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Reproductive Health > Fibroids > Flashcards

Fibroids Flashcards

1
Q

What are fibroids?

A

Benign smooth muscle tumours of the uterus

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2
Q

What is another term for fibroids?

A

Uterine leiomyomas

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3
Q

Are there often multiple?

A

Yes and vary in size from seedlings to tumours occupying large part of abdomen

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4
Q

How do they start?

A

A lumps in the wall of the uterus

May grow and bulge out

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5
Q

Where can they be located?

A

Intramural
Subserosal (under visceral peritoneum) 20% - develop into pelvis and can become very large
Submucosal (under the endometrium) 5% - grow into the uterine cavity
Peduncuated - attached to uterus by narrow stalk of tissue

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6
Q

Are they common?

A

Yes

20-40% of reproductive age have them

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7
Q

Frequency of fibroids increases with…

A

Increasing age
Afro Caribbean women
FH of fibroids
Obesity - increased level of oestrogen in body

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8
Q

What are they associated with?

A

Mutation in gene for fumarate hydratase

Renal cell cancer and hereditary leiomyomatosis

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9
Q

When do they enlarge?

A

In pregnancy
On the COCP
They are oestrogen dependent

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10
Q

When do they atrophy?

A

After the menopause

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11
Q

They may degenerate gradually or suddenly - called…

A

Red degeneration

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12
Q

Occasionally fibroids calcify. What are they called if this occurs?

A

Womb stones

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13
Q

How can they present?

A 
Asymptomatic 
Menorrhagia 
Fertility problems 
Pain - abdominal and lower back, constant and dull- due to pressure on organs 
cramping pains often during menstruation 
Pain during sex 
Bloating 
Mass 
Mass causing - frequency, constipation
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14
Q

Describe the menorrhagia that fibroids can cause

A

Heavy and prolonged periods +/- anaemia
Do not generally cause IMB or PMB
May be associated dysmenorrhea

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15
Q

Why can fibroids cause fertility problems?

A

Interfere with the implantation

Large or multiple tumours can distort uterine cavity - may cause miscarriage should pregnancy occur

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16
Q

Why might pain occur?

A

Torsion of pedunculated fibroid

Red degeneration following thrombosis of of fibroids blood supply

17
Q

Can large fibroids be felt abdominally?

A

Yes

18
Q

Why can frequency occur?

A

If fibroid large it could press on the bladder

19
Q

Why can oedematous legs and varicose veins occur?

A

Fibroid May press on veins

20
Q

Does the risk increase of decrease with the more children women have?

A

Decrease

21
Q

If symptoms are minimal/ none, do they need to be treated?

A

No

22
Q

What symptomatic management options are there?

A

Levonorgestrel releasing IUS
Tranexamic acid or mefanamic acid
COCP, POP

23
Q

What management options are there to reduce size of fibroids?

A

GnRH agonists e.g goserelin 3.6mg SC monthly for 3-6 months prior to surgery (not a long term option)
Ulipristal acetate - taken daily for 3-6 months to shrink fibroids and induce amenorrhoea, licensed for this purpose prior to surgery

24
Q

Surgery is sometimes needed:

A

Myomectomy - hysteroscopic, open room laparoscopic depending on size and location

25
Q

How is uterine artery embolisation done?

A

Done by an interventional radiologist after assessment by MRI
Uterine artery catheterised then embolised
Avoids general anaesthetic
Can be very painful in recovery period
Can lead to necrotic, infected uterus

26
Q

Is UAE recommended for those who want to retain fertility?

A

No

27
Q

Who is hysterectomy reserved for?

A

Women who have competed family or have no wish to preserve fertility

28
Q

If large fibroids are noted prior to labour, what should be planned?

A

Caesarian section

29
Q

What do fibroids look like?

A

Round
Firm
Greyish white

30
Q

Are fibroids benign?

A

Yes

31
Q

How is diagnosis made?

A

Symptoms
Pelvic examination
USS

Rarely biopsy - to rule out uterine sarcoma

32
Q

What is red degeneration?

A

Usually occurs in pregnancy
When fibroids grow and outstrip their blood supply they can undergo a type of degeneration - usually due to venous thrombosis

33
Q

What symptoms are associated with fibroid degeneration?

A

Low grade fever
Pain - abdominal
Localised peritoneal tenderness
Vomiting

34
Q

How is fibroid degeneration managed?

A

Conservatively
Rest and analgesia
Should resolve within 4-7 days

35
Q

Can endometrial ablation be used for fibroids?

A

Yes, but mainly used to reduce heavy bleeding in women without fibroids. It can be used to treat small fibroids in the uterine lining.
It is a relatively minor procedure that involves removing the uterine lining (laser, heated wire loop, hot fluid in a balloon) - under local or general anaesthetic

Reproductive Health (70 decks)

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