fibroids Flashcards
what are fibroids?
benign tumours of smooth muscle of uterus
what is another name for fibroids?
- Also called uterine leiomyomas
what do fibroids grow in response to?
- Oestrogen sensitive and grow in response to oestrogen
what is the prevalance of fibroids?
very common in older reproductive years
- More common in black women
what are the 4 types of fibroids?
intramural
subserosal
submucosal
pedunculated
where is an intramural fibroid located?
within myometrium and change shape and distort uterus as they grow
where is subserosal fibroids located?
just below outer layer and grow outwards grow very large and fill abdo cavity
where are submucosal fibroids located?
just below lining of uterus – endometrium
how would fibroids present?
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
what can be seen within abdo/ bimanual exam for fibroids?
reveal palpable pelvic mass/ enlarged firm non-tender uterus
what is first line investigations for fibroids?
assessing for submucosal fibroids in those presenting with heavy bleeding
when would pelvic US be indicated for investigating fibroids?
: for larger fibroids
when would MRI be indicated for investigating fibroids?
maybe used prior to surgery for gain more info
how would you manage <3cm fibroids?
same management as menorrhagia
mirena
symptomatic
COCP
cyclical oral progesterone
when could a mirena coil be used within fibroids?
if no distortion of uterus
what symptomatic management can be used in fibroids
NSAID and tranexamic acid
what medical pills can be used to help smaller fibroids?
- Combined oral contraceptive
- Cyclical oral progesterone’s
name a cyclical progesterone?
norethisterone
what surgical management can be put in place for smaller fibroids that cause excessive bleeding?
- Endometrial ablation
- Resection of submucosal fibroids during hysteroscopy
- Hysterectomy
when should fibroids be referred to gynae?
excessive bleeeding - not PC controlled
>3cm
what medical management can be used to help with larger fibroids?
- Medical: Mirena coil: if no distortion of uterus
- Symptomatic : NSAID and tranexamic acid
- Combined oral contraceptive
- Cyclical oral progesterone’s
what surgical options are there for larger fibroids >3cm?
uterine artery embolisation
- Myomectomy
- Hysterectomy
what is a uterine artery embolisation?
starves fibroid of oxygen causing it to shrink
what medical management can be given prior to fibroid surgery?
GnRH agonists eg goserelin
