Fibroids (Degeneration of Fibroids)
Definition
- Benign monoclonal tumours arising from the smooth muscle cells of myometrium. Most common form of pelvic tumour in women, typically in reproductive age women.
- Location: intramural, submucosal, subserosal, cervical
- Most, not all, have shrinkage of fibroids at menopause
Risk factors
- Reproductive age group
- Race: Black>White (3:2)
- Early menarche (<10yo)
- Family history of fibroids
- Hypertension
- Uterine infections
Protective factors
- ↑ pregnancy >20/40 – protective (↓ risk)
- Smoking ↓ risk
Clinical Features
Symptoms
- 3 distinct categories
1) Heavy or prolonged menstrual bleeding (significant menorrhagia) – most common
a. May lead to 2° complication: iron-deficient anaemia, affect daily function
b. Degree of bleeding ∝ with location of fibroids mainly, (size is 2° consideration)
2) Pelvic pressure and pain i.e. dysmenorrhoea, dyspareunia, pressure-related sx. May have acute pain from degeneration or torsion of pedunculated fibroid.
a. Due to pressure; dysmenorrhoea; dyspareunia
3) Reproductive dysfunction – ∵ distort shape → ↑ risk infertility; miscarriage
Signs
- Bimanual pelvic examination: enlarged, mobile uterus with irregular contours
Investigations
- Pelvic U/S (TV US & TA US) – confirm diagnosis and exclude other masses
Management
- Iron + vitamins if anaemic
Medical
o Contraception
o NSAIDS e.g. ibuprofen, naproxen: ↓ menstrual cramp and flow in some
o Contraception – pill, patch, ring, shot, hormonal IUD, implant
§ Continuous dosing without break
o GnRH – injection once every 1-3 month – temporarily shrink fibroid/temporarily stop bleeding. "turn off" ovaries.
Surgical
o Myomectomy
o Hysterectomy
DDx of uterine mass ± menorrhagia ± dysmenorrhoea
- Adenomyosis – resemble fibroid mass on U/S; but dysmenorrhoea usu more prominent sx
- Endometriosis – dysmenorrhea, pelvic pain
- Uterine sarcoma – rare; but also enlarged uterus
- Endometrial carcinoma – AUB ± uterine mass; U/S thickened endometrium
Source
UpToDate 2014
- Benign monoclonal tumours arising from the smooth muscle cells of myometrium. Most common form of pelvic tumour in women, typically in reproductive age women.
- Location: intramural, submucosal, subserosal, cervical
- Most, not all, have shrinkage of fibroids at menopause
Risk factors
- Reproductive age group
- Race: Black>White (3:2)
- Early menarche (<10yo)
- Family history of fibroids
- Hypertension
- Uterine infections
Protective factors
- ↑ pregnancy >20/40 – protective (↓ risk)
- Smoking ↓ risk
Clinical Features
Symptoms
- 3 distinct categories
1) Heavy or prolonged menstrual bleeding (significant menorrhagia) – most common
a. May lead to 2° complication: iron-deficient anaemia, affect daily function
b. Degree of bleeding ∝ with location of fibroids mainly, (size is 2° consideration)
2) Pelvic pressure and pain i.e. dysmenorrhoea, dyspareunia, pressure-related sx. May have acute pain from degeneration or torsion of pedunculated fibroid.
a. Due to pressure; dysmenorrhoea; dyspareunia
3) Reproductive dysfunction – ∵ distort shape → ↑ risk infertility; miscarriage
Signs
- Bimanual pelvic examination: enlarged, mobile uterus with irregular contours
Investigations
- Pelvic U/S (TV US & TA US) – confirm diagnosis and exclude other masses
Management
- Iron + vitamins if anaemic
Medical
o Contraception
o NSAIDS e.g. ibuprofen, naproxen: ↓ menstrual cramp and flow in some
o Contraception – pill, patch, ring, shot, hormonal IUD, implant
§ Continuous dosing without break
o GnRH – injection once every 1-3 month – temporarily shrink fibroid/temporarily stop bleeding. "turn off" ovaries.
Surgical
o Myomectomy
o Hysterectomy
DDx of uterine mass ± menorrhagia ± dysmenorrhoea
- Adenomyosis – resemble fibroid mass on U/S; but dysmenorrhoea usu more prominent sx
- Endometriosis – dysmenorrhea, pelvic pain
- Uterine sarcoma – rare; but also enlarged uterus
- Endometrial carcinoma – AUB ± uterine mass; U/S thickened endometrium
Source
UpToDate 2014