Fibroids

Question 1

What are fibroids?

Answer 1

Benign tumor (leiomyoma) arising from myometrium

Question 2

What is the aetiology of fibroids?

Answer 2

Hormone dependentL contain large numbers of oestrogen and progesterone receptors, Enlarge in pregnancy (high OES) and shrink in menopause (low OES).

RF: nuliparity, FHx, obese. Reduced irsk with smoking, hormonal contraception.

Question 3

What is the epidemiology of fibroids?

Answer 3

30% women reproductive age.

Question 4

What is in the history of fibroids?

Answer 4

Menhorragia, dysmenhorrea, abdominal swelling, pressure symptoms, dyspareunia, miscarriage, infertility (often asymptomatic)

Question 5

What is in the examination of fibroids?

Answer 5

Abdomen: may be palpable

Vaginal: uterine enlargement

Question 6

What is the pathology of fibroids?

Answer 6

Can be submucosal, intramural or subserosal. Rounds of smooth muscle and connective tissue. Can undergo secondary changes:

· Hyaline degeneration (mucopolysaccharides deposit around fibres)

· Calcification (postmenopausal)

· Red degeneration (coagulative necrosis, pregnancy)

· Cystic change (liquefaction)

Question 7

What investigations do you do for fibroids?

Answer 7

Blood: FBC for anaemia

USS: TVS to diagnose.

Other: hysteroscopy – can see submucosal ones.

Question 8

What is the management of fibroids?

Answer 8

No tx if asymptomatic, Medical: tranexamic acid and mefenamic acid. COCP, IUS, GnRH analogues.

Surgical: endometrial ablation, transcervical resection of fibroid, uterine artery embolisation, myomectomy, hysterectomy.

Question 9

What are the complications/ prognosis of fibroids?

Answer 9

Anaemia (menhorragia), miscarriage, infertility, malignant change (leiomyosarcoma). In pregnancy, red degeneration, malpresentation, PPH. 10y recurrence after removal 15%.