Fibroids

Question 1

What is the scientific term for fibroids?

Answer 1

Leiomyoma

Question 2

Give 3 main types of fibroids and where they are located?

Answer 2

Subserosal - develop near the outer serosal surface of the uterus, >50% of fibroid mass extends outside the uterine contours
Intramural - develop within the myometrium, without extending predominantly into the uterine cavity
Submucosal - develop near the inner mucosal surface of the uterus and extend into the uterine cavity, >50% projection into uterine cavity

Note: subserosal and submucosal may become pedunculated (attached to the myometrium by a pedicle containing their blood supply)

Question 3

Give other types of fibroids not limited to the 3 main types

Answer 3

Cervical –> difficult to excise
Pedunculated –> mobile and prone to torsion
Parasitic –> become detached from the uterus and attached to other structures
IV leiomyomatosis –> very rare, spread through the pelvic veins and vena cava to involve the heart

Question 4

What is the % risk of malignant change for leiomyomas?

Answer 4

0.1% chance of change to leiomyosarcoma

Question 5

Woman with a history of fibroids who has sudden abdominal pain during pregnancy, what is going on?

Answer 5

Red degeneration - rapid growth of fibroid, promoted by high levels of sex hormones, outgrows its blood supply –> avascular necrosis occurs.

Question 6

3 complications of fibroids in pregnant women?

Answer 6

Unstable lie
Postpartum haemorrhage
Obstructed labour
Preterm labour

Question 7

5 risk factors for fibroid development?

Answer 7

Chemical reasons (increased oestrogen):

1. Early menarche
2. HRT use
3. Obesity
4. Nulliparity

Other reasons:

1. Increasing age
2. Black ethnicity
3. Family history of fibroids

Question 8

What are the SSx of fibroids?

Answer 8

Asymptomatic
Abdominal pain
Gynae symptoms:
1. Heavy menstrual bleeding
2. Painful periods
3. Dyspareunia (painful sex)
4. Infertility
GI symptoms: bloating, diarrhoea 
Urinary symptoms: Urinary frequency

On Bimanual examination: Large, bulky uterus

Question 9

3 complications of fibroids for non-pregnant women?

Answer 9

Hairline degeneration
Cystic degeneration
Recurrent miscarriages
Pedunculated fibroid (torsion)

Question 10

1st line Ix for fibroids?

Answer 10

Transvaginal/transabdominal USS

Question 11

Treatment for fibroids?

Answer 11

Medical:

• fibroid < 3cm = IUS system (if no want pregnant), tranexamic acid if want pregnancy
• fibroid > 3cm = Ulipristal acetate

Surgical:

• myomectomy (if want children) [increased risk of haemorrhage and hence hysterectomy]
• hysterectomy (if don’t want children)
• -> can do uterine artery embolisation as alternative to hysterectomy