Fibroids (leiomyomas) Flashcards
what- fibroids?
Benign tumour of smooth muscle (myometrium)
symptoms- fibroids?
SYMPTOMS:
-Menorrhagia (heavy menstrual bleeding)
-Infertility/ subfertility
-Pressure symptoms +/- abdominal distention (includes urinary frequency or chronic retention)
-Associated pain (rare)
(Their growth is oestrogen dependant so they are more likely to be a problem in reproductive years
More concerned if you have one in post menopausal state)
SIGNS:
-Solid mass or enlarged uterus which may be palpable on abdominal or bimanual examination
-uterus is non tender
what imaging used for fibroids?
-pelvic US
-MRI (rarely required, unless sarcoma is suspected)
submucosal fibroids presenting with heavy bleeding= hysteroscopy
what would be seen on histoligcal biopsy of fibroids?
-interlacing smooth muscle cells
(usually only looked at to excluse leiomyosarcoma)
Management of fibroid <3cm?
Same management as heavy menstrual bleeding!
1st line= Mirena Coil must be no distortion of uterus
NSAIDs + tranexamic acid (symptomatic)
COC
Cyclical oral progesterones
Surgical:
-endometrial ablation
-Resection hysterascopically for submucosal fibroids
-Hysterectomy
Medical managment of fibroid >3cm
Refer to gynaecology!!
Mirena Coil (depending on size and shape of fibroid)
NSAID + tranexamic acid (symptomatic)
COC
Cyclical oral progesterones
Surgical:
-Uterine artery embolisation
-Myomectomy
-Hysterectomy
role of GnRH analogues?
they shrink the fibroids (often used before surgery)
why can’t GnRH analogues be used long term?
due to osteoperosis risk
who is more at risk of developing fibroids?
-women in later reproductive years
-black women
what type of fibroid is on a stalk?
pedunculated fibroid
describe a subserosal fibroid
-a fibroid just below the outer layer of the uterus
-these fibroids grow outwards and become very large filling the abdominal cavity
describe intramural fibroid
-a fibroid found within the wall of the myometrium
-as they grow they can change the shape of the uterus
describe submucosal fibroid
-fibroid found just below the lining of the uterus (endometrium)
treatment for fibroid affecting fertility?
myomectomy
examples of GnRH agonists?
Leuprolide, goserelin, triptorelin and histrelin
