Uterine fibroids Flashcards
What are uterine fibroids?
Benign smooth muscle tumours of the uterus
What do uterine fibroids develop in response to?
Oestrogen.
This is why they are rare before puberty and don’t tend to progress following menopause
Which population group is this condition more prevalent in?
More common in Afro-Caribbean women
Symptoms?
- may be asymptomatic
- menorrhagia
- lower abdominal pain: cramping pains, often during menstruation
- bloating
- urinary symptoms, e.g. frequency, may occur with larger fibroids
- subfertility
What rare feature may be caused by this condition?
Polycythaemia secondary to autonomous production of erythropoietin
Diagnosis?
Transvaginal ultrasound
First-line symptomatic treatment?
Levonorgestrel-releasing intrauterine system
What other treatment options are there?
- Tranexamic acid
- COCP
- GnRH agonists (may reduce the size of the fibroid but are typically useful for short-term treatment)
- Surgery
- Uterine artery embolization
What occurs in uterine artery embolization?
A catheter is inserted and embolic agents are put into the arteries supplying the fibroid. These embolic agents then help sludge and block the vessel so no blood reaches the fibroid.
What surgeries can take place for this condition?
- Myomectomy
- Hysteroscopic endometrial ablation
- Hysterectomy
Complications?
Red degeneration
What is red degeneration of uterine fibroids?
Red degeneration refers to ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply. Red degeneration is more likely to occur in larger fibroids (above 5 cm) during the second and third trimester of pregnancy. Red degeneration may occur as the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic. It may also occur due to kinking in the blood vessels as the uterus changes shape and expands during pregnancy.
