uterine fibroids Flashcards
what are fibroids?
benign smooth muscle tumours of the uterus
what are fibroids associated with?
- more common in Afro-Caribbean women
- rare before puberty, develop in response to oestrogen
what are the features of fibroids?
- may be asx
-
menorrhagia
- may result in iron-def anaemia
-
lower abdo pain
- cramping pains, often during mensturation
- bloating
- urinary sx
- e.g. frequency, may occur w larger fibroids
- subfertility
- rare: polycythaemia 2˚ to autonomous production of eryhtropoietin
how do you diagnose fibroids?
transvaginal ultrasound
how is asx fibroids managed?
no rx needed other than periodic review to monitor size and growth
how do you manage menorrhagia 2˚ to fibroids?
-
levonogestrel intrauterine system (LNG-IUS)
- useful if woman also requires contraception
- can’t be used if theres distortion of uterine cavity
-
NSAIDs
- e.g. mefenamic acid
- tranexamic acid
- COCP
- oral progestogen
- injectable progestogen
what are the treatment available to shrink/remove fibroids?
- medical: GnRH agonists (short-term)
- surgical: myomectomy / hysteroscopic endometrial ablation / hysterectomy
- uterine artery embolisation
when do fibroids generally regress?
after menopause
what are the complications of fibroids?
- subfertility
- iron-def anaemia
- red degeneration (haemorrhage into tumour) - commonly during pregnancy, presents with low-grade fever, pain and vomiting
what is the effectove treatment for large fibroids causing problems with fertility?
myomectomy
what does uterine fibroid embolisation involve and who should it be avoided in?
injection of polyvinyl alcohol (PVA) into uterine arteries to shrink the fibroid
not used in cases of infertility as it usually leaves pts infertile
