[31] Fibroids Flashcards
What are uterine fibroids also known as?
Leiomyomas
What are uterine fibroids?
Benign smooth muscle tumours of the uterus
How common are uterine fibroids compared to other benign tumours in women?
They are the most common
What is the estimated incidence of fibroids?
20-40%
What is the risk of a fibroid becoming malignant?
0.1%
What do fibroids arise from?
The myometrium of the uterus
What are fibroids classified based on?
Their position in the uterine wall
What are the classifications of fibroids?
- Intramural
- Submucosal
- Subserosal
What is the most common type of fibroid?
Intramural
Where is an intramural fibroid found?
Confined to myometrium of the uterus
Where is a submucosal fibroid?
Develops immediately underneath the endometrium of the uterus, and protrudes into the uterine cavity
Where is a subserosal fibroid?
Protrudes into and distorts the serosal surface of the uterus
What is the serosal surface of the uterus?
The outer surface
What might be a feature of subserosal fibroids?
May be pedunculated (on a stalk)
Describe the pathogenesis of fibroids?
Poorly understood, but their growth is thought to be stimulated by oestrogen
What are the risk factors for fibroids?
- Obesity
- Early menarche
- Increasing age
- Family history
- Ethnicity
How much does a family history of fibroids increase the risk?
Women with a 1st degree relative carry a 2.5x increased risk
How does ethnicity affect the risk of fibroids?
African-Americans are 3x more likely than Caucasians
How are the majority of cases of fibroids discovered?
Women are asymptomatic, and the fibroids are discovered incidentally on pelvic or abdominal examination
If symptomatic, how may fibroids present?
- Pressure symptoms +/- abdominal distention
- Heavy menstrual bleeding
- Subfertility
- Acute pelvic pain (rare)
What pressure symptoms may be present in fibroids?
- Urinary frequency
- Chronic retention
Why might sub fertility be a sign of fibroids?
Due to the obstructive effect of the fibroid
What might cause acute pelvic pain in fibroids?
- Red degeneration
- Pedunculated fibroids can undergo torsion
When can red degeneration of fibroids occur?
In pregnancy
What is red degeneration of fibroids?
Where rapidly growing fibroid undergoes necrosis and haemorrhage
What may be found on examination in fibroids?
A solid mass or enlarged uterus may be palpable on abdominal or bimanual examination. The uterus is normally non-tender
What are the differential diagnoses of fibroids?
- Endometrial polyp
- Ovarian tumours
- Leiomyosarcoma
- Adenomyosis
What is leiomyosarcoma?
Malignancy of myometrium
What is adenomyosis?
Presence of functional endometrial tissue within the myometrium
What is the main investigation for suspected fibroids?
Imaging
What imaging may be done in suspected fibroids?
- Pelvic ultrasound
- MRI
When is MRI used in suspected fibroids?
Rarely used, unless sarcoma is suspected
When are blood tests used in fibroids?
Usually reserved for patients where the diagnosis is unclear, or as a pre-operative work-up if surgery is indicated
What can the management of fibroids be divided into?
- Medical
- Surgical
What is involved in the medical management of fibroids?
- Transexamic or mefanamic acid
- Hormonal contraceptives
- GnRH analogues
- Selective Progesterone Receptor Modulators
What are hormonal contraceptives useful for in fibroids?
Controlling menorrhagia
What hormonal contraceptives can be used in fibroids?
- COCP
- POP
- Mirena IUS
Give an example of a GnRH analogue
Zolidex
What do GnRH analogues do?
Suppress ovulation, inducing a temporary menopausal state
When are GnRH analogues useful in fibroids?
Pre-operatively
Why are GnRH analogues useful pre-operatively in fibroids?
They reduce fibroid size and lower complications
How long can GnRH analogues be used for?
6 months
Why can GnRH analogues only be used for 6 months?
Due to risk of osteoporosis
Give 2 examples of selective progesterone receptor modulators (SERMs)
- Ulipristal
- Esmya
What do SERMs do in fibroids?
Reduces size of fibroid and menorrhagia
When are SERMs useful in the management of fibroids?
Pre-operatively or as an alternative to surgery
What are the surgical options for the treatment of fibroids?
- Hysteroscopy and transcervical resection of fibroid (TCRF)
- Myomectomy
- Uterine artery embolism (UAE)
- Hysteroscopy
What is TCRF useful for?
Submucosal fibroids
Who is myomectomy a good option for?
Women wanting to preserve their uterus
Who performs uterine artery embolism?
Radiologists
What artery is used for uterine artery embolisation?
Femoral artery
What does UAE commonly cause post-operatively?
- Pain
- Fever
