Fibroids Flashcards
What are fibroids?
benign smooth muscle tumours (leiomyomas) of the uterus
How common are fibroids?
40-60% of women in the later reproductive years (More common in black women)
How does oestrogen affect fibroids?
They are oestrogen sensitive, so grow in response to oestrogen
What are some types of fibroid?
Intramural - Myometrium
Subserosal - Just below perimetrium
Submucosal - Just below endometrium
Pedunculated - On a stalk
How do fibroids usually present?
Menorrhagia (Distortion of lining causes thinning)
Prolonged menstruation
Abdominal pain
Bloating
urinary or bowel symptoms
Deep dyspareunia
Reduced fertility
investigations in fibroids
Hysteroscopy
Pelvic USS (For larger fibroids)
MRI possibly before surgery
Medical management of fibroids <3cm
Mirena coil (Must be no uterine distortion)
NSAIDs and tranexamic acid (Symptoms)
COC
Cyclical oral progesterone
Surgical management for smaller fibroids if required
Endometrial ablation
Resection during hysteroscopy
Hysterectomy
Medical management of fibroids >3cm
- Referral
- NSAIDs and tranexamic acid (Symptoms)
- COC
- Cyclical oral progesterone
What are some surgical options for >3cm fibroids?
Uterine artery embolisation
Myomectomy
Hysterectomy
(GnRH agonists to shrink before surgery)
What is involved in uterine artery embolisation?
Interventional radiologists insert a catheter into the femoral artery and then uterine artery, before injecting a blockage to starve the fibroid of oxygen
What are some possible complications of fibroids?
- Iron deficiency anaemia
- Reduced fertility
- Pregnancy complications
- Constipation
- Urinary outflow obstruction
- Red degeneration of the fibroid
- Torsion
- Malignant change to leiomyosarcoma
What is red degeneration of a fibroid
Ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply
What are some causes of red degeneration of a fibroid?
- Rapid enlargement during pregnancy causes inadequate blood supply
- Kinking of the blood vessels due to changes in uterine shape during pregnancy
Diagnosis - Pregnant women, history of fibroids, severe abdominal pain and low-grade fever
Red degeneration of a fibroid
