Fibroids Flashcards
What are fibroids
Benign tumours of the smooth muscle of the uterus
What is another name for fibroids
Uterine leiomyomas
Fibroids pathophysiology
Oestrogen sensitive - grow in response to oestrogen
What are the types of fibroids
Intramural - within myometrium
Subserosal - just below outer layer of uterus. Can grow outwards and fill abdominal cavity
Submucosal - just below lining of uterus (endometrium)
Pedunculated - on a stalk
Fibroids presentation
30-50yr old black woman
Menorrhagia and prolonged bleeding.
Abdo pain, especially during menstruation.
Bloating or fullness of abdomen
Urinary or bowel symptoms due to pelvic pressure
Deep dyspareunia (pain during sex)
Reduced fertility
Fibroids investigations
Abdominal and bimanual examination - look for palpable pelvic mass or an enlarged firm non-tender uterus.
Hysteroscopy
Pelvic ultrasound for larger fibroids
MRI scan before surgical options considered
Fibroid management
Less than 3cm then same management as menorrhagia - Mirena coil/COCP or symptomatic management with meds.
More than 3cm refer to gynaecology.
Surgical options for larger fibroids - Hysterectomy, myomectomy (remove fibroids), uterine artery embolisation (inject embolic agent, causes blockage in arteries supplying fibroids = shrink and die)
Fibroid complications
Heavy menstrual bleeding often with iron deficiency anaemia
Reduced fertility and pregnancy complications
Fibroid torsion
Malignant changes
Red degeneration of fibroid
What is red degeneration of fibroids
Infarction, ischaemia and necrosis of fibroid due to disrupted blood supply. More likely to occur in larger fibroids more than 5cm during the second and third trimester of pregnancy.
Presentation of red degeneration of fibroids
severe abdo pain, low grade fever, tachycardia and often vomiting most commonly in pregnant women with a history of fibroids
Red degeneration of fibroids management
Supportive treatment with rest, fluids and analgesia
