Fibroids Flashcards
What are they?
4 types
What hormone are they sensitive to?
What makes them worse?
Uterine leiomyomas - Benign smooth muscle tumours
Intramural
Submucosal
Sub-serosal
Pedunculated
Oestrogen so shrink after menopause and commoner in obese women
Pregnancy - increased oestrogen
What ethnicity is it common in?
Black women
Presentation:
Changes to menstruation - 3
What might they have pain doing?
What type of fibroid could cause infertility? Why does it interfere with fertility?
What may be felt on examination?
What may happen to pedunculated fibroids?
Menorrhagia
Dysmenorrhoea
Prolonged periods
Pain having sex - dyspareunia
Submucosal fibroids - still quite rare
Interferes with implantation
Abdominal mass arising from pelvis and bloating
Torsion
Menorrhagia:
- What is this likely to lead to?
- Why do they get heavy bleeding?
Iron-deficiency anaemia
Submucosal fibroids - increase the area of the lining, and also increase menstrual flow and decrease the normal ability of the lining to stop the bleeding.
Intramural fibroids that are larger or close to the cavity will increase blood flow to the uterus and affect the normal systems that control bleeding in the uterus. These fibroids will also increase the size of the cavity of the uterus, thereby increasing bleeding.
Presentation:
What are the pressure symptoms?
What type of fibroid might cause pressure symptoms?
Constipation
Urinary frequency
Subserosal
Investigations:
Bloods and why? - 1
Imaging that should be done? - 1
What type of fibroids would saline infusion US be used for?
What imaging is usually done before uterine artery embolisation?
What should be done if endometrial cancer is suspected and would also help with the diagnosis of submucosal fibroids?
FBC - iron-deficiency anaemia
TVUS or trans-abdominal US
Submucosal fibroids
MRI
Hysteroscopy
Management:
Why can conservative Rx be used?
Most are asymptomatic so don’t need Rx
Management - Medical:
Ulipristal acetate:
- What is it?
- How does it help?
- How long do they take it?
- What is it done before?
Progesterone receptor modulator
Reduces size and induces amenorrhoea
3-6 months
Before surgery
Management - Medical:
GnRH analogues:
- Give name - L
- Route
- MOA
- How does it help symptoms?
- What sort of Rx needs to be done if it is being used for more than 6 months?
Leuprorelin IM
Induces temporary menopause
Reduces bleeding and shrinks fibroids pre-operatively
Need HRT to prevent osteoporosis
Management - Surgical:
THE ONLY WAY TO RESOLVE!
Indications? - 3
Myomectomy:
- What is it?
- What type of fibroid is removed laparoscopically?
- What type of fibroid is removed hysteroscopically?
Hysterectomy - MOST EFFECTIVE:
- Indications
Failed medical therapy
Large fibroid (>3cm) or pressure symptoms
Infertility
Subserosal
Submucosal
Large or multiple fibroids
Offer to women who have completed family
Uterine artery embolisation by interventional radiology:
- What is done?
- Who is it a good alternative for?
- CI’s
Spheres or beads reduce blood flow to the fibroid
Not a permanent solution
For those not fit for surgery
Infection
Cancer
Contraindications:
What does someone with fibroid presenting with acute pain suggest?
During pregnancy:
- What happens to the fibroids?
- Red degeneration - what is it? Rx?
- The fibroids can lead to uterine atony after childbirth. What potentially life-threatening complication could this lead to?
Fetal complications - list
Torsion of pedunculated fibroid
Fibroid growth exceeds blood supply, so presents with fever and vomiting
Nothing - self-resolves
Post-partum haemorrhage ------ Miscarriage Intrauterine growth restriction Prematurity Malpresentation
