67. Uterine myoma . Treatment methods. Flashcards
what is uterine myoma ?
benign smooth muscle tumors of the uterus - lieyomyoma / fibroids
what is the cause of uterine fibroids ?
dependant on estrogen for growth - menopause they shrink
genetic mutation translocations , familial history
risk factors : older women nullipara , early menarche , late menopause not breastfeeding tamoxifen obesity red meat
what are the main factor that determine if uterine fibroid leads to symptoms ?
growth and location
small lesion can be symptomatic located in uterine cavity
while large lesion outside of uterus may be asymptomatic
what are the classification of uterine fibroid according to location ?
Subserosal leiomyoma: localized in the outer uterine wall beneath the peritoneal surface
sessile or pedunculated and grow out of the uterine wall.
Intramural leiomyoma (most common): growing from within the myometrium
Submucosal leiomyoma: localized directly below the endometrial layer (uterine mucosa)
can cause pain
(miscarriage )
sessile or pedunculated. If pedunculated, may protrude through the cervical os. Leiomyomas that bulge out of the cervical os may undergo torsion and infarction
Diffuse uterine leiomyomatosis: The uterus is grossly enlarged due to the presence of numerous fibroids
which hormone has a key link to uterine fibroid growth ?
estrogen - has estrogen receptors
because estrogen has a key link to uterine fibroids are not common in whom ?
uncommon before puberty and after menopause
when does fibroid growth increase other than during menses period ?
pregnancy
if submucosal fibroids become pedunculate what happens?
present in the vagina through the cervix
what happens if there is a large submucosal fibroid ?
may push down the cervix
what are the signs and symptoms of uterine fibroids ?
asymptomatic most common
abnormal uterine bleeding hypermenorrhea
dysmenorrhea
pelvic pain
pain during intercourse - Anterior or fundal fibroids
urinary symptoms - urgency and frequency , incontinence
INFERTILITY
complication of uterine fibroids
INFERTILITY
pregnancy - miscarriage - sub mucous and malpresentation
acute abdomen pain by :
torsion , erosion , degenrating , infection
blood loss can lead to anemia
in pregnancy occurs during the 2nd trimester - red degeneration - torsion/ pressure - ischemic hemorrhagic infraction
increase risk for PPH
peurperium - sub involution - secondary pph
increased risk for sepsis
how do we diagnose uterine fibroids ?
pelvic examination - firm nodular mass which is mobile side to side and not tender
Enlarged, firm and irregular uterus during bimanual pelvic examination
US - hypoechoic lesion
Calcifications or cystic areas suggest necrosis
saline infusion sonography - help differentiate sub mucous from intramural fibroids
hysteroscpy
MRI most accurate - differentiate between adenomyoma and leiyomyoma
what is the clinical magament of fibroid if asymptomatic ??
regular follow up every 6 months
routine pelvic examination
baseline imagine to compare regression or growth
what is the clinical management of uterine fibroid that is symptomatic
pain relief - NSAIDS
to relive hypermenorrhea and dysmenorrhea - does not treat fibroid
progestogen releasing IUD - levonorgestrel
reduce heavy bleeding -tranexamic acid -antifirbinolytic
Androgenic agonists (e.g., danazol): side effects - acne and hairless
=====
to decrease size
mifepristone - antiprogeteron
GnRH agonist-NOT USED OTHER THAN PREOPERATIVE (reduce estrogen- osteoporosis, hot flushes and depression)
selective estrogen receptor modulators
=====
Continued heavy bleeding and/or severe pain with insufficient response to medical treatment
Contraindications to surgery or personal preference to avoid surgery
No wish to conceive in the future
uterine artery embolisation supplying the uterine fibroid
=======
laparoscopic or hysteroscopic myomectomy
other methods :
radioofrequency ablation
====
hysterectomy
uterine artery embolisation is contraindicated in ?
desire for pregnancy
pregnant
active infection
suspicion for malignancy
