Uterine Fibroids Flashcards
Define fibroids
Benign neoplasms that arise from the uterine smooth muscles.
Risk factors
Nulliparity/ low parity
black race
genetic/ family history
Reproductive age
why is uterine fibroids associated with reproductive age
this is because it is hormone dependent.
Peak age for fibroid
35 - 45 years
Types of fibroid
- Intramural- within the myometrium
- Subserous- projecting from the serosa
- Intraligamentary- between the layers of broad ligament
- Submucous- projecting into the uterine cavity
- Pedunculated–subserous fibroids may grow a pedicle and become pedunculated. T
Presentation of fibroids
- Symptomless- may be apparent only at clinical examination for other reason eg. during infertility
investigation, pregnancy or ultrasonography for other reasons
Abdominal swelling
Pressure effects- urinary frequency, urinary retention, edema, varicose veins
Abnormal uterine bleeding- menorrhagia, intermenstrual bleeding
Pain due to torsion, degeneration (red), infected fibroid
Dysmenorrhea–fibroid polyp being expelled through the cervix - infertility
- recurrent miscarriage
Complications of fibroid
Infection
Torsion
Degenerative changes
which type of fibroid is infection common in?
Submucous or fibroid polyps
Types of degenerative changes
Hyaline Cystic Red degeneration Calcific Sarcomatous(malignant)
why type of US is done for submucous
TVUSS
why type of US is done for intramural and subserosal
TAUSS
Differential diagnosis for uterine fibroids
Adenomyosis
Ovarian tumor
Uterine cancer
Treatment
1. Conservative/observation for Small tumours Symptomless fibroid close to menopause 2. Surgery (myomectomy or hysterectomy) is indicated in Large fibroids Symptomatic fibroids eg menorrhagia, pain, urinary retention 3. others Uterine Artery Embolisation High energy focused ultrasound
Drugs used in medical manangement
GnRH analogues
Progesterone
COC
Mechanism of action of GnRH analogues
Induces pseudo menopause by down regulating GnRH receptors in the pituitary
Reduces size of fibroids, reduces vascularity thus reducing menstrual and operative bleeding
Mechanism of action of progesterone
Reduces fibroid volume and alleviates HMB symptoms. it does not induce menopausal state and associated symptoms
Effects of Fibroid on pregnancy
infertility abortions wrong dating (larger-than-dates) abnormal lie mal-presentations obstructed labour (fibroids in lower segments/cervical fibroids) inefficient uterine contractions, leading to prolonged labour primary postpartum haemorrhage (PPH
Effects of pregnancy on fibroid
fibroids flatten out during pregnancy
increase in size
soften
degenerative changes, especially red degeneration
Indication for myomectomy
Retain fertility Woman of low parity Woman who desires to have more children Woman who has not completed her family Symptomatic patient who refuses hysterectomy
Complications of myomectomy
Haemorrhage
Adhesions involving the bowels, omentum.
Adhesions involving the fallopian tubes and ovaries—may lead to tubal blockage.
Rupture of myomectomy scar in labour- rare
recurrence
- infection
define endometrial polyp
An endometrial polyp is a hyperplastic overgrowth of endometrial glands visible as a spheroidal or
cylindrical structure which is usually pedunculated or sessile. They are rare before 20 years, increase
with age, peak in the 5th decade and decline after menopause
Risk factors for endometrial polyp
Hypertension
Obesity
Common presentation
Menorrhagia
Metorrhagia
treatment of endometrial polyp
Surgical excision
Hysterectomy
Medical treatment with progestins and GnRH agonists
