Fibroids Flashcards
What are fibroids?
Benign smooth muscle tumours of the uterus
What is another term for fibroids?
Uterine leiomyomas
Are there often multiple?
Yes and vary in size from seedlings to tumours occupying large part of abdomen
How do they start?
A lumps in the wall of the uterus
May grow and bulge out
Where can they be located?
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
Are they common?
Yes
20-40% of reproductive age have them
Frequency of fibroids increases with…
Increasing age
Afro Caribbean women
FH of fibroids
Obesity - increased level of oestrogen in body
What are they associated with?
Mutation in gene for fumarate hydratase
Renal cell cancer and hereditary leiomyomatosis
When do they enlarge?
In pregnancy
On the COCP
They are oestrogen dependent
When do they atrophy?
After the menopause
They may degenerate gradually or suddenly - called…
Red degeneration
Occasionally fibroids calcify. What are they called if this occurs?
Womb stones
How can they present?
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
Describe the menorrhagia that fibroids can cause
Heavy and prolonged periods +/- anaemia
Do not generally cause IMB or PMB
May be associated dysmenorrhea
Why can fibroids cause fertility problems?
Interfere with the implantation
Large or multiple tumours can distort uterine cavity - may cause miscarriage should pregnancy occur
Why might pain occur?
Torsion of pedunculated fibroid
Red degeneration following thrombosis of of fibroids blood supply
Can large fibroids be felt abdominally?
Yes
Why can frequency occur?
If fibroid large it could press on the bladder
Why can oedematous legs and varicose veins occur?
Fibroid May press on veins
Does the risk increase of decrease with the more children women have?
Decrease
If symptoms are minimal/ none, do they need to be treated?
No
What symptomatic management options are there?
Levonorgestrel releasing IUS
Tranexamic acid or mefanamic acid
COCP, POP
What management options are there to reduce size of fibroids?
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
Surgery is sometimes needed:
Myomectomy - hysteroscopic, open room laparoscopic depending on size and location
How is uterine artery embolisation done?
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
Is UAE recommended for those who want to retain fertility?
No
Who is hysterectomy reserved for?
Women who have competed family or have no wish to preserve fertility
If large fibroids are noted prior to labour, what should be planned?
Caesarian section
What do fibroids look like?
Round
Firm
Greyish white
Are fibroids benign?
Yes
How is diagnosis made?
Symptoms
Pelvic examination
USS
Rarely biopsy - to rule out uterine sarcoma
What is red degeneration?
Usually occurs in pregnancy
When fibroids grow and outstrip their blood supply they can undergo a type of degeneration - usually due to venous thrombosis
What symptoms are associated with fibroid degeneration?
Low grade fever
Pain - abdominal
Localised peritoneal tenderness
Vomiting
How is fibroid degeneration managed?
Conservatively
Rest and analgesia
Should resolve within 4-7 days
Can endometrial ablation be used for fibroids?
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
