Uterine Fibroids

Question 1

What is another term for uterine fibroids?

Answer 1

Leiomyomas

Question 2

What are uterine fibroids?

Answer 2

They are benign tumours of the smooth muscle of the uterus

Question 3

What hormone are the uterine fibroids sensitive to? What does this mean?

Answer 3

Oestrogen

They grow in response to oestrogen

Question 4

What are the three classifications of uterine fibroids?

Answer 4

Intramural Uterine Fibroids

Subserosal Uterine Fibroids

Submucosal Uterine Fibroids

Question 5

What is the most common uterine fibroid classification?

Answer 5

Intramural Uterine Fibroids

Question 6

What are intramural uterine fibroids?

Answer 6

They are defined as those which are confined to the myometrium of the uterus

These fibroids protrude into and distort the uterine cavity

Question 7

What are subserosal uterine fibroids?

Answer 7

They are defined as those which occur within the subserosal layer of the uterus – which is the outermost layer

These fibroids can protrude into the abdominal cavity

Question 8

What are submucosal uterine fibroids?

Answer 8

They are defined as those which occur within the submucosal layer of the uterus – which is the layer underneath the endometrium

These fibroids protrude into and distort the uterine cavity

Question 9

What fibroid classification is usually associated with subfertility? Explain?

Answer 9

Submucosal

They occur in the uterine cavity and disrupt the process of embryo implantation

Question 10

What four risk factors are associated with uterine fibroids?

Answer 10

Older Age

Afro-Caribbean Ethnicity

Family History

Early Menarche

Question 11

What are the seven clinical features of uterine fibroids?

Answer 11

Menorrhagia

Lower Abdominal Pain

Abdominal Distention

Subfertility

Urinary Frequency

Palpable Suprapubic Mass

Enlarged, Bulky & Firm Uterus

Question 12

Describe the lower abdominal pain associated with uterine fibroids

Answer 12

It is described as cramping abdominal pain

It usually occurs during menstruation

Question 13

What are the three investigations used to diagnose uterine fibroids?

Answer 13

Blood Tests

Ultrasound Scan

MRI Scan

Question 14

What blood test result indicates uterine fibroids? Explain

Answer 14

Increased Hb Levels

They can lead to polycythaemia due to autonomous production of erythropoietin

Question 15

What is the gold standard investigation used to diagnose uterine fibroids?

Answer 15

Transvaginal Ultrasound Scans

Question 16

What is the feature of uterine fibroids on transvaginal ultrasound scans?

Answer 16

Concentric, solid hypoechogenic mass

Question 17

When is conservative management used to manage uterine fibroids?

Answer 17

It is used to manage asymptomatic uterine fibroids

Question 18

What is the conservative management of uterine fibroids?

Answer 18

It involves regular monitoring of uterine fibroid size and growth

Question 19

What are the six pharmacological management options of uterine fibroids?

Answer 19

Tranexamic Acid

Levonorgestrel Intrauterine System

Combined Oral Contraceptive Pill

Progesterone Only Pill

Injectable Progesterone

GnRH Agonists

Question 20

When is tranexamic acid used to manage uterine fibroids?

Answer 20

It is used to manage symptomatic, small (<3cm) uterine fibroids

Question 21

How is tranexamic acid used to manage uterine fibroids?

Answer 21

It is administered to provide symptomatic relief of menorrhagia clinical features

Question 22

When are levonorgesteral uterine systems used to manage uterine fibroids?

Answer 22

They are used to manage symptomatic, small (<3cm) uterine fibroids – without uterine cavity distortion

Question 23

How are levonorgestrel intrauterine systems used to manage uterine fibrodis?

Answer 23

They are administered to provide symptomatic relief of menorrhagia clinical features

Question 24

When is the combined oral contraceptive pill used to manage uterine fibroids?

Answer 24

It is used to manage symptomatic, small (<3cm) uterine fibroids

Question 25

How is the combined oral contraceptive pill used to manage uterine fibroids?

Answer 25

It is administered to provide symptomatic relief of menorrhagia clinical features

Question 26

When is the progesterone only pill used to manage uterine fibroids?

