Uterine Fibroids Flashcards
What is another term for uterine fibroids?
Leiomyomas
What are uterine fibroids?
They are benign tumours of the smooth muscle of the uterus
What hormone are the uterine fibroids sensitive to? What does this mean?
Oestrogen
They grow in response to oestrogen
What are the three classifications of uterine fibroids?
Intramural Uterine Fibroids
Subserosal Uterine Fibroids
Submucosal Uterine Fibroids
What is the most common uterine fibroid classification?
Intramural Uterine Fibroids
What are intramural uterine fibroids?
They are defined as those which are confined to the myometrium of the uterus
These fibroids protrude into and distort the uterine cavity
What are subserosal uterine fibroids?
They are defined as those which occur within the subserosal layer of the uterus – which is the outermost layer
These fibroids can protrude into the abdominal cavity
What are submucosal uterine fibroids?
They are defined as those which occur within the submucosal layer of the uterus – which is the layer underneath the endometrium
These fibroids protrude into and distort the uterine cavity
What fibroid classification is usually associated with subfertility? Explain?
Submucosal
They occur in the uterine cavity and disrupt the process of embryo implantation
What four risk factors are associated with uterine fibroids?
Older Age
Afro-Caribbean Ethnicity
Family History
Early Menarche
What are the seven clinical features of uterine fibroids?
Menorrhagia
Lower Abdominal Pain
Abdominal Distention
Subfertility
Urinary Frequency
Palpable Suprapubic Mass
Enlarged, Bulky & Firm Uterus
Describe the lower abdominal pain associated with uterine fibroids
It is described as cramping abdominal pain
It usually occurs during menstruation
What are the three investigations used to diagnose uterine fibroids?
Blood Tests
Ultrasound Scan
MRI Scan
What blood test result indicates uterine fibroids? Explain
Increased Hb Levels
They can lead to polycythaemia due to autonomous production of erythropoietin
What is the gold standard investigation used to diagnose uterine fibroids?
Transvaginal Ultrasound Scans
What is the feature of uterine fibroids on transvaginal ultrasound scans?
Concentric, solid hypoechogenic mass
When is conservative management used to manage uterine fibroids?
It is used to manage asymptomatic uterine fibroids
What is the conservative management of uterine fibroids?
It involves regular monitoring of uterine fibroid size and growth
What are the six pharmacological management options of uterine fibroids?
Tranexamic Acid
Levonorgestrel Intrauterine System
Combined Oral Contraceptive Pill
Progesterone Only Pill
Injectable Progesterone
GnRH Agonists
When is tranexamic acid used to manage uterine fibroids?
It is used to manage symptomatic, small (<3cm) uterine fibroids
How is tranexamic acid used to manage uterine fibroids?
It is administered to provide symptomatic relief of menorrhagia clinical features
When are levonorgesteral uterine systems used to manage uterine fibroids?
They are used to manage symptomatic, small (<3cm) uterine fibroids – without uterine cavity distortion
How are levonorgestrel intrauterine systems used to manage uterine fibrodis?
They are administered to provide symptomatic relief of menorrhagia clinical features
When is the combined oral contraceptive pill used to manage uterine fibroids?
It is used to manage symptomatic, small (<3cm) uterine fibroids
How is the combined oral contraceptive pill used to manage uterine fibroids?
It is administered to provide symptomatic relief of menorrhagia clinical features
When is the progesterone only pill used to manage uterine fibroids?
It is used to manage symptomatic, small (<3cm) uterine fibroids
How is the progesterone only pill used to manage uterine fibroids?
It is administered to provide symptomatic relief of menorrhagia clinical features
When is injectable progesterone used to manage uterine fibroids?
It is used to manage symptomatic, small (<3cm) uterine fibroids
How is injectable progesterone used to manage uterine fibroids?
It is administered to provide symptomatic relief of menorrhagia clinical features
When are GnRH agonists used to manage uterine fibroids?
They are used to manage symptomatic, large (>3cm) uterine fibroids
How are GnRH agonists used to manage uterine fibroids?
They are used temporarily in order to reduce the size of uterine fibroids – typically in order to prepare for surgical management options
Why do we administer GnRH agonists temporarily when managing uterine fibroids?
They are associated with side effects, such as hot flushes, vaginal dryness and reduced bone mineral density
Name a GnRH agonist used to manage uterine fibroids
Triptorelin
What are the four surgical management options of uterine fibroids?
Myomectomy
Hysteroscopic Endometrial Ablation
Uterine Artery Embolisation
Hysterectomy
When is myomectomy used to manage uterine fibroids?
It is used to manage symptomatic, large (>3cm) uterine fibroids – which is particularly recommended in those with subfertility features who wish to preserve their fertility
What is myomectomy?
It involves surgical removal of uterine fibroids from the myometrium layer of the uterus
What are the three complications of myomectomy?
Uterine Adhesions
Bladder Injury
Uterine Perforation
What is the main complication associated with myomectomy?
Uterine Adhesions
When is hysteroscopic endometrial ablation used to manage uterine fibroids?
It is used to manage symptomatic, large (>3cm) uterine fibroids
What is hysteroscopic endometrial ablation?
It involves the use of various techniques in order to destroy the endometrial lining of the uterus
When is uterine artery embolisation used to manage uterine fibroids?
It is used to manage symptomatic, large (>3cm) uterine fibroids
What is uterine artery embolisation?
It involves insertion of a catheter into the femoral artery, which is then guided towards the uterine artery under x-ray guidance
There is the injection of particles into the uterine artery, which cause an occlusion of arterial supply to the uterine fibroid – leading to shrinkage of the uterine fibroid
When is hysterecomy used to manage uterine fibroids?
It is used to manage symptomatic, large (>3cm) uterine fibroids
What is hysterectomy?
It involves surgical removal of the uterus
What are the three complications of uterine fibroids?
Subfertility
Iron Deficiency Anaemia
Red Degeneration
What is red degeneration?
It is defined as a condition in which there is haemorrhagic infarction of the uterine fibroid.
What is the most common risk factor of red degeneration? Explain
2nd/3rd Trimester of Pregnancy
This is due to the expanding uterus resulting in kinking of uterine blood vessels
What are the four clincial features of red degeneration?
Low Grade Fever
Nausea & Vomiting
Severe Abdominal Pain
Tachycardia
What is the management option of red degeneration?
Supportive treatment with rest, fluids and analgesia
During pregnancy, what complication of uterine fibroids can occur?
Uterine Fibroid Degeneration
What is the pathophysiology of uterine fibroids degeneration during pregnancy?
The uterine fibroids are sensitive to oestrogen and can therefore grow during pregnancy
When growth outstrips their blood supply, they can undergo degneration
What are the three clincial features of uterine fibroid degeneration?
Low Grade Fever
Vomiting
Abdominal Pain
What is the management option of uterine fibroid degeneration?
Rest
Analgesia
