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UTERINE FIBROIDS

By Christopher Buffong
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 Fibroids are benign tumors of the uterine muscle
known as leiomyomas.

 Tumors are estrogen dependent.


CLASSIFICATION
Types
- Subserosal

- Submucosal

- Intramural

- Pedunculated
RISK FACTORS
 Ethnicity : African Descent
 Nulliparity

 Obesity

 Reproductive age
SIGNS AND SYMPTOMS
Symptoms depend on size and location of fibroids.
Some may be asymptomatic.
 Menorrhagia

 Dysmenorrhea

 Dyspareunia

 Abdominal Discomfort and bloating

 Frequency of Urination

 Symptoms of Anemia

 Back pains
COMPLICATIONS
 Fibroid Degeneration
 Subfertility

 Hydroureter and Hydronephrosis

 Anemia

 Deep Vein Thrombosis

 Post Partum Haemorrhage


MANAGEMENT
History Taking
1.Demographics : Age, Ethnicity, Parity

2. PC: Menorrhagia +/- Dysmenorrhea differentials


*Rule out Bleeding/Clotting Disorders

3. Family History: Breast , Ovarian and Endometrial


Cancer

4. Social History: Impact on daily living and family


planning.
Physical Examination
1. General : Vitals, BMI and Signs of Anemia
2. Abdominal Exam: Mass – soft, non tender,
mobile, unable to palpate beneath mass.
3. Speculum: vaginal lesions, cervical erosion and
cervicitis.
4. Bimanual Examination: Asses uterine size,
position, contour and adnexal masses.
Investigations
1. CBC
- Hb and MCV
- WBC
- Platelets

2.Abdominal and Pelvic Ultrasound.


Treatment
1. Medical
(a) Depo Provera
Benefit
- Thins endometrial lining and shrinks fibroids, significantly
reducing blood loss during menstruation.

Disadvantages
- Risk of developing osteoporosis with prolonged use.
- Reocurrance of Fibroids
(b) Analgesics
eg. Mefanamic Acid and Tranexamic Acid
Benefit
- Provides adequate analgesia for dysmenorrhea.
- Reduce menstrual blood loss by 25%
Disadvantages
- Mefanamic acid contraindicated for patients with GI
ulceration and severe asthmatics.
- Tranexamic Acid increases risk of developing Deep Vein
Thrombosis.

(c) Ferrrous Sulphate Supplementation


- Correct anemia if needed.
2. Surgical
- Depends on presenting complaint and patients’ fertility aspirations.

(i) Myemectomy
Benefit
- Used to perserve fertility of patient.

Disadvantages
- Significant blood loss.
- Uterine adhesions. May affect future
pregnancies.
- Recurrence of fibroids.
(ii) Total Abdominal Hysterectomy
• Definitive treatment of symptomatic uterine fibroids

• Chosen by patients who have completed their families


and have no aspiration for menstrual function.

• Subtotal Hysterectomy method used by younger


patients. Less risk of injury to ureters and bladder.
Preserves anatomy for greater sexual satisfaction.
(iii) Uterine Artery Embolization

Embolization of uterine arteries leading to shrinkage of


fibroids by ischaemia. Done by interventional radiologist.

Benefit
- Reduction in size of fibroids

- Less invasive

Disadvantage
- Not as effective in relieving menstrual symptoms as

other forms of surgical treatment.


REFERENCES
 Gynaecology by Ten Teachers : Asha Monga and
Stephen Dobbs