Fibroids and Ovarian Cysts Flashcards
Progressively heavier and longer menstrual cycles with firm mass in pelvis.
No inter-menstrual or post-coital bleeding.
Top differential?
Fibroids
What standard investigations should be done for menorrhagia?
FBC - Hb, Anaemia
Pregnancy test
Pelvic USS
Risk factors for fibroids
Race (African), FHx, obestiy, age
Smoking and exercise - protective effect
Which class of fibroids → increased bleeding?
Pedunculated submucosal and submucosal
What investigations should you conduct for suspected fibroids?
Hb, Tumour markers, US variegated echogenicity, endometrial biopsy
Hysteroscopy to assess cavity/remove submucosal fibroids
Laparoscopy or Laparotomy
What are the complications of a fibroid?
Degeneration
Torsion of pedunculated fibroid
Infection with pyometra (pus in endometrium)
Malignancy - Leiomyosarcoma
What is the treatment for leiomyosarcoma?
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
What is the main medical treatment for fibroids?
Esmya (Ulipristal Acetate)
Block progesterone receptors → inhibit cell proliferation and stimulates apoptosis → reduce fibroid size
Also blocks progesterone activity → ↓LH/FSH, maintain mid-follicular oestrogen levels → inhibit ovulation
Reduce uterine bleeding from endometrium
Other than Esmya, name a medical treatment for fibroids
GnRH analogue → shrink fibroid and decrease vascularity
Risk of menopausal symptoms and osteoporosis
What are the surgical treatments for fibroids?
Myomectomy - Hysteroscopic, Laparoscopic, Abdominal
Hysterectomy
Uterine artery embolisation → fibroid becomes avascular and shrinks
Sudden onset, left iliac fossa pain, guarding and rebound pain, with palpable mass
Give differentials
Ovarian cyst torsion
Diverticular disease/abscess
Palpable bladder
Large/small bowel obstruction
What are the routine blood tests for pelvic/abdominal area pain?
Tumour markers,
AFP (germ cell tumour),
β-hCG,
Androgens
What is a chocolate cyst?
Endometrioma
What is a surgical treatment option for polycystic ovaries?
Ovarian Drilling
What is the main investigation that should be conducted for ovarian cysts?
Ultrasound - size shape nature septae neovascularisation etc.
