Fibroids

Question 1

What are fibroids?

Answer 1

Leiomyomata

Question 2

Lifetime prevalence

Answer 2

30%

Question 3

Ratio black to white women

Answer 3

3-9:1

Question 4

RFs for fibroids

Answer 4

Ethnicity
Overweight
P0

Question 5

How many women symptomatic?

Answer 5

1/4

Question 6

Treatment options

Answer 6

Pharmacological
Uterine artery embolisation
MRI fcussed ultrasound
Minimally invasive surgery
Open surgery

Question 7

When are pharmacological options useful

Answer 7

Perimenopausal
Not suitable for surgery
Preoperatively (GnRH and UA)

Question 8

Pharm treatment fibroids

Non- Hormonal

Hormonal

Answer 8

TXA

COCP and POP- may increase fibroid size

IUS- increased rate of expulsion

GnRH analogues- induce a menopausal state with low oestrogen levels

Question 9

GnRH treatment- how can hypoestrogenic effects be minimised

Answer 9

Low dose HRT and tibolone.

Lmit treatment to 6 months duration

Question 10

Effects of GnRH

When do periods return?

When do firboids return?

Answer 10

Reduce size by 36%

Periods back 4-8 weeks after discontinuation

Fibroids back to pretreatment size within 4-6 months

Question 11

Mifepristone

Answer 11

Synthetic steroid- modulates progesterone receptors

Question 12

Ulipristal accetate

Answer 12

Selective progesterone receptor modulator

Question 13

MRI focused US and fertility

Answer 13

not yet recommendd if wishing to preserve fertility

Question 14

Which type of fibroids can be treated hysteroscopically?

Answer 14

Submucosal