Fibroids Flashcards
What are fibroids?
Benign smooth muscle tumours of the uterus
Describe how fibroids progress?
Start as lumps in the wall of the uterus but may grow to bulge out of the wall so that they lie under the visceral peritoneums (subserosal), intramurally, under the endometrium (submucosa) or become pedunculated.
What are associations of fibroids
Common (20-40%) of ween of reproductive age
Increasing in frequency with age
More common in Afro-Caribbean women
Develop in response to oestrogen so rare before puberty and do not tend to progress postmenopause
When do fibroids enlarge?
Oestrogen dependent
Large in pregnancy and on the COCP
Atrophy after menopasue
how do fibroids degerate?
Gradually or suddenly
Sometimes they calcify (womb stones)
What are clinical features of fibroids
Asymptomatic
Menorrhagia - heavy prolonged periods ± anaemia
Fertility problems - may interfere with implantation
Pain - lower abdominal cramping pains often during menstruation, may be due t torsion of peculated fibroid
Mass - large fibroids may be felt abdominally
Urinary symptoms - large fibroids may press on bladder causing frequency
Oedematous legs/varicose veins - compressione of veins
How are fibroids diagnosed?
TVUSS
What is management of fibroids?
Symptomatic management with a levonorgestrel releasing intra-uterine system
GnRH analoges e.g. goserelin
May reduce size of fibroid 3-6 month before surgery
Short term as cause demineralisation of bone
Ullipristal acetate - selective progesterone receptor modulator
Shrink fibroids nd induce amenorrhoea prior to surgery
Myomectomy
- hysteroscopic, laparoscopic or open
Hysterectomy - only cure for fibroids for women who have completed family or no wish to preserve fertility
Uterine artery embolisation - Uterine artery is catheterised the embossed
Complications of fibroids?
Red degeneration - thrombosis of capsular vessels is followed by venous engorgement and localised peritoneal tenderness
Usually in last half of pregnancy or puerperium
There is haemorrhage into tumour
Treat with bed rest and analgesia - resolves within week
What are the types of fibroids?
Intramural
Submucosal
Subserosal
Pedunculated - may tort
