Fibroids Flashcards
What are fibroids (leiomyomas) ?
Benign smooth muscle tumours of the uterus
What is the incidence of fibroids?
20-40%
What is the risk of a fibroid becoming malignant?
0.1%
Where do fibroids arise from?
Myometrium
How are fibroids classified?
By position in the uterine wall
What is the most common type of fiborid?
Intramural
Describe intramural fibroids
Confined to the myometrium of the uterus
Describe submucosal fibroid
Develops immediately underneath the endometrium of the uterus and protrudes into the uterine cavity
Describe subserosal fibroid
Protrudes into and distorts the serosal surface of the uterus
May be pedunculated (on a stalk)
What is the growth of fibroids thought to be stimulated by?
Oestrogen
List the risk factors for developing fibroids
Obesity Early menarche Increasing age FH - 2.5x risk if 1st degree relative Ethnicity - African American X3 than Caucasians
Describe the features from the history of a woman with firboids
Asymptomatic
Pressure symptoms +/- abdominal distension - urinary frequency or chronic retention
Heavy menstrual bleeding
Subfertility - obstructive effect
Acute pelvic pain is rare by may occur in pregnancy due to red degeneration or sometimes pedunculated fibroid may undergo torsion
What is red degeneration
Rapidly growing fibroid undergoes necrosis and haemorrhage
What is found on examination of fibroids
Solid mass
Enlarged uterus
Non-tender uterus
What are the differentials for an uterine fibroid
Endometrial polyp
Ovarian tumour
Leiomyosarcoma
Adenomyosis
What is adenomyosis?
Presence of functional endometrial tissue within the myometrium
What is leiomyosarcoma
Malignancy of myometrium
Describe the investigations for fibroids
Imaging - pelvic USS, MRI rarely required unless sarcoma suspected
Blood tests - unclear diagnosis or surgery pre-op workup
Describe the medical management of fibroids
Tranexamic or mefanmic acid
Hormonal contraceptives - COCP, POP, IUS
GnRH analogues
Selective progesterone receptor modulators (ulipristal/esmya)
Describe GnRH analogue use in treatment of fibroids
Supresses ovulation, inducing temporay menopause
Used pre-operatively to reduce fibroid size and lower complications
How long can GnRH analogues be used for and why?
<6 months
Osteoporosis risk
Describe the use of selective progesterone receptor modulators in the treatment of fibroids
Reduces fibroid size and menorrhagia
Used pre-operatively or as an alternative to surgery
Describe the surgical treatment of fibroids
Hysteroscopy and transcervical resection of fibroid
Myomectomy
Uterine artery emolisation
Hysterectomy
Which fibroids is transcervical resection of fibroid most useful for?
Submucosal
In which women is myomectomy a good option for?
Those wanting to preserve their uterus
Describe uterine artery embolisation
Performed by a radiologist via the femoral artery
What are some common post op side effects of uterine artery embolisation
Pain
Fever
