Fibroids Flashcards
(18 cards)
What are fibroids?
Benign tumours of the myometrium.
What percentage of women over 40 will have fibroids?
50%
What is the more medical name for fibroids?
Uterine leiomyoma
What are the risk factors for developing fibroids?
Increasing age
Nulligravidity (pregnancy protective)
Obesity
black
What are the protective factors for developing fibroids?
Cigarette smoking
Use of combined oral contraceptive pill
Full term pregnancy
What are the symptoms associated with fibroids?
Approx 50-60% of women with fibroids will be asymptomatic.
Menstrual irregulariteis
- Menorrhagia
- Intermenstrual bleeding
- Postcoital bleeding
- Continuous bleeding
Abdominopelvic mass
- pressure sensation
- abdominal bulkiness
Pain - secondary to complications
Subfertility
Urinary
- frequency
- Nocturia
- Urgency
What are the complications of fibroids?
Degeneration ( i.e. red degeneration)
Torsion of pedunculated fibroids
Mass effect
- urinary retention
- constipation
Infertility
Obstructed labour
PPH (Post-Partum Haemorrhage)
malignancy (1:1000)
With regard to fibroids, what is red degeneration?
In weeks 12-22 of pregnancy, the blood supply to the fibroid can be interrupted, causing it to turn red and die. This causes severe pain and can lead to premature labour or even miscarriage due to massive release of prostaglandins.
What is the malignancy associated with fibroids?
Leiomyosarcoma
What does the term pedunculated mean with regard to fibroids?
When they have come through the cervix dragging the endometrium with it.
What investigations would you do in a patient with suspected fibroids?
FBC - anaemia
?EUCs - renal issues (ureteric obstruction)
Ultrasound
Consider
- Endometrial Biopsy
- MRI
When would you treat a patient with fibroids?
If they were symptomatic
If they were rapidly enlarging
If they are thought to be causing infertility
What are the medical therapies used as adjuncts to surgery in the management of fibroids?
Gonadotrophin-releasing hormone analogues - lead to a temporary reversible menopausal state, which can lead to a reduction in fibroid size by 50%
What are the surgical types of definitive surgery used in the treatment of fibroids?
Transcervical resection of fibroids (TCRF) + endometrial ablation
Myomectomy
Hysterectomy
Uterine artery embolization
What are the possible complications of myomectomy?
Haemorrhage
Adhesion formation which may impair future fertility (especially posterior wall fibroids)
re-occurance of fibroids
Which fibroid surgical options are available for women who still want to have children.
Only myomectomy/ transcervical resection of fibroids.
Hysterectomy and uterine artery embolisation are contra-indicated
Can you use medical and surgical treatment in combination for fibroids.
Yes, you should do so pre-operatively,
How should you treat fibroids in a pregnant woman
Expectant and symptomatic management only.
Surgeries are contra-indicated due to risk of bleeding or preterm labour.
