Fibroids Flashcards
Medical term for fibroids
Leiomyoma - benign tumour of the smooth muscle of the uterus
Epidemiology of fibroids
1/5th of white and 1/2 of Afro-carribean women esp in later reproductive years
Symptoms of fibroids
Can be ASYMPTOMATIC
Or:
Heavy menstrual bleeding + IDA symptoms
Abdo bloating + crampy pain during menstruation
Increased urinary frequency if pressing on bladder
Bowel problems e.g. painful defecation, constipation
SUBFERTILITY
Obstetric complications - miscarriages, premature labour, obstructive delivery
TWO main complications of fibroids
Anaemia
Subfertility
Diagnosis
TVUSS
(also MRI)
Management options for MENORRHAGIA
Menorrhagia Mx
IUS - Levonorgestrel intrauterine system COIL
Tranexamic acid / Mefenamic acid
COCP or Oral/injectable progestogen
Management options to shrink or remove the fibroids + which of these is ok for preserving fertility
Medical
GnRH agonists (short term) - Goserelin
Surgical
- myomectomy (esp if they want to get pregnant later)
- endometrial ablation (not good if they want to get pregnant)
- hysterectomy
- uterine artery embolisation (to remove blood supply to the fibroid)
What transition occurs during pregnancy with a fibroid?
Red degeneration - when the fibroid outgrows its blood supply in pregnancy, leading to ischemia, infarction and necrosis.
How does a pt with fibroid red degeneration present?
Pregnant
Severe abdo pain
Low grade fever
What percentage of fibroids become malignant?
Less than one percent
Risk of myomectomy
Life threatening bleeding needing a hysterectomy
Endometrial ablation risk
Future infertility
Best option for preserving fertility
Myomectomy
Why isn’t goserelin given long term?
Can cause menopause like symptoms such as hot flushes and vaginal dryness
How would you describe uterine artery embolisation to a patient?
Under x ray guidance, a small tube is passed into the uterine arteries and some small particles are delivered to block off the blood supply to the fibroid.
NO scars
Minimally invasive
Done under LA