Fibroids

Question 1

Define fibroids

Answer 1

Benign smooth muscle tumours of the uterus -> oestrogen dependent.
Consists of a single cell lineage, making smooth muscle, connective tissue and a thin capsule.

Question 2

What are the risk factors for uterine fibroids?

Answer 2

Early menses -> late menopause
Nulliparity
Not breastfeeding
Obesity
Alcohol use
Black (50%)

Question 3

What is the epidemiology of fibroids?

Answer 3

Common -> typically found incidentally in women of perimenopause or late reproductive years (40s +50) -> takes time to grow

Question 4

What are the key locations of uterine fibroids?

Answer 4

The majority are intramural. (in the myometrium)
Some are subserosal
Some are submucosal (can cause PV bleeding)

Question 5

What are the key symptoms of fibroids?

Answer 5

Asymptomatic
Intermenstrual PV bleeding
Menorrhagia
Abdo pain
Bloating
Sub/infertility
Bowel and bladder problems (rare only if very large -> mass effect)

Question 6

What examinations should be done for uterine fibroids?

Answer 6

Abdo -> palpable mass
Bimanual -> palpable mass
Transvaginal US/Transabdo US

Question 7

What are the key investigations for fibroids?

Answer 7

First line -> Trans vaginal US
Gold standard -> histology (biospy)

Question 8

What is the key treatment for a fibroid?

Answer 8

Monitoring for growth or symptoms
If affecting fertility -> surgical removal.
Gold standard: Levonorgestrel-releasing IUS -> synthetic progestin -> binds to PG receptors to prevent fibroid growth

2nd: Tranexamic acid, COCP, GnRH agonist (short term)

Question 9

How do uterine fibroids relate to pregnancy?

Answer 9

Grow during pregnancy as oestrogen-dependent tissue
May restrict foetal growth -> cause difficulty monitoring foetal growth
Inc risk of AN haemorrhage, placental abruption/praevia, uterine rupture etc.

Question 10

What is the key prognosis of uterine fibroids?

Answer 10

Good prognosis
Benign -> do not become metastatic
Shrink/resolve with menopause.

Question 11

What are some complications of a uterine fibroid?

Answer 11

Red degeneration -> common during pregnancy -> outgrows blood supply, becomes necrotis, painful, feverish, N+V.