Uterine Flashcards
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What are fibroids?
Fibroids (uterine leiomyomata) are benign smooth muscle tumours of the uterus, often multiple, vary in size
Where are fibroids found?
Wall of uterus initially (intramural), but may bulge to lie under visceral peritoneum (subserosal 20%), live intramurally under the endometrium (submucosal, 5%) or become peduncluated
How common are fibroids?
20-40% women of reproductive age
By the age of 50, 70% white and 80% black women have at least 1 fibroid
When would the frequency of fibroids be more likely to occur?
Age Afrocarribean and Asian women FHx Obesity Early menarche
Associations with fibroids?
Mutation in fumarate dehydrogenase
Assoc between skin and uterine leiomyomata and renal cell carcinoma (rare)
Natural hx of fibroids?
Oestrogen dependent
Enlarge in pregnancy/COCP and atropy after menopause
May degenerate gradually or suddenly (red degeneration, typically from tortion of peduculated fibroid)
May calcify (‘womb stones’)
Rarely undergo sarcomatous change (pain, bleeding, inc fibroid size, malaise)
Presentation of fibroid?
- Many asymptomatic 50%
- Menorrhagia (heavy, prolonged +/- anaemia; generally not intermenstral/postmenopausal) 30%
- Fertility problems (submucosal interfere with implantation; large f may cause miscarriage by distorting uterine cavity)
- Pain (torsion - red degeneration following thrombosis of blood supply)
- Mass (may press on bladder - frequency, or veins - oedema. Pelvic fibroids may obstruct labour/cause urine retention)
Treatment for fibroids?
- If asymptomatic, none needed
- GnRH analogues
- Ullipristal acetate
- Myomectomy
- Uterine artery embolization (UAE)
- Hysterectomy
Why use GnRH analogues?
e.g. Goserelin 3.6mg SC monthly for 3-6 months prior to surgery to shrink fibroid
Not long term solution due to demineralisation of bone
Why use Ullipristal acetate?
Selective progesterone receptor modulator
3-6 months OD to shrink fibroids/amenorrhoea (prior to surgery)
May reduce fibroid size by >40% (so surgery may not be necessary)
Why use myomectomy?
Hysteroscopic, laparoscopic or open
Best for submucosal fibroid
Open myomectomy has 10% of hysterectomy due to bleeding
If endometrial cavity breached, resulting pregnancy requires elective CS (prevent uterine rupture in labour)
Why use hysterectomy?
Only cure
Useful in women who have finished family/have no interest in fertility
May be conversion from other operation
How common are fibroids in pregnancy?
5 in 1000 Caucasian
Higher in Afro-American
What happens to fibroids in pregnancy?
Increase in size (esp 2nd trimester)
What is red degeneration of fibroid?
Thrombosis of capsular vessels followed by venous engorgement and inflammation
Causes abdo pain (+/-vomiting, fever) and localised peritonitis (typically in last half of pregnancy/puerpurium)
