases with oestrogen exposure. However, there are no cases following menopause

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5
Q

What gene is mutated in fibroids

A

Fumerate Hydrase

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6
Q

What is the fumerate hydrase gene also associated with

A

Renal Cell Carcinoma

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7
Q

What causes growth of fibroids

A

Oestrogen

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8
Q

When are fibroids worse and why

A

COCP or pregnancy - due to greater oestrogen

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9
Q

When are fibroids at there smallest

A

Post-menopausal

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10
Q

What are 5 risk factors for fibroids

A 
Age 
Obesity 
Early menarche
FH
Afro-Carribean
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11
Q

Why are obesity, early menarche and age risk factors for fibroids

A

Increase oestrogen exposure

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12
Q

How may women with fibroids present

A

Asymptomatically - found incidentally on abdominal or pelvic exam

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13
Q

What is the most common symptom of fibroids

A

Menorrhagia

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14
Q

Explain menorrhagia in fibroids

A

Periods may be heavier and prolonged

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15
Q

What pressure symptoms may fibroids cause

A
  • Urinary frequency and urgency, retention
  • Bloating
  • Oedema and varicose veins.
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16
Q

Why may fibroids cause subfertility

A

Obstruction

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17
Q

What is the condition when fibroids cause acute severe pain

A

Red degeneration

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18
Q

What is red degeneration

A

Condition during pregnancy where there is necrosis and haemorrhage of the fibroid. That presents with acute pelvic pain

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19
Q

What can happen to fibroids

A

Calcify to form womb stones

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20
Q

What can be found on examination in fibroids

A

Non-tender enlarged uterus

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21
Q

What are fibroids

A

benign smooth muscle tumours derived from myometrium

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22
Q

What are the 3 types of fibroids

A

Subserosal
Intra-mural
Submucosal

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23
Q

What are subserosal fibroids

A
  • Fibroids that project from serosal surface

- Can be pedunculated

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24
Q

What are intramural fibroids

A
  • Confined to myometrium
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25
Q

What are submucosal fibroids

A
  • Fibroids located under endometrium
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26
Q

How are fibroids investigated

A

Pelvic US.

Gold-standard is pelvic MRI - but reserved for surgical planning

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27
Q

What may be used to control menorrhagia in fibroids

A

Tranexamic acid and mefenamic acid

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28
Q

What is first-line pharmacological management of fibroids

A

GnRH analogue

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29
Q

Name a GnRH analogue

A

Gosrelin

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30
Q

How is GnRH analogue given

A

Once-monthly SC injection

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31
Q

What is the maximum duration patients can be on GnRH for and why

A

6-months, as osteoporotic changes after this

32
Q

What is the typical indication of GnRH analogues for fibroids

A

Often used to shrink fibroids prior to surgery

33
Q

What is second-line pharmacological management for fibroids

A

Ulipristal acetate

34
Q

What is ulipristil acetate

A

Selective progesterone receptor modulator (SPRM)

35
Q

How long is ulipristal acetate taken for and why

A

3-6m - to shrink fibroids

36
Q

What are indications of medical therapy for fibroids

A

To reduce size of fibroids prior to surgical resection

37
Q

What is first-line surgery for submucosal fibroids

A

Hysteroscopy and transcervical resection fibroids

38
Q

When can hysteroscopy and transcervical resection of fibroids only be used (TCRF)

A

Submucosal fibroids

39
Q

What is first-line surgery for fibroids

A

Myomectomy

40
Q

When is myomectomy indicated

A

Women who want to preserve their fertility

41
Q

What are indications for uterine artery embolisation

A

Large fibroid

42
Q

What is required before uterine artery embolisation

A

MRI to check blood supply

43
Q

Who is uterine artery embolisation NOT recommended for

A

Women who want to preserve their fertility

44
Q

What is the only definitive cure of fibroids

A

Hysterectomy

45
Q

What is the most serious risk of fibroids

A

Transformation to uterine sarcoma

46
Q

What is the risk of fibroids transforming to sarcoma

A

0.1%

47
Q

How will uterine sarcoma present

A

Pain
Bleeding
Increase in size, despite post-menopausal

48
Q

What is a complication of fibroids during pregnancy

A

Red degeneration

49
Q

What is red degeneration

A

Haemorrhage and necrosis of fibroid

50
Q

How will red degeneration present clinically

A

Occurs during pregnancy

Pain and Bleeding

51
Q

Define adenomyosis

A

Presence of endometrial tissue in myometrium

52
Q

Define fibroids

A

Benign smooth muscle tumours of the myometrium

53
Q

When does the peak incidence of adenomyosis occur

A

40-50years

54
Q

What causes adenomyosis

A

Abnormal connection between endometrial stroma and myometrium

55
Q

What can cause adenomyosis

A
  1. Uterine Surgery
  2. C-Section
  3. Child birth
56
Q

What are 4 risk factors for adenomyosis

A

Uterine surgery: Curettage, Endometrial ablation
FH
Previous C-Section
Multiparous

57
Q

When may someone of had endometrial ablation

A

Menorrhagia

58
Q

What are 3 symptoms of adenomyosis

A
  1. Menorrhagia
  2. Dysmenorrhoea
  3. Deep pareunia
59
Q

Explain dysmenorrhoea in adenomyosis

A

Starts as cyclical pain, the progresses to dysmenorrhoea

60
Q

Will adenomyosis present in post-menopausal women and why

A

No. As endometrial tissue is oestrogen dependent

61
Q

Describe how uterus will present on examination in adneomyosis

A

Symmetrically enlarged tender uterus - described as ‘boggy’ uterus

62
Q

In which part of the uterus does adneomyosis occur more

A

Posterior wall

63
Q

what is adenomyoma

A

Collection several adenomyosis to form a node

64
Q

what is the only way to definitively diagnose adenomyosis

A

Biopsy post-hysterectomy

65
Q

what is used to diagnose adenomyosis

A

TVUS

MRI

66
Q

what will be seen on TV-US in adenomyosis

A

Globular uterine configuration

Poor definition endometrium-myometrium

67
Q

what will be seen on MRI in adenomyosis

A

Irregular thickening of endometrial-myometrial junction zone

68
Q

What is pathognomic of adenomyosis

A

Irregular thickening of endometrial-myometrial junction zone on MRI

69
Q

What is the only curative treatment for adenomyosis

A

hysterectomy

70
Q

What does other management of adenomyosis aim to do

A

controlling symptoms

71
Q

What is first line for adenomyosis

A

analgesia for dysmenorrhoea (NSAIDs)

72
Q

What hormonal treatments are used to treat adenomyosis

A

COCP
Progesterone
GnRH analogues
Aromatase inhibitors

73
Q

What is the only definitive treatment for adneomysois

A

Hysterectomy

74
Q

How does uterine artery embolisation work for adenomyosis

A

It occludes blood supply to endometrial tissue in the myometrium causing shrinkage

75
Q

Who is uterine artery embolisation indicated for

A

Temporary treatment for women who want to preserve fertility

Gynaecology (22 decks)

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