2.6 Fibroids

Question 1

Another name for fibroids?

When are they common?

Answer 1

uterine leiomyomas

(benign smooth muscle tumours)

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

Question 2

What hormone are fibroids sensitive to?

Answer 2

oestrogen sensitive

Question 3

What are the 3 / 4 types of fibroids?

Answer 3

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

Question 4

How can fibroids present?

Answer 4

• 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

Question 5

Investigations for fibroids?

Answer 5

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

Question 6

What is the medical management of fibroids?

Answer 6

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

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

Question 7

What is the surgical management for small and large fibroids?

Answer 7

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)

Question 8

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

Answer 8

GnRH agonists:

• goserelin (Zoladex)
• leuprorelin (Prostap)

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

Question 9

What is red cell degeneration and when does it happen?

Answer 9

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)

Question 10

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

Answer 10

red degeneration

Mx: supportive, fluids, analgesia, rest

Question 11

Complications of fibroids?

Answer 11

• 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%