3 - Gynae - The Uterus and its abnormalities - Fibroids Flashcards
fibroids - what are they? % of women? more common in who? less common in who?
benign tumours of myometrium
25%
-near menopause, afro-carib, FHx
-parous women, taken COCP or injectable progestogens
Pathology/sites - 3 locations? what occasionally form intracavity polyps?
intramural, subserosal, submucosal
submucosal ones
Aetiology - dependent on? pregnancy effect? why reduce after menopause? each fibroid is ??? in origin?
androgen dependent
equal chance of growth/shrinking/neither
each one is monoclonal in origin
how normally diagnosed? Sx are related to what rather than what?
50% aSx and discovered at pelvic or abdo exam
site rather than size
Sx- Menstrual problems
- 30% get??
- what is usually unchanged?
- submucosal or polypoid may cause what?
menorrhagia
timing of menses
IMB
Sx - Pain
-can cause what? seldom cause pain unless???
dysmenorrhea
torsion, red degeneration or rarely sarcomatous change
Sx - other
- can press on two structures causing what Sx?
- how can fertility be affected?
bladder - freq and retention
ureters - hydronephrosis
impaired if tubal ostia are blocked or submucosal fibroids prevent implantation
Enlargement - what happens after menopause? what may stim further growth? when might they enlarge? pedunculated fibroids can do what?
often stop growing and calcify
oestrogen in HRT may stim further growth
in mid preg they may enlarge
occasionally undergo torsion > pain
degeneration - normally due to? red degen characteristics? what occur alongside? when is fibroid soft and partly liquefied?
inadequate blood supply
pain and uterine tenderness
haemorrhage and necrosis occur
in hyaline and cystic degen
Malignancy - % are ? may be due to?
malignant change or de novo malignant transformation of normal SM
~0.1% are leiomyosarcomata (cancerous)
fibroids and pregnancy - what can occur? what is common in preg and causes severe pain? what should be done at C/s?
PPH, obstructed labour, malpresentations, premature labour, transverse lie
red degeneration
do not remove at C/S - bleeding can be heavy
HRT and fibroids - what can HRT do? trt?
continued fibroid growth post menopause
trt - as for premenopausal or HRT withdrawn
Ix - to establish diagnosis:
- what is helpful? what is needed to distinguish from ovarian mass? what else needs to be distinguished from? what is used to assess distortion of uterine cavity? esp if?
USS
MRI or laparoscopy
adenomyosis - (MRI)
hysteroscopy or hysterosalpingogram
Ix - to establish fitness - effect on Hb?
Hb conc may be low due to vaginal bleed, but also high as fibroids secrete EPO
who needs no trt? who serially measured by Ex/USS?
small/slow growing fibs
larger ones not removed but measured serially
