Fibroids Flashcards
What are fibroids?
Benign tumours of smooth muscle of the uterus, oestrogen sensitive
What are the types of fibroids?
- Intramural (in myometrium - muscle of uterus)
- Subserosal (below outer layer uterus - grow large)
- Submucosal (just below endometrium)
- Pedunculated
What are common clinical features of fibroids?
- Often asymptomatic
- Menorrhagia
- Prolonged menstruation (>7 days)
- Abdominal pain
- Bloating or feeling full in abdomen
- Urinary or bowel symptoms
- Deep dyspareunia
- Reduced fertility
What may abdominal and bimanual examination reveal in cases of fibroids?
- Palpable pelvic mass
- Enlarged firm non-tender uterus
What is the initial investigation for submucosal fibroids presenting with heavy menstrual bleeding?
Hysteroscopy
What investigation is used for larger fibroids?
Pelvic ultrasound
When is MRI scanning considered in fibroid management?
Prior to surgery for more information on size, blood supply, shape
What are the management options for fibroids <3cm?
- Mirena coil (first line)
- Symptomatic management (NSAIDs, tranexamic acid)
- COCP, cyclical oral progestogens
- Surgical options (endometrial ablation, resection of submucosal fibroids, hysterectomy)
What should be done for fibroids >3cm?
- Refer to gynaecology
- Symptomatic management (NSAIDs, tranexamic acid)
- Mirena coil, COCP, cyclical oral progestogens
- Surgical options (uterine artery embolisation, myomectomy, hysterectomy)
What is uterine artery embolisation for fibroids?
An interventional radiology procedure that blocks arterial supply to fibroids, causing hypoxia and shrinking
What is myomectomy?
Removing fibroid via laparoscopic or laparotomy surgery
What is the only fibroids treatment known to potentially improve fertility?
Myomectomy
What are the types of hysterectomy?
- Laparoscopic
- Laparotomy
- Vaginal approach
What are GnRH agonists used for in fibroids?
To shrink fibroids prior to surgery and induce a menopause-like state
What are some complications of fibroids?
- Heavy menstrual bleeding
- Reduced fertility
- Pregnancy complications
- Constipation
- Urinary outflow obstruction
- UTIs
- Red degeneration of fibroid
- Torsion of fibroid
- Malignant change (rare, <1%)
What is red degeneration of fibroids?
Ischaemia, infarction, and necrosis of fibroid due to disrupted blood supply
When is red degeneration of fibroids more likely to occur?
If fibroid >5cm during the second or third trimester of pregnancy
What are the clinical presentations of red degeneration of fibroids?
- Severe abdominal pain
- Low-grade fever
- Tachycardia
- Vomiting
What is the management for red degeneration of fibroids?
- Supportive care
- Rest
- Fluids
- Analgesia
