Fibroid, HMB (Heavy menstrual bleeding)

Question 1

Mcc of HMB

Answer 1

1. Fibroids*
2. Adenomyosis*
3. Endometrial polyp
4. Endometriosis
5. 50% idiopathic - Dysfunctional uterine bleeding
6. PID

Question 2

Irregular, heavy, painful periods are common when?

Answer 2

first 2-3yrs of menarche

Question 3

Endometrial thickness

Answer 3

Best on 4-7day of cycle
Premeno: 6-12mm
Perimeno: <5mm
Postmeno: =<4mm

Question 4

Investigations for HBM

Answer 4

Initial:
1. FBP - r/o anaemia, iron deficiency
2. Pregnancy test
3. Sr ferritin

4. STI screening
5. Thyroid
6. Coagulation
7. ANA
8. Transvaginal USG

Best:
D&C, Hysteroscopy

Question 5

When do you do Transvaginal USG in HMB pt

Answer 5

1. 6 months medical rx - no response
2. ↑risk of malignancy
   Best 5-10day of cycle
   Endometrial thickness checked

Question 6

*Mx of HMB

Answer 6

1. Best/first line: Tranexamic acid/mefanamic acid (active bleeding)
2. Most effective: Mirena
   … Sx
3. Fibroid - myomectomy
4. Endometrial ablation
5. Hysterectomy

Question 7

Fibroids c/f

Answer 7

Leiomyoma
1. Benign, from myometrium
2. Submucosal, subserosal, intramural, cervical, pedunculated
3. Estrogen dependent - only seen in reproductive age group
4. Bulky uterus
5. Can cause infertility

Question 8

Red degeneration of fibroid

Answer 8

Fibroid + pregnancy
Painful
Fever

Question 9

Best investigation for fibroid

Answer 9

Transvaginal USG

Question 10

Mx of fibroid

Answer 10

●First rx HMB - Medical(tranexamic)/Mirena

●GnRH analogues - shrink fibroid, before sx, >42yrs

●Sx
Myomectomy - reproductive age
Hysterectomy - family complete
Endoscopic ablation
Uterine artery embolisation