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Obs and Gynae > Fibroids > Flashcards

Fibroids Flashcards

1
Q

What are the proper name of fibroids?

A

Leiomyomata

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2
Q

What are fibroids?

A

Benign tumours of the myometrium

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3
Q

What percentage of women have fibroids by age 50?

A

By age 50, nearly 70% of white women and >80% of black women have at least one fibroid

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4
Q

RFx for fibroids?

A 
Increasing age during reproductive years
Black and Asian women (also more likely to have multiple fibroids)
Obese women
Early menarche (before age 11)
Affected 1st degree relative
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5
Q

Factors that make you less likely to have fibroids?

A

Parous women
Taken OCP
Taken injectable preogesterones

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6
Q

What sizes can fibroids range between?

A

A few millimetres to huge tumours filling the abdomen

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7
Q

Types of fibroid?

A

Intramural
Subserosal
Submucosal
(Submucosal can also form intercavity polyps)

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8
Q

What types of tissue make up a fibroid?

A

Smooth muscle and fibrous tissue

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9
Q

What does a transverse section of a fibroid look like?

A

A ‘whorled’ appearance of smooth muscle and fibrous tissues

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10
Q

What does fibroid growth depend on?

A

Oestrogen and progesterone

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11
Q

What is likely to happen to fibroids during pregnancy?

A

Grow, shrink or show no change

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12
Q

What happens to fibroids after the menopause and why?

A

Regression due to reduction in circulating sex hormones

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13
Q

What percentage of fibroids are asymptomatic and how are these discovered?

A

50%, discovered only at physical or US examinatiob

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14
Q

What are Sx related to?

A

Site rather than size of fibroid

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15
Q

What type of fibroid are most likely to cause Sx?

A

Intercavity and submucosal

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16
Q

What Sx can fibroids cause?

A

Menstrual problems (prolonged, heavy periods and intermenstrual bleeds)
Pain
Urinary frequency (or retention) if pressing on bladder
Hydronephrosis if pressing on ureters
Impaired fertility if tubal ostia (opening of Fallopian tubes) blocked or submucosal prevent implantation

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17
Q

Menstrual Sx caused by fibroids?

A

Heavy menstrual bleeding in 30% (although timing of menses unchanged)
Intermenstrual loss may occur if fibroid submucosal or polypoid

18
Q

What pain Sx are caused by fibroids?

A

Dysmenorrhoea
Seldom cause pain unless; torsion (twisting), red degeneration (haemorrhagic infarction of fibroid) or rarely, sarcomatous (malignancy) change occurs

19
Q

What is felt on examination?

A

A solid mass may be palpable on pelvic or abdo exam
Will arise from pelvis and be continuous with uterus
Multiple small fibroids can cause irregular ‘knobbly’ enlargement of uterus

20
Q

Complications of fibroids?

A
  1. Enlargement
  2. Degenerations
  3. Malignancy
21
Q

Enlargement of fibroids?

A

Very slow
Often stop growing an calcify after menopause
Oestrogen in HRT can stimulate further growth
Can enlarge in mid-pregnancy
Pedunculated fibroids can undergo torsion, causing pain

22
Q

When does ‘degeneration’ occur?

A

Inadequate blood supply

23
Q

Types of degeneration?

A

Red degeneration
Hyaline degeneration
Cystic degeneration

24
Q

What happens in red degeneration?

A

Pain and uterine tenderness

Haemorrhage and necrosis occur

25
Q

What happens in hyaline and cystic degeneration?

A

Fibroid is soft and partly liquefied

26
Q

What percent of fibroids are malignant (leiomyosarcomata)?

A

0.1%

27
Q

How to diagnose malignancy?

A

Histology

28
Q

When should malignancy be expected?

A

Fibroid growth in postmenopausal women
Rapidly enlarging fibroids
Sudden onset of pain

29
Q

Problems that can occur in pregnancy?

A 
Premature labour
Malpresentations (abnormal presentation in labour)
Transverse lie
Obstructed labour
Postpartum haemorrhage
Red degeneration common and cause pain
30
Q

Should fibroids be removed in a c-section

A

No as bleeding can be heavy

31
Q

What should be done when HRT is causing fibroid growth?

A

Tx as for premenopausal women

Remove HRT

32
Q

What Ix should be done to establish diagnosis?

A
  1. US; determine number, size, and position
  2. MRI (if diagnosis unclear or greater accuracy required when determining mode of Tx)
  3. Hysteroscopy, saline transvaginal US or hysterosalpingogram (HSG) is used to assess distortion of uterine cavity, particularly if fertility is an issue
33
Q

When is Tx required?

A

When causing Sx

34
Q

What guides type of Tx chosen?

A

Desire for fertility

Preservation of uterus

35
Q

Medical Tx of fibroids?

A
  1. Tranexamic acid
  2. NSAIDs
  3. Progesterones
    (1-3 often ineffective when causing menorrhagia but worth trying 1st line)
  4. Progesterone IUS (but cannot be used when uterine cavity distorted)
  5. GnRH agnosists
  6. Selective progesterones receptor modulators (SPRMs)
36
Q

How do GnRH agonists treat fibroids?

A

Cause temporary amenorrhoea and fibroid shrinkage by inducing a temporary menopausal state
Side effects and and BMD restrict use to only 6 months, so usually used near to menopause or just before surgery to make easier and safer
Once GnRH stopped, fibroids will return to initial size
Not appropriate for women trying to conceive

37
Q

Surgical Tx of fibroids?

A

Hysteroscopic surgery (up to 3cm)
Myomectomy
Radical: hysteroscopy

38
Q

Problems with myomectomy?

A

Heavy blood loss (risk of blood transfusions, or hysterectomy to save life)
Small fibroids can be missed
New ones can develop so recurrence of problems
Scar tissue or adhesions
Pregnancy or childbirth complications (e.g. scar rupture during labour)

39
Q

When is myomectomy performed?

A

Medical Tx failed, but preservation of reproductive function required

40
Q

What is hysteroscopic surgery?

A

Done with tools inserted into the uterus via the vagina. Cut and resect areas affected until fibroids removed

41
Q

Further Tx (not medical or surgical) for fibroids?

A

Embolisation

Ablation

Obs and Gynae (19 decks)

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