FIBROIDS Flashcards
What are fibroids?
Benign tumours of the myometrium.
What percentage of women over 40 will have fibroids?
50%
What is the histological description of fibroids?
Spiralled bundles of smooth muscle
What is the more medical name for fibroids?
Uterine leiomyoma
What are the risk factors for developing fibroids?
African-Caribbean
Increasing age
Nulligravidity
Obesity
What are the protective factors for developing fibroids?
Cigarette smoking
Use of combined oral contraceptive pill
Full term pregnancy
What are the symptoms associated with fibroids?
Approx 50% of women with fibroids will be asymptomatic.
Heavy periods - menorrhagia
Intermenstrual bleeding
Postcoital bleeding
Continuous bleeding
Abdominopelvic mass
Pain
Subfertility
Urinary frequency
Nocturia
Urgency
What are the complications of fibroids?
Degeneration Torsion of pedunculated fibroids Malignancy Infertility Obstructed labour Risk of PPH (Post-Partum Haemorrhage) Blockage of ureters
With regard to fibroids, what is red degeneration?
In weeks 12-22 of pregnancy, the blood supply to the fibroid can be interrupted, causing it to turn red and die. This causes severe pain and can lead to premature labour or even miscarriage due to massive release of prostaglandins.
What is the malignancy associated with fibroids?
Leiomyosarcoma
What does the term pedunculated mean with regard to fibroids?
When they have come through the cervix dragging the endometrium with it.
Why would you do U&Es in someone with fibroids?
Renal problems due to blockage of ureters
What investigations would you do in a patient with suspected fibroids?
FBC - aneamia
U&Es
Ultrasound
MRI
How might you differentiate between a fibroid from other pelvic masses?
MRI
When would you treat a patient with fibroids?
If they were symptomatic
If they were rapidly enlarging
If they are thought to be causing infertility
What are the medical therapies used as adjuncts to surgery in the management of fibroids?
Gonadotrophin-releasing hormone analogues - lead to a temporary reversible menopausal state, which can lead to a reduction in fibroid size by 50%
For what period of time are gonadotrophin-releasing hormone analogues licenced to be used for?
6 months maximum
What are the three surgical types of definitive surgery used in the treatment of fibroids?
Transcervical resection of fibroids (TCRF)
Myomectomy
Hysterectomy
What types of fibroid would transcervical resection of fibroids (TCRF) be the suitable of surgery for?
Submucous fibroids
What types of fibroids would myomectomy be the suitable choice of surgery for?
Pedunculated
Subserosal
Intramural fibroids
What are the possible complications of myomectomy?
Haemorrhage
Adhesion formation which may impair future fertility (especially posterior wall fibroids)
In what proportion of women who have a myomectomy to treat fibroids do fibroids return?
40%
Other than definitive surgical treatment of fibroids, what other newer procedures can be done to treat fibroids?
Uterine artery embolization
Interstitial laser photocoagulation
Laporoscopic diathermy
Directed high energy ultrasound
