Fibroids

Question 1

What are fibroids

Answer 1

Benign tumours of smooth muscle of uterus - uterine leiomyomas

Question 2

Which ethnic group are fibroids more common in

Answer 2

Black women

Question 3

What are fibroids repsonsive to

Answer 3

Oestrogen - causes growth

Question 4

Types of fibroid

Answer 4

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

Question 5

How do fibroids present

Answer 5

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

Question 6

What may find on abdo and bimanual examination in fibroids

Answer 6

Palpable pelvic mass or enlarged firm non tender mass

Question 7

What is the initial investigations fro submucosal fibroids presenting with heavy menstrual bleeding

Answer 7

Hysteroscopy

Question 8

What is teh investigation for larger fibroids

Answer 8

US

Question 9

When is an MRI done for fibroids

Answer 9

Before surgical options when more needed about size, shape and blood supply of fibroids

Question 10

What is teh medical management for fibroids <3cm

Answer 10

Same as heavy menstrual bleeding
Mirena coil - 1st line - if no distortion
Symptomatic management - NSAIDs, tranexamic acid
COCP
Cyclical oral progesterons

Question 11

Surgical options for smaller fibroids with heavy menstrual bleeding

Answer 11

Endometrial ablation
Resection of submucosal fibroids during hyesteroscopy
Hysterectomy

Question 12

What is management for fibroids >3cm

Answer 12

Referral to gynaecology
Same medical management as <3CM
sURGICAL|:
Uterine artery embolisation
Myomectomy
Hysterectomy

Question 13

What may be used to reduce the size of fibroids before surgery

Answer 13

GnRH agonists eg goserelin or lepropelin
Induce menopause like state - less oestrogen to maintatin fibroid

Question 14

What is uterine artery embolisation

Answer 14

Interventional radiologist -> catheter -> femoral artery -> uterine artery under X ray guidance
PARTICLES INJECTED -> blockage in arterial supply to fibroid, starve of oxygen

Question 15

Which surgical treatment can improve fertibility with fibroids

Answer 15

Mymectomy - laproscopic

Question 16

What is endothermal ablation

Answer 16

Used to destroy endometrium
Balloon thermal ablation can be done - high temp fluid burns lining in uterus

Question 17

Complications of fibroids

Answer 17

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

Question 18

What is red degeneration of a fibroid

Answer 18

Ishcamia, infarction and necrosis due to disrupted blood supply

Question 19

When is red degneration of fibroids more likely

Answer 19

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

Question 20

How does red degneration of fibroids present

Answer 20

Severe abdominal pain
Low grade fever
Tachycardia
Vomitting
Supportive management - rest, fluids, analgesia