Menstruation and Menstrual Disorders - Fibroids Flashcards
What are Fibroids?
Oestrogen-Sensitive Benign tumours of the smooth muscle of the uterus - a.k.a. uterine leiomyomas.
Epidemiology of Fibroids.
- 40-60% of Women in later Reproductive Years.
2. Commoner in Black Women.
Types of Fibroids (4).
- Intramural - Within Myometrium (growth distorts uterus).
- Subserosal - Below Outer Layer of Uterus (growth distorts abdomen).
- Submucsal - Below Endometrium.
- Pedunculated (Stalk).
Clinical Features of Fibroids (7).
- Asymptomatic.
- Menorrhagia (Commonest).
- Prolonged Menstruation.
- Abdominal Pain (worse during Menstruation).
- Bloating/Feeling Full in Abdomen/Urinary or Bowel Symptoms.
- DEEP Dysparenia.
- Reduced Fertility.
What blood findings may be seen in Fibroids?
- Iron-Deficiency Anaemia.
2. Polycythaemia.
Investigations of Fibroids (3).
- Initial Investigation for Menorrhagia : Hysteroscopy.
- Larger Fibroids : Pelvic US.
- MRI Scan : Before Surgery to get details about size, shape and blood supply of fibroids.
Clinical Examination of Fibroids (2).
- Abdomen : Palpable Pelvic Mass.
2. Bimanual : Enlarged Firm Non-Tender Uterus.
Management of Fibroids.
- Asymptomatic - Conservative.
- Medical.
- Surgical.
Medical Management of Small (Less than 3cm) Fibroids (4).
- same as Menorrhagia :
1. 1st Line : Mirena Coil (if no uterus distortion).
2. Symptomatic : NSAIDs and Tranexamic Acid.
3. COCP.
4. Cyclical Oral Progestogens.
Surgical Management of Small (Less than 3cm) Fibroids (3).
- Endometrial Ablation.
- Resection of Submucosal Fibroids during Hysteroscopy.
- Hysterectomy.
Medical Management of Large (More than 3cm) Fibroids.
Same as for Small Fibroids but with Referral to Gynaecology.
Surgical Management of Large Fibroids (More than 3cm) (3).
- Uterine Artery Embolisation.
- Myomectomy.
- Hysterectomy.
What medications can be used to reduce the size of Fibroids before surgery?
GnRH Agonists induce a menopause-like state ad reduce the amount of Oestrogen that maintains the fibroid.
What is Uterine Artery Embolisation?
A surgical option used by interventional radiologists - insert catheter into an artery (usually femoral) to the uterine artery under X-ray guidance to inject particles that cause blockage in arterial supply to fibroid.
What is a Myomectomy?
Laparoscopic or Laparatomic surgical removal of the fibroid.
Important Consideration of Myomectomy.
Only treatment known to potentially improve fertility in patients with Fibroids.
What is Balloon Thermal Ablation?
Second Generation Non-Hysteroscopic Technique : insert a specially designed balloon into the endometrial cavity and filling it with a high-temperature fluid that burns the endometrial lining of the uterus.
What is a Hysterectomy?
Laparotomic/Laparoscopic/Vaginal Removal of the Uterus and Fibroids.
Complications of Fibroids.
- Menorrhagia (& IDA).
- Reduced Fertility.
- Pregnancy Complications (Miscarriages, Premature Labour, Obstructive Delivery).
- Constipation.
- Urinary Outflow Obstruction and UTIs.
- Red-Degeneration.
- Torsion of Pedunculated Fibroids.
- Malignant Change - Leiomyosarcoma.
What is Red Degeneration of a Fibroid?
Ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply.
How does Red Degeneration of a Fibroid present?
- Severe abdominal pain.
- Low Grade Fever.
- Tachycardia.
- Vomiting.
Risk Factors of Red Degeneration of a Fibroid.
Larger Fibroids (5+cm) during Pregnancy’s 2nd/3rd Trimester : fibroid rapidly enlarges to outgrow its blood supply or kinking in blood vessels as the uterus changes shape.
Management of Red Degeneration of a Fibroid.
Supportive with Rest, Fluids and Analgesia (4-7 day resolution).
