Fiboids (leimyoma) Flashcards
What is fibroids? (aetiology, types, changes, RF)
Benign tumours arising of myometrium types–
submucosal, intramural or subserosal
they can change - Hyaline degen, calcification (post menopause), red degeneration-coag necrosis in pregnancy (v bad)
aetiologgy - hormone dependent - lot of receptors
enlarge in pregnancy and shrink in menopause
1/3 women ofa ge
RF /Protective BONE/SMC B-Black O-obese N-nullparity E-expecting (preg)
S-Smoke
M-mutliparity
C-COCP
Sx and Ix of fibroids
Sx - astymotamic -
Sx - DUB, miscarriage, subfertility, pain, mennorgahea
on exam - abdo swell, pressure sx of bowel and bladder
can palp pelvic masses
Ix - like DUB ones
1st line TVUSS -
if 4mm when not expected -> hysteroscopy
Mx of firboids
IF none identified, fibroids<3cm, suspected adenomyosi -see DUB (tranexamic and mefanemic acid)
Fibroids> 3cm—
1stline non hormonal (non conta)- Tranexamic, Mefanemic
1st line hormonal (contraceptive)- COCP, cyclical oral proestorrens
surgical
short term before surg- inject GnRh agonist- induces menopause (short term)-SE of menopause
Ulipristal acetate-shrinks firboids (doesnt induce menopause)-but not as popular
surgeries - Hystescopies (small submucosal)
Mymectomy (best to improve fertility)
open or lapro- SE of bleed and risk of c section/Uterine rupture
Hysterctomies, endometrial ablation (removes fertility, contaception needed)
Radiological—-
Uterine artery embolisation- may preserve fertility- infarct the firboids
Complications and prognosis of fribroids
Pregancy - red degeneration causing misscariage, malpresentation, PTL, PPJ
(Sx- low fever, pain, vomit)
Mx- conservative
Leiomyosarcoma- <1 in 100000 VERY rare SMC cancer
Prognosis-10 year reccurence of 20%
