Uterine fibroids Flashcards

1
Q

Definition

A

Benign tumours in or around the uterus
AKA: uterine myomas or leiomyomas.

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2
Q

Epidemiology

A
  • 30-50 years
  • Black
  • Obesity
  • Nulliparity: no children
  • Early puberty
  • FHx
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3
Q

Pathophysiology

A

They are a mixture of fibroblasts and smooth muscle cells which form hard, round, “whorled” tumours in the myometrium (muscular layer of the uterus).
- Fibroid growth is linked to increased oestrogen and progesterone , therefore less common after menopause.

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4
Q

Locations which fibroids can grow

A
  • Subserosal: between the outer muscular later of the myometrium and overlying serosa.
    = Commonly ASx, v.large can press on adjacent structures, e.g. bladder
  • Intramural (MC): between muscular layers of the myometrium
    = Sx: Menorrhagia or dysmenorrhoea.
  • Submucosal: Between the inner muscular layer of the myometrium and underlying mucosa
    = Sx: Menorrhagia, dysmenorrhoea or subfertility; may occur with even small submucosal fibroids.
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5
Q

What is an pedunculated fibroid

A

Subserosal and submucosal uterine fibroids can grow on a stalk and extend away from the myometrium.

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6
Q

Signs

A

Pelvic examination:
- firm, enlarged, and irreguarly shaped non-tender uterus (CHARACTERISTIC)
Abdominal examination: a central irregular mass may be found in cases of large fibroids

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7
Q

Symptoms

A
  • Menorrhagia
  • Dysmenorrhoea (submucosal and intramural)
  • Dyspaerunia
  • Intermenstrual bleeding
  • Urinary frequency or retention (large subserosal fibroids)
  • Bloating or constipation: (large subserosal fibroids)
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8
Q

Diagnosis

A

FIRST LINE:
- FBC: fibroids can secrete erythropoietin which may cause polycythaemia
GOLD STANDARD: Transvaginal USS:
Consider:
- Hysterectomy
- Laproscopy

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9
Q

Treatment

A

Asx = no Tx
<3cm = Primary care:
- FIRST LINE: Intrauterine system (IUS): levonorgestrel-releasing coil (e.g. Minera) Cannot be used if there is a distortion of the uterine cavity
- Second line: Tranexamic acid or NSAID
- OR Hormone treatment COCP/Progestogen

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10
Q

When to refer to specialist

A
  • Complications: dyspareunia, constipation or urinary symptoms
  • Suspicion of malignancy
  • Fertility complications e.g. subfertility
  • Fibroids which are palpable abdominally
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11
Q

Non-surgical methods secondary care

A
  • GnRH analogues: e.g. leuprorelin acetate, these agonists prevent FSH/LH release causing a drop in oestrogen/progesterone leading to shrinking of fibroids; short term
  • Uterine artery embolization (UAE): injecting small particles into the uterine artery to block supply to the fibroids to relieve symptoms and reduce their size
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12
Q

Surgical methods

A
  • Myomectomy: surgical removal of a fibroid;
  • GOLD STANDARD: Hysterectomy: the removal of the uterus = recommended for large fibroids and severe bleeding;
  • Hysteroscopic resection or endometrial ablation: usually for patients with submucosal fibroids
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13
Q

Complications

A

Malignancy
Torsion
Subfertility
Pregnancy complications
Degenerative changes:
- ‘Red degeneration’: necrosis and haemorrhage
- Hyaline degeneration: ASx softening and liquefaction
- Cystic degeneration: ASx central necrosis of the fibroid leaving cystic spaces, can become calcified
Asherman’s syndrome

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