Female reproductive system part 2

Question 1

What are fibroids ?

Answer 1

Non - cancerous growths that develop in and around the uterus .

• Made up of fibrous connective tissue ( vs polyps - growths of the endometrium )

cause not known but have been Linked to oestrogen
usually develop between 16 and 50 - when oestrogen levels are highest.

Tend to strink during menopause with oestrogen is low.

• Found more frequently in African American women, Overweight women (higher level of oestrogen )
• Risk decreases if you have had children , decrease more if the more children you have.

Question 2

Types of Fibroids ?

Answer 2

0 intramural fibroids – the most common type of fibroid, which develop in the muscle wall of the womb

0 subserosal fibroids – fibroids that develop outside the wall of the womb into the pelvis and can become very large

0 submucosal fibroids – fibroids that develop in the muscle layer beneath the womb’s inner lining and grow into the cavity of the womb

*In some cases, subserosal or submucosal fibroids are attached to the womb with a narrow stalk of tissue. These are known as pedunculated fibroids.

Question 3

Management of fibroids ?

Answer 3

If imaging shows the presence of uterine fibroids, appropriate treatment should be planned with the woman, based on the size, number, and location of the fibroids and her symptoms.
Refer to a specialist, women with:

0 Complications, such as compressive symptoms from large fibroids (for example dyspareunia, pelvic pain or discomfort, constipation, or urinary symptoms).

0 Fertility or obstetric problems associated with fibroids — for more information, see the CKS topic on Infertility.

0 A clinical or radiological suspicion of malignancy.
Fibroids which are palpable abdominally, or intracavity fibroids and/or whose uterine length is measured at ultrasound, or hysteroscopy, greater than 12 cm.

For women with fibroids that are asymptomatic:
The majority of women require no further investigation or treatment once diagnosed unless there is rapid growth or reason to suspect pelvic malignancy.
Arrange annual follow up to monitor size and growth.
For women with menorrhagia associated with fibroids, see the CKS topic on Menorrhagia for management information.

Question 4

Differtial diagnosis of fibroids ?

Answer 4

Malignant causes of a pelvic mass include:
- Ovarian cancer.
- Endometrial carcinoma.
- recognition and referral.
Uterine sarcoma (for example, leiomyosarcoma).
- Gastrointestinal, or urinary tumour. recognition

Benign causes of a pelvic mass include:
0 Endometrial polyp.

0 Endometrial
0 hyperplasia.
0 Adenomyosis - endometrium breaks through into muscle wall.

Other causes of a pelvic mass include:
Pregnancy.
Full bladder.

Question 5

Treatment of fibroids ?

Answer 5

Surgery - remove fibroids fr severe symptoms or non- response to medications.
Hysterectomy - complete removal of the womb ( if you have large bleeding aont eant anymore children

  Myoectomy - remove of fiboids from wall of womb - not suitable for all fibroids