Fibroids

Question 1

What are fibroids?

Answer 1

Benign smooth muscle tumours of the myometrium of the uterus

Question 2

What is the epidemiology of fibroids?

Answer 2

Fibroids affect 40-60% of women in later reproductive years
Prevelance is slightly lower in women under 30

Question 3

How do fibroids grow?

Answer 3

They grow in response to oestrogen
It is thought that they originate from a single smooth muscle cell

Question 4

What are the types of fibroids?

Answer 4

Submucosal - just below the lining of the uterus
Intramural - within the myometrium
Subserosal - just below the outer layer of the uterus
Pedunculated - on a stalk

Question 5

What are the differentials of fibroids?

Answer 5

Adenomyosis
Endometriosis
Endometrial polyps
Endometrial hyperplasia
Uterine sarcoma
Pregnancy

Question 6

What is the presentation of fibroids?

Answer 6

Often asymptomatic
Heavy menstrual bleeding
Prolonged menstruation
Abdominal pain
Bloating
Urinary or bowel symptoms
Dyspareunia
Reduced fertility

Question 7

What are the risk factors for fibroids?

Answer 7

Black ethnicity
Increasing age
Being overweight

Question 8

What is the first line investigation for diagnosis of fibroids?

Answer 8

Transvaginal and transabominal ultrasound
Hysteroscopy

Question 9

What other investigations may be useful in diagnosis of fibroids?

Answer 9

MRI
Endometrial biopsy

Question 10

What is the non-surgical management of fibroids?

Answer 10

Mirena coil - often first line
Anti-fibrinolytics
NSAIDs
Combined hormonal contraception
GnRH agonist

Question 11

What is the surgical management of fibroids?

Answer 11

Endometrial ablation
Resection of fibroids
Uterine artery embolisation
Hysterectomy

Question 12

What are the complications of fibroids?

Answer 12

Reduced fertility
Heavy menstrual bleeding
Pregnancy complications
Torsion of fibroid
Malignant change to leiomyosarcoma
Ischaemia and necrosis of the fibroid (red degeneration)
Constipation
Urinary tract outflow obstruction

Question 13

What happens during red degeneration?

Answer 13

A fibroid rapidly outgrows it’s blood supply during pregnancy and becomes ischaemic

Question 14

Why does red degeneration occur?

Answer 14

Increased oestrogen during pregnancy promotes growth of the fibroids

Question 15

What medication is used in a patient with fibroids before surgery?

Answer 15

GnRH agonists to reduce the size of the fibroids