Question 13: Fibroids

Question 1

What are the common symptoms of fibroids?

Answer 1

Heavy menstrual bleeding
✅ Pelvic pressure/pain
✅ Prolonged periods
✅ Urinary urgency
✅ Enlarged irregular uterus

Question 2

How is the diagnosis confirmed?

Answer 2

First-line: Pelvic ultrasound (transabdominal + transvaginal)

Additional imaging: MRI pelvis (for surgical planning, adenomyosis)

Other tests:
FBC → Check for anemia
Endometrial biopsy → Exclude endometrial pathology
Pap smear → Screen for cervical pathology

Question 3

What is the first-line medical management for fibroids?

Answer 3

Tranexamic acid (if fertility is desired).

Question 4

What hormonal therapies can be used for fibroids?

Answer 4

COC or Mirena (to reduce bleeding) and GnRH agonist (e.g., leuprolide) for preoperative shrinking.

Question 5

What are the surgical management options for fibroids?

Answer 5

Myomectomy (if future pregnancy is desired), hysterectomy (definitive treatment if childbearing is not a concern), and uterine artery embolization (UAE) as a minimally invasive option.

Question 6

What are the types of changes that fibroids may undergo?

Answer 6

Cystic, calcifications, hydatid, and red degeneration.

Question 7

What are the symptoms of fibroids with red degeneration in a pregnant woman?

Answer 7

Severe localized abdominal pain, low-grade fever, nausea and vomiting, abnormal lie/presentation of the fetus.

Question 8

What are four other symptoms that could be associated with fibroids?

Answer 8

Chronic pelvic pain, constipation, urinary retention, infertility, abdominal distension, leg edema, and varicose veins.