Fibroids

Question 1

What is this?

How does it present?

What may be found O/E?

What’s its prognosis?

Answer 1

➊ Benign growth arising from the myometrium

➋ • Often asymptomatic - 25-50% are symptomatic
• Menorrhagia
• Dysmenorrhoea
• Abnormal uterine bleeding
• Pelvic/abdominal pain/pressure
• Deep Dyspareunia
• Constipation
• Subfertility

➌ Enlarged, firm, non-tender uterus

➍ Tends to regress after menopause as it’s oestrogen-sensitive

Question 2

Which investigation should be done?
→ What should be done after if in doubt over diagnosis?

Answer 2

TVUS
→ Hysteroscopy – biopsy may be taken to differentiate it from endometrial ca.

Question 3

Management:
When would a conservative approach be appropriate?

What are the medical options?

What are the surgical options?

Answer 3

➊ For women approaching menopause with minimal symptoms

➋ Symptomatic relief:
• NSAIDs
• Tranexamic acid
• COCP
• Mirena coil (IUS) – often 1st line but not an option if pt wishes to remain fertile
• GnRH agonists – shrinks fibroids prior to surgical resection

➌ • Myomectomy (removal of fibroid) – for those who want to preserve uterus and fertility
• Ablation – laser fired at fibroid to induce necrosis
• Uterine artery embolisation – for those who want to preserve uterus and fertility, and want to avoid surgery
• Hysterectomy – for those who don’t want to preserve uterus and fertility

Question 4

What are the complications that can occur with this?

Which complication should you think of if a pregnant woman with a hx of fibroids presents with severe abdominal pain and low-grade fever?
→ What occurs here?

Answer 4

➊ • Anaemia
• Subfertility
• Malpresentation
• C-section
• Premature birth
• Urinary outflow obstruction and UTIs

➋ Red degeneration of fibroids
→ Ischaemia, infarction and necrosis of fibroid due to disrupted blood supply by uterus – More likely to occur in larger fibroids during 2nd/3rd trimester as it outgrows its blood supply and uterus expands and kinks the supplying vessels to it