Fibroids

Question 1

What are fibroids?

Answer 1

Benign, hormone-sensitive uterine smooth muscle neoplasm

Question 2

What are the classifications for fibroids?

Answer 2

Intramural leiomyoma (most common)
Subserosal leiomyoma
Submucosal leiomyoma
Diffuse uterine leiomyomatosis

Question 3

What are the risk factors of fibroids?

Answer 3

Nulliparity
Early menarche (< 10 years old)
Reproductive age 
African Americans 
Obesity
Family history

Question 4

What are the clinical features of fibroids?

Answer 4

(Abnormal menstruation) Hypermenorrhea, menorrhagia, intermentrual bleeding (possibly associated anemia)
Dysmenorrhea
(Features of mass effect) Enlarged , firm and irregular uterus during bimanual pelvic examination
Back or pelvic pain/discomfort
Urinary tract or bowel symptoms
(Reproductive abnormalities) Infertility
Dyspareunia

Question 5

How are fibroids diagnosed?

Answer 5

(Best initial) US

MRI

Question 6

What are some differential diagnosis of fibroids?

Answer 6

Endometriosis, Uterine polyps, Adenomyosis

Question 7

What is the treatment for uterine fibroids?

Answer 7

(Asymptomatic) No treatment + follow-up
(Symptomatic) Hormonal therapy:
GnRH agonists (e.g. leuprolide, goserelin, nafarelin)
Combined contraceptive pill
Progestin-releasing intrauterine device
Antifibrinolytic (Transexamic acid, reduc bleeding)
NSAIDs (for pain)
Surgery: Uterine fibroid embolisation
Myoectomy
Hysterectomy