Fibroids

Question 1

Define fibroids

Answer 1

Benign growths of the muscle in the uterus

• Vary in size
• Can grow and shrink and disappear
• Very common
• Many women have them with no symptoms

Question 2

What causes fibroids?

Answer 2

• Idiopathic
• FHx
• Afro-Caribbean
• Obesity
• sensitive to oestrogen and progesterone growing bigger when levels are high and shrinking when levels are low

Question 3

What are the clinical features of fibroids?

Answer 3

• Menorrhagia
• Subfertility
• Increase fibroid size = mass effect = dysuria, hydronephrosis, constipation, sciatica

RED FLAGS

1. Pedunculated = torsion = abdo pain = necrosis = sepsis
2. Red fibroid degeneration = decreased blood supply to fibroid = pain, bleeding, sepsis

Question 4

What investigations are carried out for fibroids?

Answer 4

BLOODS

• hCG = pregnancy
• FBC/iron studies = anaemia from menorrhagia
• Hormone levels = growth of fibroids

IMAGING
-Pelvic US - visualise mass

SURGICAL
-Hysteroscopy w/ biopsy

Question 5

How are fibroids managed?

Answer 5

GENERAL
-Observtion if not causing many symptoms

MEDICAL
-Treat for menorrhagia

SURGICAL

• Myomectomy
• Hysteroscopic endometrial ablation
• Hysterectomy (rare)

Question 6

What happens to fibroids during pregnancy?

Answer 6

Fibroids can grow during pregnancy due to increased levels of oestrogen and progesterone
-Increase risk in >35yrs, primip, afro-Caribbean origin

Question 7

What clinical features can present during pregnancy?

Answer 7

PAIN

• Red degeneration
• Torsion of pedunculated
• Fibroid impaction

1st & 2nd TRIMESTER

• Increased risk miscarriage
• Invasive procedures (e.g. amnio) may be difficult

3rd TRIMESTER

• Preterm risk ++
• Placental abruption risk
• Large fibroids = pressure on foetus = difficulties developing
• DIC, uterine invasion, acute renal failure, urinary retention

Question 8

What risk factors can present with fibroids during delivery?

Answer 8

Increased CS incidence = malpresentation, dysfunctional labour, obstruction

Increased PPH risk

Higher incidence of retained placenta

Question 9

How are fibroids during pregnancy managed?

Answer 9

Symptomatic pain relief

Regular monitoring