Flashcards in Uterine fibroids Deck (21):
What are uterine fibroids?
leiomyoma, benign monoclonal tumors derived from the smooth muscle cells of the myometrium, most common pelvic tumor in women
What is the prevalence?
45% of women have them by 5th decade, usually asymptomatic
What is the primary cause of hysterectomies in the US?
What are the risk factors?
increasing age, african americans, nulliparity, family hx, red means, ham, increased BMI
What's the pathogenesis?
unknown, but estrogen and progesterone are important for growth, inc levels of growth factors produce fibronectin and collagen
Characteristics of fibroids?
spherical, well-circumscribed, whorled appearance, white, firm lesions, arise from myometrium, migrate to other locations, has poor internal blood and lymph supply
What are the 3 locations that fibroids can be in?
submucosal- towards endometrium, intramural- within myometrium, subserosal- towards serosal surface
microscopically leiomyomas are composed of bland smooth muscle, can be more fibrotic or more cellular
heavy or prolonged menstrual bleeding, pelvic pressure and pain, reproductive dysfunction
How are they diagnosed?
Pelvic exam, bimanual, enlarged, mobile uterus w/ irregular contour, consistent w/ a leiomyomatous uterus, US, hysteroscopy, MRI
What has a high sensitivity for detecting small myomas?
transvaginal US, most widely used modality due to availability and cost
What can fibroids be confused with?
polyps or hyperplasia
Differential diagnosis of uterine fibroids?
adenomyoma, pregnancy, hematometra, uterine sarcoma, carcinosarcoma, endometrial carcinoma, metastatic disease
relief of sx, hysterectomy, surgery to remove fibroids, endometrial ablation, uterine artery embolization, MRgFUS, and myolysis
When would a myomectomy be performed?
if future fertility is desired, laparotomy for larger fibroids, laparoscopic if peduncculated or subserosal, hysteroscopic if submucosal and >50% in cavity
When would be preformed if desire uterine preservation but not fertility?
endometrial ablation or uterine artery embolization
When would a hysterectomy be preformed?
if no desire for uterine preservation or fertility, laparotomy for larger fibroids, laparascopic for smaller fibroids
What is the 1st line treatment?
NSAIDs, progestin only therapies (Depoprovera, mirena), or combo therapies (OCP, patches, rings)
What is second line treatment?
GnRH analog (Lupron), blocks endometrial proliferation, shrinks myometrium and reduces leiomyoma volume; GnRH analog and hormonal agents; mifepristone- a progesterone receptor antagonist
What is used for the treatment of heavy bleeding?
antifibrinolytic agens (tranexamic acid)