Fibroids

Question 1

What are fibroids?

Answer 1

aka Leiomyomata Benign tumours of the myometrium

Question 2

What is the prevalence of fibroids?

Answer 2

25% of women

Question 3

What are the risk factors for fibroids?

Answer 3

Peri-menopausal Afro-Caribbean Family history

Question 4

What is protective for fibroids?

Answer 4

Multiparity COC/ injectable progestogens

Question 5

Outline the different sites of fibroids

Answer 5

Intramural (within myometrium) Subserosal (beneath myometrium ‘coat’) Submucosal (inner myometrium) Cervical Subserosal may form subserous polyps and submucosal may for intracavity polyp.

Question 6

What is the histology of fibroids?

Answer 6

Smooth muscle Fibrous tissue ‘Whorled’ appearance

Question 7

What is the pathophysiology of fibroid development?

Answer 7

Oestrogen (and probably progesterone) dependent Pregnancy is non-protective Regress after menopause due to low oestrogen Fibroids are monoclonal origin

Question 8

What are the symptoms of fibroids?

Answer 8

50% asymptomatic & discovered during examination Symptoms depend on size/ location;

• Menstrual problems
  
  • Menorrhagia (1/3)
  • Intermenstrual loss (submucosal/ polyp)
• Dysmenorrhoea
• Large fibroids compressing;
  
  • Urinary freq. & retention
  • Hydronephrosis
  • Fertilitity issues (tubal ostia, implanation)

Question 9

How would you investigate fibroids?

Answer 9

Examination

• Palpable solid mass continuous with uterus
• ‘Knobbly’ enarlgement of uterus

Ultrasound helpful

MRI/ laparoscopy

• Distinguish from ovarian mass, adenomyosis

Hysterscopy/ hysterosalpingogram

• Assess distortion of uterus (fertility issues)

Question 10

Outline possible complications of fibroids?

Answer 10

• Enlargment
  
  • Stop & calcify after menopause (unless HRT)
  • May enlarge mid-pregnancy
• Torsion of pedunculated fibroid
• Degeneration
  
  • ​Inadequate blood supply
  • Causes pain & uterine tenderness ⇒ haemorrhage & necrosis
  • Hyaline/ cystic degeneration fibroid will be soft & party liquefied
• Malignancy (0.1%)
  
  • Due to malignant change or de novo malignanct transformation of normal smooth muscle

Question 11

What can HRT do to fibroids?

Answer 11

Continued fibroid growth aftet menopause

Question 12

What effect does pregnancy have on fibroids and visa versa?

Answer 12

• Complications
  
  • Premature
  • Malpresentations/ lie
  • PPH
  • Obstructed labour