Fibroids

Question 1

What are they?
Where are they?
When and in whom are they more common?
When and in whom are they less common?

Answer 1

1) Benign tumours of the myometrium, oestrogen and progesterone dependent
2) May be intramural, submucosal or subserous
3) Just before the menopause; Afro-Carribean women and those with a family history
4) After the menopause; in parous women and those who have taken the COC or injectable progesterones

Question 2

Clinical features

Answer 2

50% asymptomatic
Menorrhagia (30%)
Intermenstrual bleeding
Dysmenorrhagia
Fibroids may press on bladder (urinary symptoms) or obstruct uterine tubal ostia/prevent implantation (fertility issues)
Solid mass may be palpable on pelvic or abdominal examination. Will arise from pelvis and be continuous with uterus. Multiple small fibroids can cause a ‘knobbly’ enlarged uterus

Question 3

Complications - not in pregnancy

Answer 3

May grow
Pedunculated ones may torte and cause pain
May degenerate, red degeneration causes pain, uterine tenderness and haemorrhage
0.1% malignancy

Question 4

Complications - in pregnancy

Answer 4

Premature labour
Malpresentations/transverse lie
Obstructed labour
PPH
Red degeneration common in pregnancy

Question 5

Treatment

Answer 5

Antifibrinolytics (tranexamic acid, NSAIDs eg mefanamic acid)
COCs/progesterone
GnRH (gonadatrophin releasing hormone) agonists (only short-term)
Interventional radiology via femoral artery/uterine artery embolisation
Endometrial ablation (hysteroscopic surgery)
Hysteroscopic resection
Myomectomy (medical treatment failed, want to remain fertile, many routes)
Hysterectomy