Fibroids_Flashcards

Question 1

What is the conservative management for asymptomatic fibroids?

Answer 1

The conservative management for asymptomatic fibroids involves observation without active treatment.

Question 2

What is a common symptom of fibroids and its treatment options?

Answer 2

A common symptom of fibroids is menorrhagia, and treatment options include LNG-IUS, tranexamic acid, NSAIDs, COCP, and oral progesterones.

Question 3

What is the role of the LNG-IUS in the treatment of fibroids?

Answer 3

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.

Question 4

What non-hormonal treatments are available for fibroid-related menorrhagia?

Answer 4

Non-hormonal treatments for fibroid-related menorrhagia include tranexamic acid and NSAIDs.

Question 5

What hormonal treatments are available for fibroid-related menorrhagia?

Answer 5

Hormonal treatments for fibroid-related menorrhagia include COCP and oral progesterones.

Question 6

Why might medical treatments be ineffective in the presence of certain fibroids?

Answer 6

Medical treatments may be ineffective in the presence of submucous fibroids or an enlarged uterus that is palpable abdominally.

Question 7

What is the only effective medical treatment for fibroids?

Answer 7

The only effective medical treatment for fibroids is injectable GnRH agonists.

Question 8

What are the side effects of GnRH agonists?

Answer 8

GnRH agonists induce a menopausal state, which can cause severe menopausal symptoms that are poorly tolerated.

Question 9

How long are GnRH agonists usually used to reduce fibroid size pre-operatively?

Answer 9

GnRH agonists are usually used for short-term treatment, typically for 3 months, to reduce fibroid size pre-operatively.

Question 10

Why is the use of ulipristal acetate currently suspended?

Answer 10

The use of ulipristal acetate is currently suspended due to a safety review regarding liver injury.

Question 11

Why are GnRH agonists and ulipristal acetate not considered long-term solutions for fibroids?

Answer 11

GnRH agonists and ulipristal acetate are not considered long-term solutions for fibroids because the fibroids regrow as soon as ovarian function returns.

Question 12

What factors influence the choice of surgical treatment for fibroids?

Answer 12

The choice of surgical treatment for fibroids depends on the presenting complaint and the patient’s preferences regarding menstrual function and fertility.

Question 13

What minimally invasive surgical option is available for removing submucous fibroids?

Answer 13

Minimally invasive hysteroscopic surgery can be used to remove submucous fibroids and fibroid polyps.

Question 14

What are the surgical options for a bulky fibroid uterus causing pressure symptoms or refractory menorrhagia?

Answer 14

Surgical options for a bulky fibroid uterus causing pressure symptoms or refractory menorrhagia include myomectomy, hysterectomy, and hysteroscopic endometrial ablation.

Question 15

What are the risks associated with myomectomy?

Answer 15

The risks associated with myomectomy include a small but significant risk of uncontrolled life-threatening bleeding that may require a hysterectomy.

Question 16

What pre-treatment can be used to reduce fibroid bulk and vascularity before hysterectomy or myomectomy?

Answer 16

GnRH agonist pre-treatment for 3 months can be used to reduce the bulk and vascularity of fibroids before hysterectomy or myomectomy.

Question 17

What is the benefit of pre-treatment with GnRH agonists before surgery for fibroids?

Answer 17

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.

Question 18

What is uterine artery embolisation (UAE) and when is it offered?

Answer 18

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.

Question 19

What are the complications associated with uterine artery embolisation (UAE)?

Answer 19

Complications associated with UAE include fever, infection, fibroid expulsion, potential ovarian failure, and the need for further treatment within 5 years.

Question 20

What is the effectiveness of UAE compared to myomectomy?

Answer 20

UAE is as effective as myomectomy for alleviating fibroid-related menorrhagia and pressure symptoms.

Question 21

What is the first line symptomatic treatment for fibroids?

Answer 21

The first line symptomatic treatment for fibroids is LNG-IUS.

Question 22

What are the other options for symptomatic treatment of fibroids?

Answer 22

Other options for symptomatic treatment of fibroids include tranexamic acid and COCP.

Question 23

What are the surgical options for treating fibroids?

Answer 23

Surgical options for treating fibroids include minimally invasive hysteroscopy, myomectomy, hysteroscopic endometrial ablation, and hysterectomy.

Question 24

What interventional radiology option is available for fibroids?

Answer 24

The interventional radiology option available for fibroids is uterine artery embolisation.

Question 25

What are the risk factors for fibroids?

Answer 25

Risk factors for fibroids include increasing age until menopause, early puberty, obesity, Afro-Caribbean ethnicity, and family history.

Question 26

How should the diagnosis of fibroids be explained to a patient?

Answer 26

The diagnosis of fibroids should be explained to a patient as common smooth muscle masses that can cause heavy menstrual bleeding and fertility issues.

Question 27

How common are fibroids among women over 30 years?

Answer 27

Fibroids are very common and increase in prevalence with age until menopause, affecting 20-50% of women over 30 years.

Question 28

What management options should be explained to a patient with fibroids in the context of their fertility plans?

Answer 28

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.