Fibroids Flashcards
What are fibroids?
benign smooth muscle tumours originating from the myometrium of the uterus.
What is the aetiology?
Oestrogen and progesterone, the hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more oestrogen and progesterone receptors than normal uterine muscle cells.
What are symptoms?
Fibroids can often be asymptomatic. However, when symptoms do occur, they usually present as:
Menstrual dysfunction, such as menorrhagia and dysmenorrhoea
Infertility, if the fibroid is large enough to distort the uterine cavity
Palpable mass on abdominal or pelvic examination if the fibroid is large
What are the 2 main differentials for fibroids?
The main differentials for fibroids include other causes of menorrhagia and dysmenorrhoea. These include:
Endometrial polyps: Present with irregular menstrual bleeding and spotting
Endometriosis: Characterized by dysmenorrhoea, deep dyspareunia, chronic pelvic pain, and infertility
What are investigations for fibroids?
Trans-vaginal ultrasound: Used to assess the size and location of the fibroids
MRI: Used if ultrasound does not provide enough detail to assess the fibroid for surgery
Biopsy: May be taken if there is any doubt over the diagnosis to differentiate the fibroid from other conditions such as endometrial cancer
What does management of fibroids depend on and what are the options?
Depends on symptoms and size.
Non-surgical management for fibroids causing abnormal bleeding and under 3cm in size with no uterine distortion. This includes NSAIDs, anti-fibrinolytics, combined hormonal contraception, and Levonorgestrel-releasing intrauterine system (Mirena).
Surgical management for fibroids causing symptoms due to their mass effect. This includes myomectomy, ablation, uterine artery embolisation, and hysterectomy.
