fibroids Flashcards
What are they
smooth muscle tumours of the uterus
Who are they prevalent in
They are thought to occur in around 20% of white and around 50% of black women in the later reproductive years.
Develop in response to what
Oestrogen
What are the symptoms
may be asymptomatic
- menorrhagia
- bulk-related symptoms
- subfertility
- rare features:
What can menorrhagia result in
may result in iron-deficiency anaemia
What are the bulk related symptoms
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
What are the rare features
polycythaemia secondary to autonomous production of erythropoietin
How to diagnose
transvaginal ultrasound
What is the treatment for asymptomatic fibroids
no treatment is needed other than periodic review to monitor size and growth
Management of menorrhagia secondary to fibroids
levonorgestrel intrauterine system (LNG-IUS)
useful if the woman also requires contraception
cannot be used if there is distortion of the uterine cavity
What medications given for menorrhagia management
NSAIDs e.g. mefenamic acid
tranexamic acid
combined oral contraceptive pill
oral progestogen
injectable progestogen
How to medically shrink a fibroid
GnRH agonists may reduce the size of the fibroid but are typically used more for short-term treatment due to side-effects such as menopausal symptoms (hot flushes, vaginal dryness) and loss of bone mineral density
What surgical options are available
myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically
hysteroscopic endometrial ablation
hysterectomy
uterine artery embolization
what happens after menopause
Fibroids generally regress
