Uterine fibroids (Complete) Flashcards
Define fibroids
Benign smooth muscle tumors of myometrium of uterus
What are the main risk factors for uterine fibroids?
Non-modifiable:
Afro-carribean ethnicity
Increasing age (until menopause)
What is the peak incidence of uterine fibroids
40s
N.B. 30-50% of woman have fibroids over age 30
What is the pathophysiology of uterine fibroids
Unknown however:
Oestrogen and progesterone promote fibroid growth
Fibroids have more oestrogen and progesterone recpetors than normal uterine muscle cells
What are the main signs/symptoms of uterine fibroids?
Menorrhagia (Heavy bleeding)
Lower abdominal pain: (Dysmenorrhoea)
- Cramping
- Occurs during menstruation
Bloating
Infertility (if fibroid large enough to distort uterine cavity)
Increased urinary frequency (Occurs with larger fibroids)
N.B. Can be assymptomatic in many cases
What findings on examination are suggestive of uterine fibroids?
Palpable mass on abdominal examination
What are the main differentials to consider alongside uterine fibroids?
Endometriosis
Endometrial polyps
Endometrial cancer
Ovarian cancer (due to bloating)
How can uterine fibroids be distinguished from endometriosis
Pain:
Fibroids: Pain typically not related to menstrual cycle and constant due to fibroid mass effects
Endometriosis: Pain typically cyclical
Bleeding patterns:
Fibroids: Heavy or prelonged menstrual bleeding, irregular periods
Endometriosis: Possible spotting between periods
What investigations should be considered for patients with uterine fibroids?
Bedside:
Basic obs: Check haemodynamically stable
Bloods:
FBC: If worried about anaemia
Iron studies: If worried about anaemia
Ca-125: Rule out ovarian cancer
Imaging:
Transvaginal ultrasound
MRI: If ultrasound does not provide clear enough picture to guide surgery
Biopsy: To rule out potential endometrial cancer
What is the management for patients with uterine fibroids who are assymptomatic?
No treatment required, just occasional monitoring of fibroid size and growth
What is the general management for symptomatic fibroids?
Medicine:
Menorrhagia: Any of the following
- Levonorgestrel-releasing intrauterine system (Mirena)
- NSAIDs (e.g. mefenemic acid)
- Tranexamic acid
- COCP
Shrinkage of fibroid:
- GnRH agonists (e.g. goserelin): Shrink or remove fibroid
Surgical: To resolve symptoms caused by mass effect
Myomectomy
Ablation
Uterine artery embolisation
Hysterectomy.
What is contraindicted in management of menorrhagia in women with confirmed uterine distortion?
Levonorgestrel-releasing intrauterine system (Mirena)
What medical management option is suitable for women who are planning pregnancy?
Tranexamic acid
When is surgical management for uterine fibroids indicated?
May be indicated if fibroids are:
Large
Rapidly growing
Non-responsive to medical treatment
What medication can be given prior to surgery to shrink fibroid size?
Goserelin (GnRH agonists)
What surgical options are available for patients with uterine fibroids (4).
Myomectomy
Hysterectomy
Uterine artery embolisation
Ablation
When is Mirena contraindicted for management of menorrhagia?
If patient has uterine distortion
Why is it reccomended for GnRH agonsists to be used only for short-term management?
Has side effects such as:
Loss of bone mineral density
Can cause menopausal symptoms
When would GnRH agonists be effective?
Effective before possible surgical management to reducen the size of fibroids and alleviate heavy bleeding which could complicate surgery if anaemic
Name an example of a GnRH agonist
Goserelin
What are some complications of uterine fibroids? (3)
Red degeneration (aka vascular infarction of fibroid)
Iron-deficiency anaemia
Subfertility
Red degeneration typically occurs in which patients with uterine fibroids?
Pregnant woman
What are the main features of red degeneration? (4)
Severe lower abdominal pain
Low-grade fever
Tacchycardia
Vomitting
