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4: Y4 - Gynaecology [8] > [31] Fibroids > Flashcards

[31] Fibroids Flashcards

1
Q

What are uterine fibroids also known as?

A

Leiomyomas

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2
Q

What are uterine fibroids?

A

Benign smooth muscle tumours of the uterus

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3
Q

How common are uterine fibroids compared to other benign tumours in women?

A

They are the most common

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4
Q

What is the estimated incidence of fibroids?

A

20-40%

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5
Q

What is the risk of a fibroid becoming malignant?

A

0.1%

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6
Q

What do fibroids arise from?

A

The myometrium of the uterus

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7
Q

What are fibroids classified based on?

A

Their position in the uterine wall

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8
Q

What are the classifications of fibroids?

A
  • Intramural
  • Submucosal
  • Subserosal
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9
Q

What is the most common type of fibroid?

A

Intramural

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10
Q

Where is an intramural fibroid found?

A

Confined to myometrium of the uterus

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11
Q

Where is a submucosal fibroid?

A

Develops immediately underneath the endometrium of the uterus, and protrudes into the uterine cavity

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12
Q

Where is a subserosal fibroid?

A

Protrudes into and distorts the serosal surface of the uterus

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13
Q

What is the serosal surface of the uterus?

A

The outer surface

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14
Q

What might be a feature of subserosal fibroids?

A

May be pedunculated (on a stalk)

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15
Q

Describe the pathogenesis of fibroids?

A

Poorly understood, but their growth is thought to be stimulated by oestrogen

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16
Q

What are the risk factors for fibroids?

A
  • Obesity
  • Early menarche
  • Increasing age
  • Family history
  • Ethnicity
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17
Q

How much does a family history of fibroids increase the risk?

A

Women with a 1st degree relative carry a 2.5x increased risk

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18
Q

How does ethnicity affect the risk of fibroids?

A

African-Americans are 3x more likely than Caucasians

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19
Q

How are the majority of cases of fibroids discovered?

A

Women are asymptomatic, and the fibroids are discovered incidentally on pelvic or abdominal examination

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20
Q

If symptomatic, how may fibroids present?

A
  • Pressure symptoms +/- abdominal distention
  • Heavy menstrual bleeding
  • Subfertility
  • Acute pelvic pain (rare)
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21
Q

What pressure symptoms may be present in fibroids?

A
  • Urinary frequency

- Chronic retention

22
Q

Why might sub fertility be a sign of fibroids?

A

Due to the obstructive effect of the fibroid

23
Q

What might cause acute pelvic pain in fibroids?

A
  • Red degeneration

- Pedunculated fibroids can undergo torsion

24
Q

When can red degeneration of fibroids occur?

A

In pregnancy

25
Q

What is red degeneration of fibroids?

A

Where rapidly growing fibroid undergoes necrosis and haemorrhage

26
Q

What may be found on examination in fibroids?

A

A solid mass or enlarged uterus may be palpable on abdominal or bimanual examination. The uterus is normally non-tender

27
Q

What are the differential diagnoses of fibroids?

A
  • Endometrial polyp
  • Ovarian tumours
  • Leiomyosarcoma
  • Adenomyosis
28
Q

What is leiomyosarcoma?

A

Malignancy of myometrium

29
Q

What is adenomyosis?

A

Presence of functional endometrial tissue within the myometrium

30
Q

What is the main investigation for suspected fibroids?

A

Imaging

31
Q

What imaging may be done in suspected fibroids?

A
  • Pelvic ultrasound

- MRI

32
Q

When is MRI used in suspected fibroids?

A

Rarely used, unless sarcoma is suspected

33
Q

When are blood tests used in fibroids?

A

Usually reserved for patients where the diagnosis is unclear, or as a pre-operative work-up if surgery is indicated

34
Q

What can the management of fibroids be divided into?

A
  • Medical

- Surgical

35
Q

What is involved in the medical management of fibroids?

A
  • Transexamic or mefanamic acid
  • Hormonal contraceptives
  • GnRH analogues
  • Selective Progesterone Receptor Modulators
36
Q

What are hormonal contraceptives useful for in fibroids?

A

Controlling menorrhagia

37
Q

What hormonal contraceptives can be used in fibroids?

A
  • COCP
  • POP
  • Mirena IUS
38
Q

Give an example of a GnRH analogue

A

Zolidex

39
Q

What do GnRH analogues do?

A

Suppress ovulation, inducing a temporary menopausal state

40
Q

When are GnRH analogues useful in fibroids?

A

Pre-operatively

41
Q

Why are GnRH analogues useful pre-operatively in fibroids?

A

They reduce fibroid size and lower complications

42
Q

How long can GnRH analogues be used for?

A

6 months

43
Q

Why can GnRH analogues only be used for 6 months?

A

Due to risk of osteoporosis

44
Q

Give 2 examples of selective progesterone receptor modulators (SERMs)

A
  • Ulipristal

- Esmya

45
Q

What do SERMs do in fibroids?

A

Reduces size of fibroid and menorrhagia

46
Q

When are SERMs useful in the management of fibroids?

A

Pre-operatively or as an alternative to surgery

47
Q

What are the surgical options for the treatment of fibroids?

A
  • Hysteroscopy and transcervical resection of fibroid (TCRF)
  • Myomectomy
  • Uterine artery embolism (UAE)
  • Hysteroscopy
48
Q

What is TCRF useful for?

A

Submucosal fibroids

49
Q

Who is myomectomy a good option for?

A

Women wanting to preserve their uterus

50
Q

Who performs uterine artery embolism?

A

Radiologists

51
Q

What artery is used for uterine artery embolisation?

A

Femoral artery

52
Q

What does UAE commonly cause post-operatively?

A
  • Pain

- Fever

4: Y4 - Gynaecology [8] (52 decks)

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