Uterine fibroids

Question 1

What are the presenting features of Uterine fibroids

Answer 1

MAY BE ASYMPTOMATIC
* Menorrhagia [may result in iron-deficiency anaemia]
* Lower abdominal pain: cramping pains, often during menstruation
* Bloating
* Urinary symptoms, e.g. frequency, may occur with larger fibroids
* SUBFERTILITY

Question 2

What investigation is used to diagnose Uterine fibroids

Answer 2

Transvaginal ultrasound

Question 3

What is the management for Uterine fibroids

Answer 3

Asymptomatic fibroids = no treatment (other than periodic review to monitor size and growth)

Management of menorrhagia secondary to fibroids
o Tranexamic acid + Mefanamic acid
o Oral progestogen OR Injectable progestogen
o Levonorgestrel intrauterine system (LNG-IUS) [esp if woman also requires contraception]
o Combined oral contraceptive pill (if wanting a period cycle)

Medical treatment to shrink/remove fibroids = GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment

Surgical removal of fibroids:
o Myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically (Myosure)
o Hysterectomy

Note,
o {Hysteroscopic endometrial ablation (eg Novasure) – only treats menorrhagia}
o {Uterine artery embolization – only treats menorrhagia}