Uterine Leiomyoma

Question 1

Definition

Answer 1

Gynecological tumor

Question 2

Is leiomyoma benign or malignant

Answer 2

benign

Question 3

Where does it originate

Answer 3

In the smooth muscle cells of the myometrium

Question 4

Pathogenesis

Answer 4

• Hormone dependent
• Estrogen and Progestin receptors
• High estrogen cause fibrinoid enlargement
• First trimester fibrinoid enlarges
• Shrinks after puerperium
• Some dec in size during pregnancy due to prgestin
• Shrink after menopause
• Regrowth after hormonal therapy

Question 5

Risk factors

Answer 5

1. Black/African women
2. Nulliparity
3. Early menarche
4. Inc frequency of menses
5. Dysmenorrhea
6. Heredity
7. Hormonal drugs
8. Age
   Diet
   Caffeine
   Alcohol n smoking
   Obesity
   Hypertension
   Diabetes

Question 6

Clinical presentation

Answer 6

Abnormal uterine bleeding
Pelvic pain
Dysmenorrhea
Dyspareunia
Pelvic pressure can cause bladder symptoms(frequent urination and urgency), bowel dysfunction
Infertility
Pregnant complications

Question 7

What are the 3 types of fibroids

Answer 7

1. Submucosal fibroid
2. Intramural fibroid
3. Subserosal fibroid

Question 8

Diagnosis methods?

Answer 8

1. Pelvic examination : enlarged, mobile uterus and irregular contour
2. Ultrasound (high sensitivity)
3. MRI (most accurate )

Question 9

Expectant management

Answer 9

Asymptomatic patients and premenopausal women

Question 10

Medical therapy

Answer 10

1. GnRHa
2. Mifepristone

Question 11

How does GnRHa work?

Answer 11

Initially increasing the release of gonadotropins, followed by desensitization and downregulation to a hypogonadotropic, hypogonadal state that clinically resembles menopause.

Question 12

What are the side effects of GnRHa?

Answer 12

Hot flashes, sleep disturbances, vaginal dryness, myaligia, arthralgias, impairment of moof and cognition, bone loss

Question 13

How does Mifepristone work?

Answer 13

It is a progesterone receptor modulator. decreases the PR in the myometrium and leiomyoma

Question 14

What is the dose of Mifepristone?

Answer 14

2.5mg daily for 3-6 months

Question 15

Surgical treatment?

Answer 15

1. Hysterectomy
2. Myomectomy

Question 16

What is used to remove submucosal leiomyomas?

Answer 16

Hysteroscopy

Question 17

Laparoscopy?

Answer 17

Diagnosis of subserous fibroids and intramural leiomyoma and treat uterine fibroids

Question 18

Advantages of robotic assisted laparoscopy?

Answer 18

1. shorter learning curve
2. 3D
3. inc dexterity
4. precise

Question 19

When do you do an abdominal myomectomy?

Answer 19

1. Large no of fibroids
2. Large diamater >10cm
3. Cancer is suspected
4. Special site fibroids
5. Severe pelvic adhesions