Fibroids Flashcards
What are fibroids?
Benign smooth muscle tumours of the myometrium of the uterus
What age are women more likely to get fibroids?
Women in later reproductive years
In which race are fibroids more common?
Afro-Caribbean
What do fibroids develop in response to?
Oestrogen
How do fibroids present normally?
Asymptomatically
What menstrual dysfunction occurs due to fibroids?
Menorrhagia
Dysmenorrhoea
What might fibroids result in?
Iron-deficiency anaemia
What could occur if the fibroids are large enough
Subfertility
How are fibroids diagnosed?
Transvaginal ultrasound
What would you do if a transvaginal ultrasound is not detailed enough?
MRI
What would you do if there was doubt over the diagnosis of fibroids?
Biopsy
differentiate from endometrial cancer
What is the management of fibroids if they are asymptomatic?
No treatment
Periodic review to monitor size and growth
When would you use medical management for fibroids?
Abnormal bleeding
Under 3cm
No uterine distortion
What is the first line symptomatic management of fibroids?
The Minera coil
What is the medical management of fibroids if the patient wants to stay fertile?
NSAID’s
Anti-fibrinolytic
When would you need to surgically manage fibroids?
When there are symptoms due to mass effect of the fibroids
What are possible mass effects of the fibroid?
Pressure on the bladder
What are possible surgical managements of fibroids?
Myomectomy
Ablation
Uterine artery embolisation
What happens to fibroids after menopause?
They generally regress after menopause
What are complications of fibroids?
Subfertility
Iron-deficiency anaemia
Red degeneration
What is menorrhagia?
Heavy menstrual flow lasting more than 7 days with severe cramping
What is dysmenorrhoea?
Lower abdominal pain just before or during menstruation
What medical management can be used to shrink/remove fibroids?
GnRH agonists
What are the possible side effects of GnRH agonists?
Menopausal symptoms- hot flushes and vaginal dryness
Loss of bone mineral density
What are the main 3 symptoms of fibroids?
Menorrhagia
Pain
Subfertility
What is the main complication of fibroids?
Red degeneration
What is red degeneration?
Haemorrhage into tumour - commonly occurs during pregnancy
What can be used to manage menorrhagia due to fibroids?
- Mirena coil
- mefenamic acid (NSAID)
- tranexamic acid
- COCP or POP or progesterone injection
What are the different surgical managements of fibroids?
myomectomy
hysterocopic endometrial ablation
hysterectomy
What is the management of fibroids in a young person not ready to start a family?
COCP or Minera coil
What is the management of fibroids in a woman who is subfertile and trying to start a family?
Myomectomy
What is the management of a woman who wants to reduce the size of the masses while waiting for surgery ?
GnRH agonist
(e.g. Triptorelin)
When might urterine artery embolisation be done?
In people who don’t desire fertility- can still get pregnant after but not recommended as can cause infertility
