Fibroids

Question 1

risk factors for fibroids ?

Answer 1

increasing age
black ethnicity
high BMI

Question 2

features of how fibroids may present ?

Answer 2

menorrhagia 
dysmenorrhoea 
dysperunia 
pressure symptoms;
- bladder: frequency, urgency, incontinence
- bowel: constipation
- abdomen: bloating, 
dyspepsia 
irregularly enlarged uterus 
suprapubic mass

Question 3

1st line pharmacological treatment for fibroids ?

Answer 3

LNG IUD (mirena coil)

Question 4

when would you choose surgical treatment for fibroids?

Answer 4

symptoms due to mass effect of fibroids
> 3cm
failed medical management

Question 5

surgical options for treatment of fibroids ?

Answer 5

myomectomy
uterine artery embolisation
hysterectomy
later or radio frequency ablatio

Question 6

surgical options for treatment of fibroids if patient wishes to conserve fertility ?

Answer 6

myomectomy

uterine artery embolization

Question 7

what are the medical treatment options for fibroids ?

Answer 7

1st line: LNG IUD
2nd line: OCP, POP, TXA, mifenamix acid
3rd line: norethisterone

Question 8

when would you avoid OCP in the treatment of fibroids ?

Answer 8

if patient > 35yrs
risk of clots
smokes
high BMI

Question 9

30 year old patient with fibroid 4cm. Causes extreme menorrhagia affecting QOL. Wishes to preserve fertility.
best treatment option ?

Answer 9

surgical myomectomy

- surgical option because fibroid > 3cm

Question 10

40 year old female with fibroid 2.5cm. causes extreme menorrhagia affecting QOL. Has completed family so no desire to preserve fertility.
best treatment option?

Answer 10

medical because fibroid < 3cm

• LNG IUD
• if LNG doesn’t work or has side effects then give POP, TXA, or mifenamic acid. Avoid OCP in > 35yrs

Question 11

patient 12 weeks pregnant presents with vomiting, fever and abdominal pain. She has known fibroids.
what is the most likely diagnosis?
how would you manage this patient ?

Answer 11

fibroid degeneration

during pregnancy the rise in oestrogen can cause fibroids to grow
they grow so big that they outstrip their blood supply
this results in fibroids undergoing red or corneous degeneration

treatment = rest and analgesia
usually resolves within 4-7 days