Uterine Fibroids Flashcards
Define uterine fibroids
Uterine fibroids (leiomyomas) are benign smooth muscle tumours arising from the myometrium of the uterus.
Fibroids < 3cm/no distortion of the uterus 1st line Mx
LNG-IUS: Mirena coil
3 subtypes
Uterine fibroid subtypes
- Intramural
- Submucossal
- Subserosal (can be Pedunculated)
which subtype of uterine fibroid is the most common
Intramural
Define intramural uterine fibroid
Fibroids confined to the myometrium of the uterus
Define Submucosal uterine fibroid
Fibroids just underneath the endometrium
Define subserosal uterine fibroids
develops from the outer layer of the uterus - can be on stalks (pedunculated)
what hormone stimulate the growth of a fibroid
Oestrogen
Uterine Fibroid risk factors
- Obesity
- Early menarche < 11
- Family history
Women with a 1st degree relative affected carry a 2.5x increased risk. - Black, Afro-carribean women
Uterine Fibroids Sx
- Abdo discomfort / bloating
- Menorrhagia (HMB)
- Dysmenorrhoea
- Dysparenuia
- Prolonged menstrual cycle
- Subfertility
Uterine fibroids abdo/bimanual examination findings
- Palpable solid mass
- Enlarged uterus
- Non-tender uterus
Uterine Fibroid 1st line imaging
TA/TVUS
Fibroids < 3cm/no distortion of the uterus alternative Mx
when LNG-IUS declinced/unsuitable
- Non-hormonal: Tranexamic / Mefenamic acid
- Hormonal: COCP / cyclical progesterone
Uterine fibroids referral criteria
- Fibroids >3cm
- Uterine cavity distortion
- Severe Sx (anaemia, bulk-related pressure)
- Failed 1st line Tx
Surgical Mx for submucosal fibroids > 3cm
Hysteroscopic removal
Mx stepwise algorithm for fibroids > 3cm
- Referral
- UAE/Myomectomy - preserve fertility
- Hysterectomy - no fertility plans
How long should 1st-line Tx be trial before referral
3-6 months
Uterine Fibroids complications
- Fe def. anaemia
-
Compression of pelvic organs
- Recurrent UTIs
- Incontinence
- Hydronephrosis (ureteral obstruction from fibroids)
- Urinary retention - Subfertility/Infertility
- Torsion (esp. pedunculated)
- Hyaline degeneration
