Uterine Fibroids

Question 1

Define fibroids

Answer 1

Benign neoplasms that arise from the uterine smooth muscles.

Question 2

Risk factors

Answer 2

Nulliparity/ low parity
black race
genetic/ family history
Reproductive age

Question 3

why is uterine fibroids associated with reproductive age

Answer 3

this is because it is hormone dependent.

Question 4

Peak age for fibroid

Answer 4

35 - 45 years

Question 5

Types of fibroid

Answer 5

1. Intramural- within the myometrium
2. Subserous- projecting from the serosa
3. Intraligamentary- between the layers of broad ligament
4. Submucous- projecting into the uterine cavity
5. Pedunculated–subserous fibroids may grow a pedicle and become pedunculated. T

Question 6

Presentation of fibroids

Answer 6

• 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

Question 7

Complications of fibroid

Answer 7

Infection
Torsion
Degenerative changes

Question 8

which type of fibroid is infection common in?

Answer 8

Submucous or fibroid polyps

Question 9

Types of degenerative changes

Answer 9

Hyaline
Cystic
Red degeneration
Calcific
Sarcomatous(malignant)

Question 10

why type of US is done for submucous

Answer 10

TVUSS

Question 11

why type of US is done for intramural and subserosal

Answer 11

TAUSS

Question 12

Differential diagnosis for uterine fibroids

Answer 12

Adenomyosis
Ovarian tumor
Uterine cancer

Question 13

Treatment

Answer 13

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

Question 14

Drugs used in medical manangement

Answer 14

GnRH analogues
Progesterone
COC

Question 15

Mechanism of action of GnRH analogues

Answer 15

Induces pseudo menopause by down regulating GnRH receptors in the pituitary
 Reduces size of fibroids, reduces vascularity thus reducing menstrual and operative bleeding

Question 16

Mechanism of action of progesterone

Answer 16

Reduces fibroid volume and alleviates HMB symptoms. it does not induce menopausal state and associated symptoms

Question 17

Effects of Fibroid on pregnancy

Answer 17

 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

Question 18

Effects of pregnancy on fibroid

Answer 18

 fibroids flatten out during pregnancy
 increase in size
 soften
 degenerative changes, especially red degeneration

Question 19

Indication for myomectomy

Answer 19

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

Question 20

Complications of myomectomy

Answer 20

 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

Question 21

define endometrial polyp

Answer 21

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

Question 22

Risk factors for endometrial polyp

Answer 22

Hypertension

Obesity

Question 23

Common presentation

Answer 23

Menorrhagia

Metorrhagia

Question 24

treatment of endometrial polyp

Answer 24

Surgical excision
Hysterectomy
Medical treatment with progestins and GnRH agonists