fibroids

Question 1

what are fibroids?

Answer 1

benign tumours of smooth muscle of uterus

Question 2

what is another name for fibroids?

Answer 2

• Also called uterine leiomyomas

Question 3

what do fibroids grow in response to?

Answer 3

• Oestrogen sensitive and grow in response to oestrogen

Question 4

what is the prevalance of fibroids?

Answer 4

very common in older reproductive years
- More common in black women

Question 5

what are the 4 types of fibroids?

Answer 5

intramural
subserosal
submucosal
pedunculated

Question 6

where is an intramural fibroid located?

Answer 6

within myometrium and change shape and distort uterus as they grow

Question 7

where is subserosal fibroids located?

Answer 7

just below outer layer and grow outwards  grow very large and fill abdo cavity

Question 8

where are submucosal fibroids located?

Answer 8

just below lining of uterus – endometrium

Question 9

how would fibroids present?

Answer 9

often asymptomatic
- Menorrhagia – most frequent symptom
- Prolonged menstruation - >7days
- Abdo pain – worse during menstruation
- Bloating/ feeling full due to pelvic pressure
- Deep dyspareunia – pain during intercourse

Question 10

what can be seen within abdo/ bimanual exam for fibroids?

Answer 10

reveal palpable pelvic mass/ enlarged firm non-tender uterus

Question 11

what is first line investigations for fibroids?

Answer 11

assessing for submucosal fibroids in those presenting with heavy bleeding

Question 12

when would pelvic US be indicated for investigating fibroids?

Answer 12

: for larger fibroids

Question 13

when would MRI be indicated for investigating fibroids?

Answer 13

maybe used prior to surgery for gain more info

Question 14

how would you manage <3cm fibroids?

Answer 14

same management as menorrhagia
mirena
symptomatic
COCP
cyclical oral progesterone

Question 15

when could a mirena coil be used within fibroids?

Answer 15

if no distortion of uterus

Question 16

what symptomatic management can be used in fibroids

Answer 16

NSAID and tranexamic acid

Question 17

what medical pills can be used to help smaller fibroids?

Answer 17

• Combined oral contraceptive
• Cyclical oral progesterone’s

Question 18

name a cyclical progesterone?

Answer 18

norethisterone

Question 19

what surgical management can be put in place for smaller fibroids that cause excessive bleeding?

Answer 19

• Endometrial ablation
• Resection of submucosal fibroids during hysteroscopy
• Hysterectomy

Question 20

when should fibroids be referred to gynae?

Answer 20

excessive bleeeding - not PC controlled
>3cm

Question 21

what medical management can be used to help with larger fibroids?

Answer 21

• Medical: Mirena coil: if no distortion of uterus
• Symptomatic : NSAID and tranexamic acid
• Combined oral contraceptive
• Cyclical oral progesterone’s

Question 22

what surgical options are there for larger fibroids >3cm?

Answer 22

uterine artery embolisation
- Myomectomy
- Hysterectomy

Question 23

what is a uterine artery embolisation?

Answer 23

starves fibroid of oxygen causing it to shrink

Question 24

what medical management can be given prior to fibroid surgery?

Answer 24

GnRH agonists eg goserelin

Question 25

how does GnRH agonists help within fibroid surgery manangement?

Answer 25

may help shrink fibroids prior to surgery
- Reduce amount of oestrogen
- Only short term

Question 26

what complications can be seen within fibroids?

Answer 26

• Heave bleeding  IDA
• Reduced fertility
• Pregnancy complications – miscarriages, premature labour, obstructive delivery
• Constipation
• Urinary outflow obstruction and UTI
• Red generation of fibroid
• Torsion
• Malignant change to leiomyosarcoma  very rare <1%

Question 27

what is red generation of fibroid?

Answer 27

ischaemia, infarction and necrosis of fibroid likely to disrupted blood supply

Question 28

when are red generation fibroids most likely?

Answer 28

• More likely in big fibroids >5cm in 2nd/3rd trimester
• Pregnancy: fibroids grow  outgrows its blood supply and becomes ischaemic , may be due to uterus changing shape

Question 29

how would red generation fibroids present?

Answer 29

pregnant women: severe abdo pain, low grade fever, tachycardia, vomiting

Question 30

how do you manage red generation fibroids?

Answer 30

supportive, rest, fluids and analgesia