Fibroids

Question 1

What are fibroids (leiomyomas) ?

Answer 1

Benign smooth muscle tumours of the uterus

Question 2

What is the incidence of fibroids?

Answer 2

20-40%

Question 3

What is the risk of a fibroid becoming malignant?

Answer 3

0.1%

Question 4

Where do fibroids arise from?

Answer 4

Myometrium

Question 5

How are fibroids classified?

Answer 5

By position in the uterine wall

Question 6

What is the most common type of fiborid?

Answer 6

Intramural

Question 7

Describe intramural fibroids

Answer 7

Confined to the myometrium of the uterus

Question 8

Describe submucosal fibroid

Answer 8

Develops immediately underneath the endometrium of the uterus and protrudes into the uterine cavity

Question 9

Describe subserosal fibroid

Answer 9

Protrudes into and distorts the serosal surface of the uterus
May be pedunculated (on a stalk)

Question 10

What is the growth of fibroids thought to be stimulated by?

Answer 10

Oestrogen

Question 11

List the risk factors for developing fibroids

Answer 11

Obesity 
Early menarche
Increasing age
FH - 2.5x risk if 1st degree relative
Ethnicity - African American X3 than Caucasians

Question 12

Describe the features from the history of a woman with firboids

Answer 12

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

Question 13

What is red degeneration

Answer 13

Rapidly growing fibroid undergoes necrosis and haemorrhage

Question 14

What is found on examination of fibroids

Answer 14

Solid mass
Enlarged uterus
Non-tender uterus

Question 15

What are the differentials for an uterine fibroid

Answer 15

Endometrial polyp
Ovarian tumour
Leiomyosarcoma
Adenomyosis

Question 16

What is adenomyosis?

Answer 16

Presence of functional endometrial tissue within the myometrium

Question 17

What is leiomyosarcoma

Answer 17

Malignancy of myometrium

Question 18

Describe the investigations for fibroids

Answer 18

Imaging - pelvic USS, MRI rarely required unless sarcoma suspected
Blood tests - unclear diagnosis or surgery pre-op workup

Question 19

Describe the medical management of fibroids

Answer 19

Tranexamic or mefanmic acid

Hormonal contraceptives - COCP, POP, IUS

GnRH analogues

Selective progesterone receptor modulators (ulipristal/esmya)

Question 20

Describe GnRH analogue use in treatment of fibroids

Answer 20

Supresses ovulation, inducing temporay menopause

Used pre-operatively to reduce fibroid size and lower complications

Question 21

How long can GnRH analogues be used for and why?

Answer 21

<6 months

Osteoporosis risk

Question 22

Describe the use of selective progesterone receptor modulators in the treatment of fibroids

Answer 22

Reduces fibroid size and menorrhagia

Used pre-operatively or as an alternative to surgery

Question 23

Describe the surgical treatment of fibroids

Answer 23

Hysteroscopy and transcervical resection of fibroid

Myomectomy

Uterine artery emolisation

Hysterectomy

Question 24

Which fibroids is transcervical resection of fibroid most useful for?

Answer 24

Submucosal

Question 25

In which women is myomectomy a good option for?

Answer 25

Those wanting to preserve their uterus

Question 26

Describe uterine artery embolisation

Answer 26

Performed by a radiologist via the femoral artery

Question 27

What are some common post op side effects of uterine artery embolisation

Answer 27

Pain

Fever