🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Fibroids

Specialties > Gynaecology

Background knowledge 🧠

Definition

  • Fibroids, also known as uterine leiomyomas, are benign smooth muscle tumors of the uterus.
  • Commonly occur during reproductive years.
  • Typically vary in size, number, and location within the uterus.
  • Most are asymptomatic, but can cause significant morbidity.

Epidemiology

  • Prevalence: ~20-50% of women of reproductive age.
  • More common in women of African and Afro-Caribbean descent.
  • Usually develop between ages 30-50 years.
  • Increased prevalence in nulliparous women.
  • Risk decreases after menopause due to lower estrogen levels.

Aetiology and Pathophysiology

  • Exact cause unknown; likely multifactorial.
  • Hormonal influence: estrogen and progesterone promote growth.
  • Genetic factors: somatic mutations and familial predisposition.
  • Extracellular matrix contributes to fibroid growth.
  • Growth typically regresses after menopause.

Types

  • Intramural: located within the myometrium (most common).
  • Submucosal: bulge into the uterine cavity; may affect fertility.
  • Subserosal: project to the outside of the uterus; can become pedunculated.
  • Cervical: located in the cervix (rare).
  • Broad ligament: located within the broad ligament (uncommon).

Clinical Features 🌡️

Symptoms

  • Menorrhagia: heavy or prolonged menstrual bleeding.
  • Pelvic pain or pressure, particularly with larger fibroids.
  • Dysmenorrhea: painful menstruation.
  • Infertility or recurrent miscarriages (if submucosal).
  • Urinary frequency or retention (pressure on bladder).
  • Constipation (pressure on rectum).

Signs

  • Enlarged, irregularly shaped uterus on bimanual examination.
  • Palpable abdominal mass if large fibroids.
  • Tenderness if fibroids undergo degeneration.
  • No specific systemic signs unless complications occur.

Investigations 🧪

Tests

  • Transvaginal ultrasound: first-line imaging modality; assesses size and location.
  • MRI pelvis: used for detailed mapping, especially preoperatively.
  • Hysteroscopy: evaluates submucosal fibroids and endometrial cavity.
  • Complete blood count (CBC): assesses anemia due to menorrhagia.
  • Endometrial biopsy: excludes malignancy if there are atypical symptoms.

Management 🥼

Management

  • Conservative: observation if asymptomatic or mild symptoms.
  • Medical: NSAIDs for pain, tranexamic acid for bleeding; hormonal therapies (e.g., GnRH analogs) to shrink fibroids.
  • Surgical: myomectomy for fertility preservation; hysterectomy if definitive treatment required.
  • Uterine artery embolization (UAE): minimally invasive; reduces fibroid size and symptoms.
  • Considerations: treatment choice depends on age, symptoms, and desire for future fertility.

Complications

  • Severe anemia due to chronic menorrhagia.
  • Infertility or subfertility, particularly with submucosal fibroids.
  • Miscarriage or preterm labor if fibroids present during pregnancy.
  • Degeneration: fibroid outgrows its blood supply, causing pain and necrosis.
  • Rare: sarcomatous transformation (malignancy) in less than 1% of cases.

Prognosis

  • Generally benign with a good prognosis.
  • Symptoms typically improve post-menopause.
  • Recurrence possible after myomectomy; uncommon after hysterectomy.
  • Monitoring recommended for growth or new symptoms.
  • Reproductive outcomes favorable after appropriate management.

Key Points

  • Fibroids are common benign uterine tumors that can cause significant morbidity.
  • Diagnosis is primarily via imaging; treatment varies based on symptoms and patient factors.
  • Management options include medical, surgical, and minimally invasive techniques.
  • Complications can include anemia, infertility, and, rarely, malignancy.
  • Prognosis is generally good with appropriate management.

No comments yet 😉

Leave a Reply

Gynaecology