Uterine Leiomyomas/Fibroids Flashcards
What are uterine leiomyomas?
- Benign tumours of myometrium
- Very common
Who gets uterine leiomyomas/risk factors?
- Increasing age
- Obesity
- African American
- Nulliparity
Types of fibroids?
- Intramural fibroids
- Subserosal fibroids
- Submucosal fibroids
Most common fibroids? And where they lie?
Intramural fibroids
-Lie within myometrium
Where are subserosal fibroids situated?
Serosal outer surface and extend outwards
-These deform normal contour of uterus
Where do submucosal fibroids develop?
Near inner surface of endometrium and extend into endometrial cavity either causing distortion of cavity or filling the cavity if they are pedunculated
Effect of different fibroids?
- Very dependant on site and size of fibroid
- Subserosal fibroids can put pressure on adjacent organs and cause bowel/bladder symptoms
- Submucosal and intramural fibroids= more likely to cause heavy menstrual bleeding, infertility and pain
Main symptoms of fibroids?
- Heavy and/or painful periods
- Abdo pain
- Lower back pain
- Urinary frequency
- Constipation
- Dyspareunia
Pathology of fibroids?
- Tumour is firm, round, white with a whorled (spiral) structure
- Cells are typical long spindle muscle cells arranged in interlacing bodies
Management of asymptomatic fibroids?
-No further investigation of treatment unless there is rapid growth or reason to suspect malignancy
Management of symptomatic fibroids with heavy bleeding?
- NSAIDs
- Tranexamic acid
- COCP
- Progesterone pill
- Mirena coil
(These all may help with symptoms)
What treatments are effective at shrinking fibroids?
Ulipristal acetate GnRH analogues (only licensed for 6 months use though)
Why are GnRH analogues only licensed for 6 months use?
Risk of osteoporosis
Surgical management of fibroids?
- Hysteroscopic resection good for relatively small fibroids up to ~4cm
- Myectomy: not common because challenging blood supply of fibroid (but possibility for woman wanting to keep fertility)
- Uterine artery embolization: for someone unfit for surgery, not recommended for maintaining fertility
What is gold standard surgical treatment for someone not wanting to maintain fertility?
Hysterectomy
