Fibroids

Question 1

What is a fibroid?

Answer 1

A benign tumour of the myometrium aka fibromyoma or leiomyoma

Question 2

What is the epidemiology of fibroids?

Answer 2

Occur in 20% of women
Incidence increases as menopause approaches
More common in African and less in Asians as compared to Caucasians

Question 3

How can fibroids present?

Answer 3

Pelvic mass
Menorrhagia
Sub/infertility
Urinary retention 
Extrusion through the cervix

Question 4

How do fibroids cause menorrhagia?

Answer 4

Increased amount of endometrium due to subserosal fibroid

Abnormal vessels in the endometrium around the fibroid

Question 5

What might you find on examination in fibroids?

Answer 5

• Smooth, firm, non-tender mass on abdominal or vaginal examination

Question 6

What are some obstetric complications of fibroids?

Answer 6

Acute pelvic pain due to infarct as fibroid outgrows its blood supply during pregnancy
Malpresentation of fetus
Obstruction of outlet
Infection

Question 7

What are the broad categories of management?

Answer 7

Observation
Medical 
Surgical 
- Radiological
- Surgical

Question 8

What are the medical therapies?

Answer 8

○ Anti-fibrinolytics - transexamic acid
○ NSAIDs - mefenamic acid, naproxen, ibuprofen
○ COCP
○ Mirena

○ GnRH analogue
- Decreases size of lesion but grows back quickly after ceases, used pre-op

Question 9

What are the surgical therapies?

Answer 9

Radiological myomectomy - embolism and MRgFUS
Myomectomy
Hysterectomy