Fibroids Flashcards
What are fibroids?
benign smooth muscle tumours of the uterus
What is the risk of them becoming malignant?
0.1%
What are the types of fibroids
→ Intramural: confined to the myometrium of the uterus
→ Submucosal: develops immediately underneath the endometrium and protrudes into the uterine cavity
→ Subserosal: protrudes into and distorts the serosal surface of the uterus, may be pedunculated (on a stalk)
What causes them?
oestrogen stimulates growth
when do fibroids shrink?
menopause - reduction in circulating oestrogen
What happens to them in pregnancy?
grow
shrink
no change
What are the risk factors?
- Obesity
- Early menarche
- Increasing age
- FHx - those with 1st degree relative carry 2.5 risk
- Ethnicity - African-Americans are 3x more likely to develop a fibroid than Caucasians
Who are fibroids less common in?
Parous women
Those who have taken COPC or progestogens
How do they present?
explain the sx
menorrhagia
IMB - submucosal or polypoid
pains
bladder frequency, retention - pressing on bladder
hydronephrosis - fibroids pressing on ureters
impaired fertility - tubal ostia blocked or submucosal fibroids prevent implantation
what is found on examination?
solid mass
enlarged uterus
non tender
what are complications of fibroids
Pedunculated fibroids occasionally undergo torsion, causing pain
Red degeneration - inadequate blood supply causes pain and uterine tenderness, haemorrhage and necrosis occur
Malignancy - around 0.1% are leiomyosarcomata
What happens to fibroids after the menopause?
stop growing and calcify although oestrogen in HRT may stimulate further growth
What can fibroids cause during pregnancy?
- Malpresentations
- Transverse lie
- Obstructed labour
- PPH
- Red degeneration that can cause severe pain
what are the ix for fibroids?
US
MRI - distinguish between ovarian mass and adenomyosis
hysteroscopy
What is the management of fibroids?
Small asymptomatic fibroid - no treatment
Larger fibroids that are not removed should be serially measured by examination or US because of the remote poss of malignancy
medical rx
surgical rx
