Fibroids

Question 1

What are uterine fibroids also known as?

Answer 1

Leiomyomas

Question 2

What are uterine fibroids?

Answer 2

Benign smooth muscle tumours of the uterus

Question 3

How common are uterine fibroids compared to other benign tumours in women?

Answer 3

They are the most common

Question 4

What is the estimated incidence of fibroids?

Answer 4

20-40%

Question 5

What is the risk of a fibroid becoming malignant?

Answer 5

0.1%

Question 6

What do fibroids arise from?

Answer 6

The myometrium of the uterus

Question 7

What are fibroids classified based on?

Answer 7

Their position in the uterine wall

Question 8

What are the classifications of fibroids?

Answer 8

• Intramural
• Submucosal
• Subserosal

Question 9

What is the most common type of fibroid?

Answer 9

Intramural

Question 10

Where is an intramural fibroid found?

Answer 10

Confined to myometrium of the uterus

Question 11

Where is a submucosal fibroid?

Answer 11

Develops immediately underneath the endometrium of the uterus, and protrudes into the uterine cavity

Question 12

Where is a subserosal fibroid?

Answer 12

Protrudes into and distorts the serosal surface of the uterus

Question 13

What is the serosal surface of the uterus?

Answer 13

The outer surface

Question 14

What might be a feature of subserosal fibroids?

Answer 14

May be pedunculated (on a stalk)

Question 15

Describe the pathogenesis of fibroids?

Answer 15

Poorly understood, but their growth is thought to be stimulated by oestrogen

Question 16

What are the risk factors for fibroids?

Answer 16

• Obesity
• Early menarche
• Increasing age
• Family history
• Ethnicity

Question 17

How much does a family history of fibroids increase the risk?

Answer 17

Women with a 1st degree relative carry a 2.5x increased risk

Question 18

How does ethnicity affect the risk of fibroids?

Answer 18

African-Americans are 3x more likely than Caucasians

Question 19

How are the majority of cases of fibroids discovered?

Answer 19

Women are asymptomatic, and the fibroids are discovered incidentally on pelvic or abdominal examination

Question 20

If symptomatic, how may fibroids present?

Answer 20

• Pressure symptoms +/- abdominal distention
• Heavy menstrual bleeding
• Subfertility
• Acute pelvic pain (rare)

Question 21

What pressure symptoms may be present in fibroids?

Answer 21

• Urinary frequency

- Chronic retention

Question 22

Why might sub fertility be a sign of fibroids?

Answer 22

Due to the obstructive effect of the fibroid

Question 23

What might cause acute pelvic pain in fibroids?

Answer 23

• Red degeneration

- Pedunculated fibroids can undergo torsion

Question 24

When can red degeneration of fibroids occur?

Answer 24

In pregnancy

Question 25

What is red degeneration of fibroids?

Answer 25

Where rapidly growing fibroid undergoes necrosis and haemorrhage

Question 26

What may be found on examination in fibroids?

Answer 26

A solid mass or enlarged uterus may be palpable on abdominal or bimanual examination. The uterus is normally non-tender

Question 27

What are the differential diagnoses of fibroids?

Answer 27

- Endometrial polyp - Ovarian tumours - Leiomyosarcoma - Adenomyosis

Question 28

What is leiomyosarcoma?

Answer 28

Malignancy of myometrium

Question 29

What is adenomyosis?

Answer 29

Presence of functional endometrial tissue within the myometrium

Question 30

What is the main investigation for suspected fibroids?

Answer 30

Imaging

Question 31

What imaging may be done in suspected fibroids?

Answer 31

- Pelvic ultrasound | - MRI

Question 32

When is MRI used in suspected fibroids?

Answer 32

Rarely used, unless sarcoma is suspected

Question 33

When are blood tests used in fibroids?

Answer 33

Usually reserved for patients where the diagnosis is unclear, or as a pre-operative work-up if surgery is indicated

Question 34

What can the management of fibroids be divided into?

Answer 34

- Medical | - Surgical

Question 35

What is involved in the medical management of fibroids?

Answer 35

- Transexamic or mefanamic acid - Hormonal contraceptives - GnRH analogues - Selective Progesterone Receptor Modulators

Question 36

What are hormonal contraceptives useful for in fibroids?

Answer 36

Controlling menorrhagia

Question 37

What hormonal contraceptives can be used in fibroids?

Answer 37

- COCP - POP - Mirena IUS

Question 38

Give an example of a GnRH analogue

Answer 38

Zolidex

Question 39

What do GnRH analogues do?

Answer 39

Suppress ovulation, inducing a temporary menopausal state

Question 40

When are GnRH analogues useful in fibroids?

Answer 40

Pre-operatively

Question 41

Why are GnRH analogues useful pre-operatively in fibroids?

Answer 41

They reduce fibroid size and lower complications

Question 42

How long can GnRH analogues be used for?

Answer 42

6 months

Question 43

Why can GnRH analogues only be used for 6 months?

Answer 43

Due to risk of osteoporosis

Question 44

Give 2 examples of selective progesterone receptor modulators (SERMs)

Answer 44

- Ulipristal | - Esmya

Question 45

What do SERMs do in fibroids?

Answer 45

Reduces size of fibroid and menorrhagia

Question 46

When are SERMs useful in the management of fibroids?

Answer 46

Pre-operatively or as an alternative to surgery

Question 47

What are the surgical options for the treatment of fibroids?

Answer 47

- Hysteroscopy and transcervical resection of fibroid (TCRF) - Myomectomy - Uterine artery embolism (UAE) - Hysteroscopy

Question 48

What is TCRF useful for?

Answer 48

Submucosal fibroids

Question 49

Who is myomectomy a good option for?

Answer 49

Women wanting to preserve their uterus

Question 50

Who performs uterine artery embolism?

Answer 50

Radiologists

Question 51

What artery is used for uterine artery embolisation?

Answer 51

Femoral artery

Question 52

What does UAE commonly cause post-operatively?

Answer 52

- Pain | - Fever