(gynae) Uterine Fibroids

Question 1

Typical clinical presentation of a woman with uterine fibroids

Answer 1

Reproductive age
Nulliparous or last pregnancy more than 5 years ago

Usually complains of:
Heavy prolonged painful period
W symptoms of anemia (dyspnea, easy fatigue, palps, headache, orthopnoea, fainting spells)

Possible:
Distended abdomen
Pressure on bladder causing increased frequency of micturition
Constipation rarely

Large low posterior fibroids: urinary retention if they are wedged in pelvis and kink urethra

Large fibroids can obstruct ureters causing renal failure

Further complications of fibroids:
Red degeneration- occurs when fibroids outgrow their blood supply and center becomes ischaemic and necrotic. May also become calcified and cause intestinal obstruction

Question 2

Which type of fibroids is said to be associated with infertility and recurrent spontaneous abortions? List the other types of fibroids

Answer 2

Subserosal

Others:
Submucosal
Intramural

Question 3

Ddx of a patient with uterine fibroids

Answer 3

Full bladder
Pregnancy
Ovarian mass or tubal mass
Large lymph nodes

Question 4

Conservative treatment of fibroids

Answer 4

Analgesia for the pain
Iron replacement if ida

Conservative drugs: depo provera or GnRH (side effects is osteoporosis so can use for more than 3-6 months therefore not definitive)
Both drugs decrease bleeding and increase Hb prior to sx

GnRH also shrinks fibroids
One year after stopping GnRH fibroids will usually return to og size

Question 5

Surgical mx of fibroids

Answer 5

Myomectomy which involves removal of fibroids and uterus left in tact
Done by hysteroscopy for submucous(fibroids), laporascopic for subserous and laparotomy for all types

Question 6

Main complication of myomectomy

Answer 6

Hemorrhage
Postoperative adhesions leading to infertility in 50% of cases and intestinal obstruction in 1% If myomectomies

May need to convert to hysterectomy if bleeding too much so warm patient prior esp if Nulliparous