Fibroids Flashcards
What are fibroids?
Benign smooth muscle tumours of the uterus
What is another term for fibroids?
Uterine leiomyomas
Are there often multiple?
Yes and vary in size from seedlings to tumours occupying large part of abdomen
How do they start?
A lumps in the wall of the uterus
May grow and bulge out
Where can they be located?
Intramural
Subserosal (under visceral peritoneum) 20% - develop into pelvis and can become very large
Submucosal (under the endometrium) 5% - grow into the uterine cavity
Peduncuated - attached to uterus by narrow stalk of tissue
Are they common?
Yes
20-40% of reproductive age have them
Frequency of fibroids increases with…
Increasing age
Afro Caribbean women
FH of fibroids
Obesity - increased level of oestrogen in body
What are they associated with?
Mutation in gene for fumarate hydratase
Renal cell cancer and hereditary leiomyomatosis
When do they enlarge?
In pregnancy
On the COCP
They are oestrogen dependent
When do they atrophy?
After the menopause
They may degenerate gradually or suddenly - called…
Red degeneration
Occasionally fibroids calcify. What are they called if this occurs?
Womb stones
How can they present?
Asymptomatic Menorrhagia Fertility problems Pain - abdominal and lower back, constant and dull- due to pressure on organs cramping pains often during menstruation Pain during sex Bloating Mass Mass causing - frequency, constipation
Describe the menorrhagia that fibroids can cause
Heavy and prolonged periods +/- anaemia
Do not generally cause IMB or PMB
May be associated dysmenorrhea
Why can fibroids cause fertility problems?
Interfere with the implantation
Large or multiple tumours can distort uterine cavity - may cause miscarriage should pregnancy occur
Why might pain occur?
Torsion of pedunculated fibroid
Red degeneration following thrombosis of of fibroids blood supply
Can large fibroids be felt abdominally?
Yes
Why can frequency occur?
If fibroid large it could press on the bladder
Why can oedematous legs and varicose veins occur?
Fibroid May press on veins
Does the risk increase of decrease with the more children women have?
Decrease
If symptoms are minimal/ none, do they need to be treated?
No
What symptomatic management options are there?
Levonorgestrel releasing IUS
Tranexamic acid or mefanamic acid
COCP, POP
What management options are there to reduce size of fibroids?
GnRH agonists e.g goserelin 3.6mg SC monthly for 3-6 months prior to surgery (not a long term option)
Ulipristal acetate - taken daily for 3-6 months to shrink fibroids and induce amenorrhoea, licensed for this purpose prior to surgery
Surgery is sometimes needed:
Myomectomy - hysteroscopic, open room laparoscopic depending on size and location
