Fibroids

Question 1

Classification of fibroids

Answer 1

Subserosal
Intramural
Subendometrial/submucosal (most common)
Intrauterine

Question 2

Pathogenesis of fibroids

Answer 2

Oestrogen dependent monoclonal growth

Question 3

Epidemiology of fibroids

Answer 3

40-50% pre menopausal women >35yr
Common in african americans
Regress after menopause
1:800 develop in malignancy

Question 4

Symptoms of fibroids

Answer 4

Mostly asymptomatic 
Menorrhagia (30%)
Dysmenorrhoea
Pelvic discomfort +/- pain/pressure
Bladder dysfunction
Pain when torsion of pedunculate fibroid
Pain with red degeneration only in pregnancy (pain, fever, local tenderness and leucocytosis)
Infertility due to IUCD like effect
Calcification

Question 5

Signs of fibroids

Answer 5

Bulky uterus, asymmetrically enlarged usually mobile.

Question 6

Investigation for fibroids

Answer 6

Pelvis USS
FBC for anaemia
hystoscopy - to rule out DDX of endometrial polyp
endometrial biopsy to rule out uterine ca if AUB or >40yr.

Question 7

DDX of fibroids

Answer 7

endometrial polyp

Question 8

Mx for fibroids

Answer 8

Consider COCP
Progesterone
IUCD
GnRH analogues esp if >42 as it can shrink

Surgery - Myomectomy esp in child bearing years
Hysteroscopic resection, hysterectomy.