Fibroids

Question 1

What is adenomyosis?

NEEDS TO MOVE TO ENDOMETRIOSIS DECK

Answer 1

Occurs in older women that have had lots of children

Question 2

What are fibroids?

Answer 2

Aka lyomyoma

Benign uterine tumours 
Smooth muscle tissue 
Variable size and number 
30% prevalence in women above 30 - most common gynae condition (endometriosis is second) 
Oestrogen dependent

Question 3

How do fibroids present?

Answer 3

Depends on location and you can work out symptoms as a result:

Intracavity - pain (because contracting to try and push out), bleeding, infertility, miscarriage

Submucosal

Intramural

Subserosal - outside the uterus but still attached, can grow much larger, may impede on bowel function

Pedunculated

Question 4

How do you treat fibroids?

Answer 4

Choice of treatment depends on family planning

Progesterone contraceptive e.g. mirena or POP

Can be shrunk with GnRH - also stops bleeding

Myomectomy - open or laparoscopic (latter is better) - to remove big tumours; for laparoscopic procedures - need to macerate the fibroid intra-abdominally so can be sucked out though small openings; if intrauterine - hysteroscopic myomectomy

If older and have had kids - can do a hysterectomy (same as endometriosis)

Tranexamic acid - antifibrinolytic - to stop the bleeding

Question 5

What are endometrial polpys?

Answer 5

Pathophysiology - also oestrogen dependent, fibroid arises from endometrial epithelium (rather than muscle of fibroid)

Same presentation as fibroids - space occupying intrauterine lesion (pain, bleeding, infertility, miscarriage) and in same patient group

Can happen in any age but really scary after menopause - as growth is oestrogen dependent - you’re thinking endometrial cancer - hysterectomy should be used