Fibroids

Question 1

What are fibroids?

Answer 1

Benign tumours of smooth muscle of the uterus, oestrogen sensitive

Question 2

What are the types of fibroids?

Answer 2

• Intramural (in myometrium - muscle of uterus)
• Subserosal (below outer layer uterus - grow large)
• Submucosal (just below endometrium)
• Pedunculated

Question 3

What are common clinical features of fibroids?

Answer 3

• Often asymptomatic
• Menorrhagia
• Prolonged menstruation (>7 days)
• Abdominal pain
• Bloating or feeling full in abdomen
• Urinary or bowel symptoms
• Deep dyspareunia
• Reduced fertility

Question 4

What may abdominal and bimanual examination reveal in cases of fibroids?

Answer 4

• Palpable pelvic mass
• Enlarged firm non-tender uterus

Question 5

What is the initial investigation for submucosal fibroids presenting with heavy menstrual bleeding?

Answer 5

Hysteroscopy

Question 6

What investigation is used for larger fibroids?

Answer 6

Pelvic ultrasound

Question 7

When is MRI scanning considered in fibroid management?

Answer 7

Prior to surgery for more information on size, blood supply, shape

Question 8

What are the management options for fibroids <3cm?

Answer 8

• Mirena coil (first line)
• Symptomatic management (NSAIDs, tranexamic acid)
• COCP, cyclical oral progestogens
• Surgical options (endometrial ablation, resection of submucosal fibroids, hysterectomy)

Question 9

What should be done for fibroids >3cm?

Answer 9

• Refer to gynaecology
• Symptomatic management (NSAIDs, tranexamic acid)
• Mirena coil, COCP, cyclical oral progestogens
• Surgical options (uterine artery embolisation, myomectomy, hysterectomy)

Question 10

What is uterine artery embolisation for fibroids?

Answer 10

An interventional radiology procedure that blocks arterial supply to fibroids, causing hypoxia and shrinking

Question 11

What is myomectomy?

Answer 11

Removing fibroid via laparoscopic or laparotomy surgery

Question 12

What is the only fibroids treatment known to potentially improve fertility?

Answer 12

Myomectomy

Question 13

What are the types of hysterectomy?

Answer 13

• Laparoscopic
• Laparotomy
• Vaginal approach

Question 14

What are GnRH agonists used for in fibroids?

Answer 14

To shrink fibroids prior to surgery and induce a menopause-like state

Question 15

What are some complications of fibroids?

Answer 15

• Heavy menstrual bleeding
• Reduced fertility
• Pregnancy complications
• Constipation
• Urinary outflow obstruction
• UTIs
• Red degeneration of fibroid
• Torsion of fibroid
• Malignant change (rare, <1%)

Question 16

What is red degeneration of fibroids?

Answer 16

Ischaemia, infarction, and necrosis of fibroid due to disrupted blood supply

Question 17

When is red degeneration of fibroids more likely to occur?

Answer 17

If fibroid >5cm during the second or third trimester of pregnancy

Question 18

What are the clinical presentations of red degeneration of fibroids?

Answer 18

• Severe abdominal pain
• Low-grade fever
• Tachycardia
• Vomiting

Question 19

What is the management for red degeneration of fibroids?

Answer 19

• Supportive care
• Rest
• Fluids
• Analgesia