Fibroids

Question 1

What are fibroids?

Answer 1

Benign smooth muscle tumours of the myometrium of the uterus

Question 2

What age are women more likely to get fibroids?

Answer 2

Women in later reproductive years

Question 3

In which race are fibroids more common?

Answer 3

Afro-Caribbean

Question 4

What do fibroids develop in response to?

Answer 4

Oestrogen

Question 5

How do fibroids present normally?

Answer 5

Asymptomatically

Question 6

What menstrual dysfunction occurs due to fibroids?

Answer 6

Menorrhagia

Dysmenorrhoea

Question 7

What might fibroids result in?

Answer 7

Iron-deficiency anaemia

Question 8

What could occur if the fibroids are large enough

Answer 8

Subfertility

Question 9

How are fibroids diagnosed?

Answer 9

Transvaginal ultrasound

Question 10

What would you do if a transvaginal ultrasound is not detailed enough?

Answer 10

MRI

Question 11

What would you do if there was doubt over the diagnosis of fibroids?

Answer 11

Biopsy

differentiate from endometrial cancer

Question 12

What is the management of fibroids if they are asymptomatic?

Answer 12

No treatment

Periodic review to monitor size and growth

Question 13

When would you use medical management for fibroids?

Answer 13

Abnormal bleeding
Under 3cm
No uterine distortion

Question 14

What is the first line symptomatic management of fibroids?

Answer 14

The Minera coil

Question 15

What is the medical management of fibroids if the patient wants to stay fertile?

Answer 15

NSAID’s

Anti-fibrinolytic

Question 16

When would you need to surgically manage fibroids?

Answer 16

When there are symptoms due to mass effect of the fibroids

Question 17

What are possible mass effects of the fibroid?

Answer 17

Pressure on the bladder

Question 18

What are possible surgical managements of fibroids?

Answer 18

Myomectomy
Ablation
Uterine artery embolisation

Question 19

What happens to fibroids after menopause?

Answer 19

They generally regress after menopause

Question 20

What are complications of fibroids?

Answer 20

Subfertility
Iron-deficiency anaemia
Red degeneration

Question 21

What is menorrhagia?

Answer 21

Heavy menstrual flow lasting more than 7 days with severe cramping

Question 22

What is dysmenorrhoea?

Answer 22

Lower abdominal pain just before or during menstruation

Question 23

What medical management can be used to shrink/remove fibroids?

Answer 23

GnRH agonists

Question 24

What are the possible side effects of GnRH agonists?

Answer 24

Menopausal symptoms- hot flushes and vaginal dryness
Loss of bone mineral density

Question 25

What are the main 3 symptoms of fibroids?

Answer 25

Menorrhagia
Pain
Subfertility

Question 26

What is the main complication of fibroids?

Answer 26

Red degeneration

Question 27

What is red degeneration?

Answer 27

Haemorrhage into tumour - commonly occurs during pregnancy

Question 28

What can be used to manage menorrhagia due to fibroids?

Answer 28

• Mirena coil
• mefenamic acid (NSAID)
• tranexamic acid
• COCP or POP or progesterone injection

Question 29

What are the different surgical managements of fibroids?

Answer 29

myomectomy
hysterocopic endometrial ablation
hysterectomy

Question 30

What is the management of fibroids in a young person not ready to start a family?

Answer 30

COCP or Minera coil

Question 31

What is the management of fibroids in a woman who is subfertile and trying to start a family?

Answer 31

Myomectomy

Question 32

What is the management of a woman who wants to reduce the size of the masses while waiting for surgery ?

Answer 32

GnRH agonist
(e.g. Triptorelin)

Question 33

When might urterine artery embolisation be done?

Answer 33

In people who don’t desire fertility- can still get pregnant after but not recommended as can cause infertility