2.6 Fibroids Flashcards
Another name for fibroids?
When are they common?
uterine leiomyomas
(benign smooth muscle tumours)
common: 40-60% of women in later repro years
esp black women
What hormone are fibroids sensitive to?
oestrogen sensitive
What are the 3 / 4 types of fibroids?
- intramural
- subserosal (into abdo cavity)
- submucosal
- pedunculate (the sub- ones)
How can fibroids present?
- 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
Investigations for fibroids?
- hysteroscopy for submucosals presenting with HMB
- pelvic US for larger fibroids
- MRI scan before surgery for size, shape and blood supply of fibroid
What is the medical management of fibroids?
- mirena coil (1st line)
- NSAIDs and tranexamic acid (Sx)
- COCP
- cyclical oral progesterons
(greater than 3cm need referral to gynae, but same management)
What is the surgical management for small and large fibroids?
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)
What meds can be used to reduce the fibroid size before surgery?
GnRH agonists:
- goserelin (Zoladex)
- leuprorelin (Prostap)
Induce menopause state and reduce the amount of oestrogen that maintains the fibroid.
What is red cell degeneration and when does it happen?
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)
Pregnant woman presenting with abdo pain, low-grade fever, tachy and poss vomiting with Hx of fibroids is likely what?
red degeneration
Mx: supportive, fluids, analgesia, rest
Complications of fibroids?
- 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%