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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
What are submucosal fibroids
- Fibroids located under endometrium
26
How are fibroids investigated
Pelvic US. Gold-standard is pelvic MRI - but reserved for surgical planning
27
What may be used to control menorrhagia in fibroids
Tranexamic acid and mefenamic acid
28
What is first-line pharmacological management of fibroids
GnRH analogue
29
Name a GnRH analogue
Gosrelin
30
How is GnRH analogue given
Once-monthly SC injection
31
What is the maximum duration patients can be on GnRH for and why
6-months, as osteoporotic changes after this
32
What is the typical indication of GnRH analogues for fibroids
Often used to shrink fibroids prior to surgery
33
What is second-line pharmacological management for fibroids
Ulipristal acetate
34
What is ulipristil acetate
Selective progesterone receptor modulator (SPRM)
35
How long is ulipristal acetate taken for and why
3-6m - to shrink fibroids
36
What are indications of medical therapy for fibroids
To reduce size of fibroids prior to surgical resection
37
What is first-line surgery for submucosal fibroids
Hysteroscopy and transcervical resection fibroids
38
When can hysteroscopy and transcervical resection of fibroids only be used (TCRF)
Submucosal fibroids
39
What is first-line surgery for fibroids
Myomectomy
40
When is myomectomy indicated
Women who want to preserve their fertility
41
What are indications for uterine artery embolisation
Large fibroid
42
What is required before uterine artery embolisation
MRI to check blood supply
43
Who is uterine artery embolisation NOT recommended for
Women who want to preserve their fertility
44
What is the only definitive cure of fibroids
Hysterectomy
45
What is the most serious risk of fibroids
Transformation to uterine sarcoma
46
What is the risk of fibroids transforming to sarcoma
0.1%
47
How will uterine sarcoma present
Pain Bleeding Increase in size, despite post-menopausal
48
What is a complication of fibroids during pregnancy
Red degeneration
49
What is red degeneration
Haemorrhage and necrosis of fibroid
50
How will red degeneration present clinically
Occurs during pregnancy | Pain and Bleeding
51
Define adenomyosis
Presence of endometrial tissue in myometrium
52
Define fibroids
Benign smooth muscle tumours of the myometrium
53
When does the peak incidence of adenomyosis occur
40-50years
54
What causes adenomyosis
Abnormal connection between endometrial stroma and myometrium
55
What can cause adenomyosis
1. Uterine Surgery 2. C-Section 3. Child birth
56
What are 4 risk factors for adenomyosis
Uterine surgery: Curettage, Endometrial ablation FH Previous C-Section Multiparous
57
When may someone of had endometrial ablation
Menorrhagia
58
What are 3 symptoms of adenomyosis
1. Menorrhagia 2. Dysmenorrhoea 3. Deep pareunia
59
Explain dysmenorrhoea in adenomyosis
Starts as cyclical pain, the progresses to dysmenorrhoea
60
Will adenomyosis present in post-menopausal women and why
No. As endometrial tissue is oestrogen dependent
61
Describe how uterus will present on examination in adneomyosis
Symmetrically enlarged tender uterus - described as 'boggy' uterus
62
In which part of the uterus does adneomyosis occur more
Posterior wall
63
what is adenomyoma
Collection several adenomyosis to form a node
64
what is the only way to definitively diagnose adenomyosis
Biopsy post-hysterectomy
65
what is used to diagnose adenomyosis
TVUS | MRI
66
what will be seen on TV-US in adenomyosis
Globular uterine configuration | Poor definition endometrium-myometrium
67
what will be seen on MRI in adenomyosis
Irregular thickening of endometrial-myometrial junction zone
68
What is pathognomic of adenomyosis
Irregular thickening of endometrial-myometrial junction zone on MRI
69
What is the only curative treatment for adenomyosis
hysterectomy
70
What does other management of adenomyosis aim to do
controlling symptoms
71
What is first line for adenomyosis
analgesia for dysmenorrhoea (NSAIDs)
72
What hormonal treatments are used to treat adenomyosis
COCP Progesterone GnRH analogues Aromatase inhibitors
73
What is the only definitive treatment for adneomysois
Hysterectomy
74
How does uterine artery embolisation work for adenomyosis
It occludes blood supply to endometrial tissue in the myometrium causing shrinkage
75
Who is uterine artery embolisation indicated for
Temporary treatment for women who want to preserve fertility

Gynaecology (22 decks)

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