2.6 Fibroids Flashcards

1
Q

Another name for fibroids?

When are they common?

A

uterine leiomyomas

(benign smooth muscle tumours)

common: 40-60% of women in later repro years
esp black women

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2
Q

What hormone are fibroids sensitive to?

A

oestrogen sensitive

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3
Q

What are the 3 / 4 types of fibroids?

A
  • intramural
  • subserosal (into abdo cavity)
  • submucosal
  • pedunculate (the sub- ones)
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4
Q

How can fibroids present?

A
  • often asymptomatic
  • heavy menstrual bleeding is most common
  • prolonged menstruation >7 days
  • abdo pain worse during menses
  • bloating / feeling full
  • urinary or bowel Sx due to pelvic pressure
  • deep dyspareunia
  • reduced fertility

bimanual exam may reveal palpable mass

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5
Q

Investigations for fibroids?

A
  • hysteroscopy for submucosals presenting with HMB
  • pelvic US for larger fibroids
  • MRI scan before surgery for size, shape and blood supply of fibroid
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6
Q

What is the medical management of fibroids?

A
  • mirena coil (1st line)
  • NSAIDs and tranexamic acid (Sx)
  • COCP
  • cyclical oral progesterons

(greater than 3cm need referral to gynae, but same management)

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7
Q

What is the surgical management for small and large fibroids?

A

Small with HMB:

  • endometrial ablation (eg balloon thermal ablation)
  • resection
  • hysterectomy

Large >3cm:

  • uterine artery embolisation (IR via femoral artery)
  • myomectomy (laparoscopic or laparotomy)
  • hysterectomy (laparoscopic, laparotomy or vaginal)
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8
Q

What meds can be used to reduce the fibroid size before surgery?

A

GnRH agonists:

  • goserelin (Zoladex)
  • leuprorelin (Prostap)

Induce menopause state and reduce the amount of oestrogen that maintains the fibroid.

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9
Q

What is red cell degeneration and when does it happen?

A

ischaemia, infarction and necrosis of fibroids due to change in blood supply.

more common when >5cm
and in 2nd or 3rd trimester of pregnancy

(due to rapid enlargement or a kink in its blood supply)

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10
Q

Pregnant woman presenting with abdo pain, low-grade fever, tachy and poss vomiting with Hx of fibroids is likely what?

A

red degeneration

Mx: supportive, fluids, analgesia, rest

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11
Q

Complications of fibroids?

A
  • HMB with iron deficiency anaemia
  • reduced fertility
  • miscarriage, prem labour, obstructed delivery
  • constipation
  • urinary obstruction and infection
  • red degeneration
  • torsion of pedunculated fibroid
  • rare malignant change to leiomyosarcoma <1%
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