Fibroids

Question 1

what are they?

Answer 1

benign tumours of smooth muscle of uterus aka leiomyoma

Question 2

Risk factors?

Answer 2

• oestrogen sensitive so anything which increases oestrogen
• increasing age
• black ethnicity

Question 3

Types?

Answer 3

• submucous
• subserosal
  
  • grow outwards
• intramural
• pedunculated= polyp

Question 4

what happens as intramural fibroids grow?

Answer 4

they change shape & distort uterus

Question 5

presentation?

Answer 5

• often asymptomatic
• menorrhagia
• pressure symptoms: urinary or bowel
• subfertility, miscarriage
• O/E:
  
  • firm, non-tender, enlarged uterus
  • palpable mass O/E

Question 6

Ix?

Answer 6

• TVUS
• MRI gold standard
• hysteroscopy for submucous fibroids

Question 7

Mx?

Answer 7

• conservative if asymptomatic
• medical
  
  • mirena coil (if <3cm)
  • cyclical oral progestogens
  • NSAID/ tranexamic acid
• surgical
  
  • if small
    
    • endometrial ablation
    • resection
  • if big
    
    • myomectomy
    • hysterectomy
    • uterine artery embolisation

Question 8

what drug is given prior to surgery?

Answer 8

GnRH agonists which shrink them down prior to surgery

Question 9

complications?

Answer 9

• pregnancy
  
  • miscarriage, obstructive delivery & premature labour
• red degeneration of fibroid
• torsion of fibroid
• malignant change to leiomyosarcoma

Question 10

which type of fibroid mainly torts?

Answer 10

pedunculated

Question 11

what is red degeneration

Answer 11

• infarction, ischaemia and necrosis of fibroid, which mainly occurs in 2nd and 3rd trimester of pregnancy, due to:
  
  • fibroid grows fast during pregnancy and may out grow its’ blood supply
  • blood vessels may kink due to uterus changing shape

Question 12

presentation of red degeneration & mx

Answer 12

• severe abdo pain
• tachycardia
• low grade fever
• may vomit

mx= supportive