Fibroids_Flashcards
What is the conservative management for asymptomatic fibroids?
The conservative management for asymptomatic fibroids involves observation without active treatment.
What is a common symptom of fibroids and its treatment options?
A common symptom of fibroids is menorrhagia, and treatment options include LNG-IUS, tranexamic acid, NSAIDs, COCP, and oral progesterones.
What is the role of the LNG-IUS in the treatment of fibroids?
The LNG-IUS is useful for treating fibroid-related menorrhagia if the woman also requires contraception. It cannot be used if there is distortion of the uterine cavity.
What non-hormonal treatments are available for fibroid-related menorrhagia?
Non-hormonal treatments for fibroid-related menorrhagia include tranexamic acid and NSAIDs.
What hormonal treatments are available for fibroid-related menorrhagia?
Hormonal treatments for fibroid-related menorrhagia include COCP and oral progesterones.
Why might medical treatments be ineffective in the presence of certain fibroids?
Medical treatments may be ineffective in the presence of submucous fibroids or an enlarged uterus that is palpable abdominally.
What is the only effective medical treatment for fibroids?
The only effective medical treatment for fibroids is injectable GnRH agonists.
What are the side effects of GnRH agonists?
GnRH agonists induce a menopausal state, which can cause severe menopausal symptoms that are poorly tolerated.
How long are GnRH agonists usually used to reduce fibroid size pre-operatively?
GnRH agonists are usually used for short-term treatment, typically for 3 months, to reduce fibroid size pre-operatively.
Why is the use of ulipristal acetate currently suspended?
The use of ulipristal acetate is currently suspended due to a safety review regarding liver injury.
Why are GnRH agonists and ulipristal acetate not considered long-term solutions for fibroids?
GnRH agonists and ulipristal acetate are not considered long-term solutions for fibroids because the fibroids regrow as soon as ovarian function returns.
What factors influence the choice of surgical treatment for fibroids?
The choice of surgical treatment for fibroids depends on the presenting complaint and the patient’s preferences regarding menstrual function and fertility.
What minimally invasive surgical option is available for removing submucous fibroids?
Minimally invasive hysteroscopic surgery can be used to remove submucous fibroids and fibroid polyps.
What are the surgical options for a bulky fibroid uterus causing pressure symptoms or refractory menorrhagia?
Surgical options for a bulky fibroid uterus causing pressure symptoms or refractory menorrhagia include myomectomy, hysterectomy, and hysteroscopic endometrial ablation.
What are the risks associated with myomectomy?
The risks associated with myomectomy include a small but significant risk of uncontrolled life-threatening bleeding that may require a hysterectomy.
What pre-treatment can be used to reduce fibroid bulk and vascularity before hysterectomy or myomectomy?
GnRH agonist pre-treatment for 3 months can be used to reduce the bulk and vascularity of fibroids before hysterectomy or myomectomy.
What is the benefit of pre-treatment with GnRH agonists before surgery for fibroids?
Pre-treatment with GnRH agonists can facilitate a suprapubic incision and vaginal hysterectomy rather than a midline abdominal incision and abdominal hysterectomy, leading to quicker recovery and fewer complications.
What is uterine artery embolisation (UAE) and when is it offered?
Uterine artery embolisation (UAE) is offered to patients who do not desire fertility. It involves embolisation to induce infarction and degeneration of fibroids, leading to a reduction in fibroid volume.
What are the complications associated with uterine artery embolisation (UAE)?
Complications associated with UAE include fever, infection, fibroid expulsion, potential ovarian failure, and the need for further treatment within 5 years.
What is the effectiveness of UAE compared to myomectomy?
UAE is as effective as myomectomy for alleviating fibroid-related menorrhagia and pressure symptoms.
What is the first line symptomatic treatment for fibroids?
The first line symptomatic treatment for fibroids is LNG-IUS.
What are the other options for symptomatic treatment of fibroids?
Other options for symptomatic treatment of fibroids include tranexamic acid and COCP.
What are the surgical options for treating fibroids?
Surgical options for treating fibroids include minimally invasive hysteroscopy, myomectomy, hysteroscopic endometrial ablation, and hysterectomy.
What interventional radiology option is available for fibroids?
The interventional radiology option available for fibroids is uterine artery embolisation.
What are the risk factors for fibroids?
Risk factors for fibroids include increasing age until menopause, early puberty, obesity, Afro-Caribbean ethnicity, and family history.
How should the diagnosis of fibroids be explained to a patient?
The diagnosis of fibroids should be explained to a patient as common smooth muscle masses that can cause heavy menstrual bleeding and fertility issues.
How common are fibroids among women over 30 years?
Fibroids are very common and increase in prevalence with age until menopause, affecting 20-50% of women over 30 years.
What management options should be explained to a patient with fibroids in the context of their fertility plans?
Management options for fibroids that should be explained to a patient in the context of their fertility plans include control of menorrhagia with LNG-IUS or COCP, use of GnRH analogues (usually pre-operatively), and surgical interventions.
