Fibroids

Question 1

What are fibroids? Who tends to get them more?

Answer 1

• Leiomyomas arising from a single uterine myocyte. Clearly demarcated
• More with age and affected FDRs

Question 2

What hormone is associated with the development of fibroids? How are they classified?

Answer 2

• Related to oestrogen exposure
• Subserosal (near outer edge, growth directed outwards)
• Intramural (central growth)
• Submucosal (near inner surface, growth directed inwards)
• Uncommonly, develop in the cervix, broad ligament

Question 3

What are the common presentations of a woman with fibroids?

Answer 3

• Menorrhagia - pressure on venous plexi causing dilation elsewhere
• Pelvic pain - pressure/dyspareunia/dysmenorrhoea/non-cyclical/acute (torted)
• Pelvic mass or pressure sensation
• Infertility - tubal occlusion, cavity distortion

Question 4

How can fibroids be managed?

Answer 4

• Expectant management - slow growing, no risk of malignant transformation
• Medical management
  
  • NSAIDs (pain)
  • COCs/progesterone (menorrhagia)
  • GnRH agonists - shrink over short-medium term (dyspareunia, pressure, infertility)
  • Embolisation
• Surgical management - hysteroscopy, myomectomy, hysterectomy