Fibroids Flashcards
What are fibroids
benign tumours of the uterine myometrium
AKA leiomyomas
What are the different possible locations for fibroids
Subserosal: outer serosal surface and can extend outside into the peritoneal cavity
Intramural: within myometrium
Submucosal: inner mucosal surface and may extend into the uterine cavity
What are the risk factors for fibroids
Perimenopausal/older age
FHx fibroids
Obesity
Early menarche
Nulliparity
Older age at first pregnancy
Hypertension, diabetes
Afro-Caribbean, Asian
Epidemiology of fibroids
Affects 10-40% of women of reproductive age
Peak incidence 40yo
What are the symptoms of fibroids
Depends on size and position. May be asymptomatic or:
Menorrhagia ± clots, flooding
Dysmenorrhoea
Increased urinary frequency
Pelvic pain, pressure, discomfort
Dyspareunia
Abdominal discomfort, bloating, back pain
Bowel symptoms e.g. bloating, constipation, painful defecation
Subfertility
How can fibroids affect pregnancy
May affect the lie of the foetus
May make CS more difficult
Cervical obstruction
Higher risk of miscarriage
Red degeneration = fever, pain, vomiting due to vascular infarction as the fibroid outgrows its blood supply
What are the differentials for fibroids
Polyps
Adenomyosis
Malignancy (ovarian, cervical, endometrial)
PID
Clotting disorder
Hypothyroidism
What are the signs of fibroids on examination
Abdominal exam: central irregular abdominal mass
Pelvic: firm, enlarged, irregularly, bulky shaped non-tender uterus
What investigations should be done for fibroids
bedside: urine pregnancy test, STI swab (if indicated)
Bloods: FBC, TFTs, LFTs, Clotting
Imaging: TVUSS ± hysteroscopy and biopsy
What is the management for fibroids
Conservative
Analgesia - NSAIDs
Tranexamic acid
Anti-fibrinolytics
Medical
Mirena coil (levonorgestrel-releasing IUS)
COCP
GnRH analogues
Progesterone receptor inhibitors e.g. mifepristone
Norethisterone
Surgical
TCRF/hysteroscopy, myomectomy
Uterine artery embolisation
Hysteroctomy
+ Iron supplementation
What features would necessitate referral to a specialist for fibroids
Uncertain diagnosis
Severe heavy menstrual bleeding
Compressive symptoms
Unsuccessful treatment in primary care
Confirmed fibroids >3cm on TVUSS
Suspected fertility or obstetric issues
What is the management for red degeneration
Rest and analgesia
Should resolve within 4-7 days
What are the complications of fibroids
Iron deficiency anaemia
Hydronephrosis
Subfertility
Torsion of pedunculated fibroids
Haemoperitoneum
What is the prognosis for fibroids
Fibroids tend to persist until the menopause when they then shrink (may be delayed by HRT)
What are the side effect of the mirena coil
Acne
Breast pain, tenderness, swelling
Headaches
Dizziness
Depression
Weight gain
Infertility
Increased risk ectopic pregnancy
