Uterine Leiomyomas

Question 1

What is uterine leiomyomas?

Answer 1

Benign
Hormone sensitive uterine neoplasm

Question 2

What are the predisposing factors to uterine leiomyomas?

Answer 2

1) nulliparity
2) early menarche
3) women of reproductive age
4) obesity

Question 3

What is the classification of uterine leiomyomas?

Answer 3

1) subseroral
2) intramural
3) submucosal
4) cervical

Question 4

What are the clinical features ?

Answer 4

1) abnormal mentsruations
2)Enlarged irregular uterus
3) back or pelvic pain
4) urinary frequency
5) constipation
6) infertility
7) dyspanuria

Question 5

How to diagnosis ?

Answer 5

Pelvic ultrasound shows well circumscribed hypoechoic solid mass
Lab study : CBC for anemia , BMP for renal function

Question 6

What is the treatment for heavy menstrual bleeding with or without features of mass effect ?

Answer 6

1) GnRH antagonists in combination with hormone therapy
2) IUD
3) OC
4) tranxemic acid

Question 7

What is the treatment for mass effect with or without heavy menstrual bleeding ?

Answer 7

GnRH agonist
( leuprolide )

Question 8

What is the non surgical interventional treatment ?

Answer 8

1) uterine artery embolization : emboli got injected in uterine artery that supply the leiomyoma causes it to shrink
2 ) radio frequency ablation

Question 9

What are the surgical treatment .

Answer 9

1) myomectomy ( fertility desired )
- hystroscope myomectomy : submucosal
- labroscopic myomectomy : subserosal, intramural

2) hysterectomy ( no fertility)

Question 10

What is used prior to surgery and why ?

Answer 10

GnRH agonist and antagonis is used prior to shrink the leiomyoma