FIBROIDS

Question 1

What are fibroids?

Answer 1

Benign tumours of the myometrium.

Question 2

What percentage of women over 40 will have fibroids?

Answer 2

50%

Question 3

What is the histological description of fibroids?

Answer 3

Spiralled bundles of smooth muscle

Question 4

What is the more medical name for fibroids?

Answer 4

Uterine leiomyoma

Question 5

What are the risk factors for developing fibroids?

Answer 5

African-Caribbean
Increasing age
Nulligravidity
Obesity

Question 6

What are the protective factors for developing fibroids?

Answer 6

Cigarette smoking
Use of combined oral contraceptive pill
Full term pregnancy

Question 7

What are the symptoms associated with fibroids?

Answer 7

Approx 50% of women with fibroids will be asymptomatic.

Heavy periods - menorrhagia
Intermenstrual bleeding
Postcoital bleeding
Continuous bleeding

Abdominopelvic mass

Pain

Subfertility

Urinary frequency
Nocturia
Urgency

Question 8

What are the complications of fibroids?

Answer 8

Iron deficiency anaemia
Red degeneration 
Torsion of pedunculated fibroids
Fertility issues, miscarriages
Obstructed labour, premature labour
Risk of PPH (Post-Partum Haemorrhage)
Blockage of ureters / constipation
Malignant change to leiomyosarcoma. (<1%)

Question 9

With regard to fibroids, what is red degeneration?

Answer 9

In weeks 12-22 of pregnancy, the blood supply to the fibroid can be interrupted, causing it to turn red and die. This causes severe pain and can lead to premature labour or even miscarriage due to massive release of prostaglandins.

Question 10

What is the malignancy associated with fibroids?

Answer 10

Leiomyosarcoma

Question 11

What does the term pedunculated mean with regard to fibroids?

Answer 11

When they have come through the cervix dragging the endometrium with it.

Question 12

Why would you do U&Es in someone with fibroids?

Answer 12

Renal problems due to blockage of ureters

Question 13

What investigations would you do in a patient with suspected fibroids?

Answer 13

FBC - aneamia
U&Es

Ultrasound
MRI

Question 14

How might you differentiate between a fibroid from other pelvic masses?

Answer 14

MRI

Question 15

When would you treat a patient with fibroids?

Answer 15

If they were symptomatic
If they were rapidly enlarging
If they are thought to be causing infertility

Question 16

What are the medical therapies used as adjuncts to surgery in the management of fibroids?

Answer 16

Gonadotrophin-releasing hormone analogues - lead to a temporary reversible menopausal state, which can lead to a reduction in fibroid size by 50%

Question 17

For what period of time are gonadotrophin-releasing hormone analogues licenced to be used for?

Answer 17

6 months maximum

Question 18

What are the three surgical types of definitive surgery used in the treatment of fibroids?

Answer 18

Transcervical resection of fibroids (TCRF)

Myomectomy

Hysterectomy

Question 19

What types of fibroid would transcervical resection of fibroids (TCRF) be the suitable of surgery for?

Answer 19

Submucous fibroids

Question 20

What types of fibroids would myomectomy be the suitable choice of surgery for?

Answer 20

Pedunculated
Subserosal
Intramural fibroids

Question 21

What are the possible complications of myomectomy?

Answer 21

Haemorrhage

Adhesion formation which may impair future fertility (especially posterior wall fibroids)

Question 22

In what proportion of women who have a myomectomy to treat fibroids do fibroids return?

Answer 22

40%

Question 23

Other than definitive surgical treatment of fibroids, what other newer procedures can be done to treat fibroids?

Answer 23

Uterine artery embolization

Interstitial laser photocoagulation

Laporoscopic diathermy

Directed high energy ultrasound