Fibroids

Question 1

what are fibroids

Answer 1

benign tumours of the myometrium

Question 2

give five risk factors for fibroids

Answer 2

• increasing age
• black/asian women
• obesity
• early menarche
• family hx (1st degree)

Question 3

give some protective factors for fibroids

Answer 3

parity
COCP
Injectable progestogens

Question 4

what hormones is fibroid growth dependent on

Answer 4

oestrogen and progesterone

Question 5

what happens to fibroids after the menopause

Answer 5

regress

Question 6

what are the clinical features of fibroids

Answer 6

• 50% asymptomatic
• mass effect eg. urinary frequency, hydronephrosis
• menstrual problems: HMB/IMB/dysmenorrhoea
• reduced fertility

Question 7

when should you consider malignant fibroids

Answer 7

rapidly enlarging fibroids
sudden onset pain
post-menopausal women not on HRT

Question 8

what Ix could you consider

Answer 8

TVUS
MRI
bloods (haemoglobin)

Question 9

how can you manage fibroids

Answer 9

GnRH agonists (buserelin/leuprorelin)

Selective progesterone receptor modulators (SPRMs) - ulipristal acetate

Can also try:

• tranexamic acid
• NSAIDs
• progesterones

Surgical: uterine artery embolisation, myomectomy, hysterectomy

Question 10

discuss the use of GnRH agonists in the management of fibroids

Answer 10

cause temporary amenorrhoea and fibroid shrinkage.

Due to their vasomotor SE/bone density loss, they can only be used for 6 months at a time

good pre-op. Once stopped, fibroids will return to their origninal size

Question 11

discuss the use of selective progesterone receptor modulators (SPRM)

Answer 11

a new class of drug that reduces HMB, commonly causes a reversible amenorrhoea and shrinks fibroids wihtout causing bone density loss and menopausal SEs