Fibroids

Question 1

What is this describing?

Benign tumours of the myometrium which regress after menopause due to reduction in sex hormones.

Answer 1

Fibroids

Question 2

What are the risk factors for developing fibroids?

Answer 2

1. Increasing age during reproductive years
2. Black and Asian women
3. Obesity
4. Early menarche
5. 1st degree relative

Question 3

What percentage of fibroids are asymptomatic and when are they discovered?

Answer 3

1. 50%

2. Physical or USS exam

Question 4

What are the signs and symptoms of fibroids?

Answer 4

1. Menorrhagia - heavy and prolonged
2. Anaemia
3. Dysmenorrhoea - only if torsion/sacromatous change
4. Subfertility - blockage/prevent implantation
5. Mass effect - urinary symptoms, vein compression
6. Increases obstetric malpresentation and can prevent head engagement.

Question 5

How are fibroids investigated?

Answer 5

1. Abdominal exam, bimanual exam
2. TV USS
3. FBC
4. If fertility and issue - hysterosalpingogram/hysteroscopy

Question 6

When do you treat fibroids?

Answer 6

When they are symptomatic

Question 7

What is the medical treatment for fibroids?

Answer 7

1. Tranexamic acid/NSAID 1st line but usually ineffective

2. GnRH to shrink fibroids for surgery

Question 8

What is the surgical treatment for fibroids?

Answer 8

1. Hysteroscopic for small fibroids (TCRF)
2. Myomectomy if medical failed and fertility still desired
3. Hysterectomy is the only cure
4. Uterine artery embolisation avoids anaesthetic, extremely painful, affects fertility

Question 9

What are the complications of fibroids?

Answer 9

1. 0.1% are malignant
2. Red degeneration in pregnancy - pain due to inadequate blood supply
3. Torsion of pedunculated fibroids