Fibroids Flashcards
What are fibroids?
- benign tumours of the smooth muscle of the uterus
- they are oestrogen sensitive (grow in response to oestrogen)
also called uterine leiomyomas
Who is affected by fibroids?
- they are very common and affect 40-60% women in later reproductive years
- they are more common in black women
What are the 4 different types of fibroid?
intramural:
- grows within the myometrium (muscle of the uterus)
- can change the shape / distort the uterus
subserosal:
- just below the outer layer of the uterus
- these can become very large and fill the abdominal cavity
submucosal:
- just below the endometrium (lining of the uterus)
pedunculated:
- grows on a stalk
What is the most common presenting feature of fibroids?
- they are often asymptomatic
- the most frequent presenting symptom is menorrhagia (heavy menstrual bleeding)
What are the other symptoms associated with fibroids?
- prolonged periods (> 7 days)
- deep dyspareunia
- abdominal pain (worse during menstruation)
- bloating / feeling full
- urinary / bowel symptoms (due to pelvic pressure / fullness)
- reduced fertility
What examination findings may be present?
abdominal examination:
- may reveal a palpable pelvic mass
bimanual examination:
- may reveal an enlarged firm non-tender uterus
What are the initial investigations for fibroids?
- hysteroscopy is the initial investigation for submucosal fibroids presenting with menorrhagia
- pelvic USS is the initial investigation for larger fibroids
What type of scan may be performed in fibroids and why?
MRI
- can be performed prior to surgery
- provides more information about the size, shape + blood supply of the fibroids
What is the medical management for fibroids less than 3cm?
- Mirena coil is first line (fibroids must be < 3cm with no distortion of the uterus)
- symptomatic management with NSAIDs + tranexamic acid
- COCP
- cyclical oral progestogens
this is the same as the management for menorrhagia (heavy menstrual bleeding)
What are the surgical options for smaller fibroids?
- endometrial ablation
- resection of submucosal fibroids during hysteroscopy
- hysterectomy
What is involved in the management of fibroids > 3cm?
- medical management is the same as for smaller fibroids
surgical options:
- uterine artery embolisation
- myomectomy
- hysterectomy
mirena coil may not be appropriate if uterus is distorted / fibroids are too large
What medication may be given prior to fibroid surgery and why?
GnRH agonists:
- e.g. goserelin / leuprorelin
- they are given to shrink the fibroids prior to surgery
- they should only be used short-term
- they work by inducing a medical menopause
- this reduces the amount of oestrogen maintaining the fibroid
What is involved in uterine artery embolisation?
- a catheter is inserted into the femoral artery
- it is passed through to the uterine artery under XR guidance
- particles are injected to cause a blockage in the arterial supply to the fibroid
- this deprives it of oxygen + causes it to shrink
What is involved in myomectomy?
What is the benefit to this procedure?
- the fibroid is surgically removed via laparoscopic surgery or laparotomy
- it is the only treatment known to potentially improve fertility
What is involved in endometrial ablation?
- this involves destruction of the endometrium
- usually involves balloon thermal ablation
- a balloon is inserted into the endometrial cavity and filled with high-temperature fluid to burn the lining of the uterus
What is red degeneration of the fibroid?
ischaemia, infarction and necrosis of the fibroid due to a disrupted blood supply
