8. Fibroids

Question 1

What are fibroids (leiomyomata), and how common are they?

Answer 1

Fibroids are common benign tumors of the uterus, occurring in 20-40% of women over 35 years.

Question 2

Which populations have a higher incidence of fibroids?

Answer 2

Black and Oriental women have a 2 to 5 times higher incidence of fibroids compared to white women.

Question 3

What is the aetiology of fibroids?

Answer 3

The aetiology is unknown but is associated with nulliparity, persistent anovulation, obesity, and the presence of oestrogen and progesterone receptors.

Question 4

What happens to fibroids after menopause?

Answer 4

Fibroids tend to atrophy after menopause

Question 5

What is the typical pathology of fibroids?

Answer 5

Fibroids are firm, round, white, and have a whorled appearance. They are usually found in the fundus or body of the uterus, and 5% occur in the cervix

Question 6

What are the main classifications of fibroids based on their location in the uterus?

Answer 6

1. Subserous: Projecting from the peritoneal surface.
2. Intramural: Within the myometrial wall.
3. Submucous: Projecting into the uterine cavity.
4. Intraligamentary: In the broad ligament.
5. Parasitic/Wandering: Detached and receiving blood supply from other structures.

Question 7

What types of degenerative changes are common in fibroids?

Answer 7

Common degenerative changes include hyaline, cystic, calcific, and red degeneration (red degeneration occurs only in pregnancy).

Question 8

What complications can occur with pedunculated subserous fibroids?

Answer 8

Pedunculated subserous fibroids may undergo torsion.

Question 9

What complications can occur with submucous fibroids?

Answer 9

Submucous fibroids may prolapse through the cervix, mimicking an inevitable miscarriage, and may cause uterine inversion.

Question 10

How often do fibroids undergo malignant transformation?

Answer 10

Malignant (sarcomatous) transformation is very rare, occurring in less than 0.5% of cases.

Question 11

Are most fibroids symptomatic or asymptomatic?

Answer 11

Most fibroids are asymptomatic and are often found incidentally.

Question 12

What factors influence the symptoms of fibroids?

Answer 12

Symptoms depend on the site and size of the fibroids.

Question 13

What are the possible symptoms of fibroids?

Answer 13

• Abdominal swelling
• Pressure effects: leg oedema, varicose veins, urinary frequency or retention
• Increased menstrual loss: more common with submucosal fibroids
• Infertility

Question 14

How can fibroids affect pregnancy?

Answer 14

• May cause miscarriage if embryo implants over a submucous fibroid
• May increase in size or undergo red degeneration
• May cause abnormal lie or obstructed labor

Question 15

Are fibroids usually painful?

Answer 15

No, fibroids are usually painless but can be painful under certain circumstances, such as:
* Torsion
* Red degeneration
* Prolapse of a submucous fibroid
* Malignant change
* Compression of surrounding structures

Question 16

What is the differential diagnosis for a mass arising from the pelvis?

Answer 16

1. Pregnancy: intra-uterine or extra-uterine
2. Gynaecological causes:
   o Inflammatory mass
   o Endometriosis
   o Neoplastic causes, e.g., ovarian tumors
3. Non-gynaecological causes:
   o Appendix mass
   o Diverticular disease

Question 17

What is adenomyosis, and what causes it?

Answer 17

Adenomyosis is a benign condition caused by the infiltration of the outer myometrium by endometrial cells. The cause is unknown.

Question 18

What similarities do fibroids and adenomyosis share?

Answer 18

Both conditions result in heavy menstrual bleeding and an enlarged uterine mass

Question 19

How does adenomyosis differ from fibroids in terms of the affected population?

Answer 19

Adenomyosis typically occurs in women in their late 30s and 40s, who are of higher parity, whereas fibroids are not specifically linked to parity.
________________________________________

Question 20

What additional symptoms are associated with adenomyosis that are not common in fibroids?

Answer 20

Adenomyosis is associated with dysmenorrhea (painful periods) and dyspareunia (painful intercourse).