fibroids

Question 1

risk factors for fibroids

Answer 1

Obesity
Black ethnicity
Increasing age (within reproductive age)
Family History
Hypertension
Vitamin D deficiency

Question 2

different classifications of fibroids

Answer 2

Intramural ( in the myometrium, distorts uterus)

Subserosal (just below the outer layer of the uterus. These fibroids grow outwards and can become very large, filling the abdominal cavity)

Submucosal (just below the endometrium)

Question 3

presentation of fibroids

Answer 3

2/3rds of people with fibroids will be asymptomatic

symptoms:
menorrhagia
prolonged bleeding
abdominal pain and bloating
urinary/bowel symptoms
pain during sex

Question 4

investigations for fibroids

Answer 4

bimanual and abdo exam
intravaginal and transabdominal USS
hysteroscopy (good for submucosal)
MRI considered if surgical intervention being planned

Question 5

first line management for fibroids

Answer 5

IUS (fibroid <3cm, no distortion of the uterus)
COCP
cyclical POP

Question 6

surgical options for smaller fibroids

Answer 6

resection via hysterscopy
endometrial ablation

Question 7

surgical options for larger fibroids

Answer 7

uterine artery embolisation
myomectomy (can increase fertility)
hysterectomy

Question 8

complications of fibroids

Answer 8

Reduced fertility
Pregnancy complications
Red degeneration of the fibroid
Torsion of the fibroid
Malignant change to a leiomyosarcoma is very rare (<1%)

Question 9

management of red degeneration of the fibroid

Answer 9

supportive, with rest, fluids and analgesia

Question 10

presentation of red degeneration of the fibroid

Answer 10

severe abdominal pain, low-grade fever, tachycardia and often vomiting