Answer 26

It is used to manage symptomatic, small (<3cm) uterine fibroids

Question 27

How is the progesterone only pill used to manage uterine fibroids?

Answer 27

It is administered to provide symptomatic relief of menorrhagia clinical features

Question 28

When is injectable progesterone used to manage uterine fibroids?

Answer 28

It is used to manage symptomatic, small (<3cm) uterine fibroids

Question 29

How is injectable progesterone used to manage uterine fibroids?

Answer 29

It is administered to provide symptomatic relief of menorrhagia clinical features

Question 30

When are GnRH agonists used to manage uterine fibroids?

Answer 30

They are used to manage symptomatic, large (>3cm) uterine fibroids

Question 31

How are GnRH agonists used to manage uterine fibroids?

Answer 31

They are used temporarily in order to reduce the size of uterine fibroids – typically in order to prepare for surgical management options

Question 32

Why do we administer GnRH agonists temporarily when managing uterine fibroids?

Answer 32

They are associated with side effects, such as hot flushes, vaginal dryness and reduced bone mineral density

Question 33

Name a GnRH agonist used to manage uterine fibroids

Answer 33

Triptorelin

Question 34

What are the four surgical management options of uterine fibroids?

Answer 34

Myomectomy Hysteroscopic Endometrial Ablation Uterine Artery Embolisation Hysterectomy

Question 35

When is myomectomy used to manage uterine fibroids?

Answer 35

It is used to manage symptomatic, large (>3cm) uterine fibroids – which is particularly recommended in those with subfertility features who wish to preserve their fertility

Question 36

What is myomectomy?

Answer 36

It involves surgical removal of uterine fibroids from the myometrium layer of the uterus

Question 37

What are the three complications of myomectomy?

Answer 37

Uterine Adhesions Bladder Injury Uterine Perforation

Question 38

What is the main complication associated with myomectomy?

Answer 38

Uterine Adhesions

Question 39

When is hysteroscopic endometrial ablation used to manage uterine fibroids?

Answer 39

It is used to manage symptomatic, large (>3cm) uterine fibroids

Question 40

What is hysteroscopic endometrial ablation?

Answer 40

It involves the use of various techniques in order to destroy the endometrial lining of the uterus

Question 41

When is uterine artery embolisation used to manage uterine fibroids?

Answer 41

It is used to manage symptomatic, large (>3cm) uterine fibroids

Question 42

What is uterine artery embolisation?

Answer 42

It involves insertion of a catheter into the femoral artery, which is then guided towards the uterine artery under x-ray guidance There is the injection of particles into the uterine artery, which cause an occlusion of arterial supply to the uterine fibroid – leading to shrinkage of the uterine fibroid

Question 43

When is hysterecomy used to manage uterine fibroids?

Answer 43

It is used to manage symptomatic, large (>3cm) uterine fibroids

Question 44

What is hysterectomy?

Answer 44

It involves surgical removal of the uterus

Question 45

What are the three complications of uterine fibroids?

Answer 45

Subfertility Iron Deficiency Anaemia Red Degeneration

Question 46

What is red degeneration?

Answer 46

It is defined as a condition in which there is haemorrhagic infarction of the uterine fibroid.

Question 47

What is the most common risk factor of red degeneration? Explain

Answer 47

2nd/3rd Trimester of Pregnancy This is due to the expanding uterus resulting in kinking of uterine blood vessels

Question 48

What are the four clincial features of red degeneration?

Answer 48

Low Grade Fever Nausea & Vomiting Severe Abdominal Pain Tachycardia

Question 49

What is the management option of red degeneration?

Answer 49

Supportive treatment with rest, fluids and analgesia

Question 50

During pregnancy, what complication of uterine fibroids can occur?

Answer 50

Uterine Fibroid Degeneration

Question 51

What is the pathophysiology of uterine fibroids degeneration during pregnancy?

Answer 51

The uterine fibroids are sensitive to oestrogen and can therefore grow during pregnancy When growth outstrips their blood supply, they can undergo degneration

Question 52

What are the three clincial features of uterine fibroid degeneration?

Answer 52

Low Grade Fever Vomiting Abdominal Pain

Question 53

What is the management option of uterine fibroid degeneration?

Answer 53

Rest Analgesia