Fibroids Flashcards
What are fibroids
Benign tumours of smooth muscle of uterus - uterine leiomyomas
Which ethnic group are fibroids more common in
Black women
What are fibroids repsonsive to
Oestrogen - causes growth
Types of fibroid
Intramural - in myometrium. Can distort shape uterus
Subserosal - just below outer layer, grow outwards and become v large, fill abdo cavity
Submucosal - just below lining uterus (endometrium)
Pedunculated - on a stalk
How do fibroids present
Heavy menstrual bleeding (menorrhagiea)
Prolonged menstruation >7 days
Abdominal pain, worse during menstruation
Bloating or feeling full in abdomen
Urinary or bowel symptoms - perlvic pressure or fullness
Deep dyspareunia
Reduced fertility
What may find on abdo and bimanual examination in fibroids
Palpable pelvic mass or enlarged firm non tender mass
What is the initial investigations fro submucosal fibroids presenting with heavy menstrual bleeding
Hysteroscopy
What is teh investigation for larger fibroids
US
When is an MRI done for fibroids
Before surgical options when more needed about size, shape and blood supply of fibroids
What is teh medical management for fibroids <3cm
Same as heavy menstrual bleeding
Mirena coil - 1st line - if no distortion
Symptomatic management - NSAIDs, tranexamic acid
COCP
Cyclical oral progesterons
Surgical options for smaller fibroids with heavy menstrual bleeding
Endometrial ablation
Resection of submucosal fibroids during hyesteroscopy
Hysterectomy
What is management for fibroids >3cm
Referral to gynaecology
Same medical management as <3CM
sURGICAL|:
Uterine artery embolisation
Myomectomy
Hysterectomy
What may be used to reduce the size of fibroids before surgery
GnRH agonists eg goserelin or lepropelin
Induce menopause like state - less oestrogen to maintatin fibroid
What is uterine artery embolisation
Interventional radiologist -> catheter -> femoral artery -> uterine artery under X ray guidance
PARTICLES INJECTED -> blockage in arterial supply to fibroid, starve of oxygen
Which surgical treatment can improve fertibility with fibroids
Mymectomy - laproscopic
What is endothermal ablation
Used to destroy endometrium
Balloon thermal ablation can be done - high temp fluid burns lining in uterus
Complications of fibroids
Heavy menstrual bleeding, often + iron deficiecny anaemia
Reduced fertility
Pregnancy complications ef miscarriages, premature labour and obstructive delivery
Constipation
Urinary otuflow obstruction and UTIs
Red degeneration of fibroid
Torsion of fibroid, affecting pedunculated fibroids
Malignant change - <1% leiomyosarcoma
What is red degeneration of a fibroid
Ishcamia, infarction and necrosis due to disrupted blood supply
When is red degneration of fibroids more likely
More likely in >5cm fibrpids in second and third trimester of pregnancy
Fibroid rapidly enlarges during pregnancy outgrowing blood supply -> ischaemic
Kinking of blood vessels as uterus changes shaoe
How does red degneration of fibroids present
Severe abdominal pain
Low grade fever
Tachycardia
Vomitting
Supportive management - rest, fluids, analgesia
