Uterine fibroids

Question 1

what are they?

Answer 1

benign smooth muscle tumours of the uterus.

Question 2

epidemiology

Answer 2

20% of white and around 50% of black women in the later reproductive years.

more common in Afro-Caribbean women
rare before puberty, develop in response to oestrogen

Question 3

features

Answer 3

asymptomatic

menorrhagia

bulk related symptoms

sub fertility

Question 4

rare features

Answer 4

polycythaemia secondary to autonomous production of erythropoietin

Question 5

Ix

Answer 5

TV US

Question 6

Mx asymptomatic fibroids

Answer 6

none

monitor

Question 7

Mx of menorrhagia related to fibroids

Answer 7

levonorgestrel intrauterine system (LNG-IUS)
useful if the woman also requires contraception
cannot be used if there is distortion of the uterine cavity

NSAIDs e.g. mefenamic acid

tranexamic acid

combined oral contraceptive pill

oral progestogen

injectable progestogen

Question 8

Mx to shrink/removed fibroids medical

Answer 8

GnRH agonists

Question 9

surgical Mx to shrink/removed fibroids

Answer 9

myomectomy

hysteroscopic endometrial ablation

hysterectomy

uterine artery embolization

Question 10

prognosis

Answer 10

generally regress post menopause

Question 11

complications

Answer 11

subfertility and iron-deficiency anaemia have been mentioned previously.

Other complications

red degeneration - haemorrhage into tumour - commonly occurs during pregnancy