uterine fibroids for undergraduates max brinsmead mb bs phd september 2012
TRANSCRIPT
Uterine Uterine FibroidsFibroids
for for UndergraduaUndergradua
testes
Max Brinsmead MB BS PhDMax Brinsmead MB BS PhDSeptember 2012September 2012
Uterine FibroidsUterine Fibroids
Benign tumours (leiomyomata) of Benign tumours (leiomyomata) of uterine smooth muscleuterine smooth muscle
Common – 25% of women in a lifetimeCommon – 25% of women in a lifetime Usually multipleUsually multiple Various sizesVarious sizes Genetic predispositionGenetic predisposition
more common in black racesmore common in black races More common in the obeseMore common in the obese Less common in smokersLess common in smokers More common in nulliparasMore common in nulliparas Accounts for Accounts for ~30% of hysterectomies~30% of hysterectomies
Fibroid LocationsFibroid Locations
SubserousSubserous– Project from the uterus into the peritoneal cavityProject from the uterus into the peritoneal cavity– Sometimes pedunculatedSometimes pedunculated– Least likely to cause symptomsLeast likely to cause symptoms
SubmucousSubmucous ( (~5% of all fibroids)~5% of all fibroids)– Project into the uterine cavityProject into the uterine cavity– Sometimes pedunculatedSometimes pedunculated– Most likely to cause symptomsMost likely to cause symptoms
IntramuralIntramural– Most commonMost common– Usually multipleUsually multiple
Intramural & Submucous Intramural & Submucous FibroidsFibroids
Subserous Fibroid at Subserous Fibroid at LaparoscopyLaparoscopy
Fibroid SymptomsFibroid Symptoms
Mostly asymptomaticMostly asymptomatic MenorrhagiaMenorrhagia
– Heavy regular periodsHeavy regular periods– Iron deficiency anaemiaIron deficiency anaemia
Pressure effectsPressure effects– Urine frequencyUrine frequency– Pelvic tumour awarenessPelvic tumour awareness– Difficulty initiating micturitionDifficulty initiating micturition
Pain, Infertility & Irregular vaginal Pain, Infertility & Irregular vaginal bleedingbleeding– May be due to other pathologyMay be due to other pathology
Fibroids’ Natural Fibroids’ Natural HistoryHistory
Oestrogen-dependent tumours that Oestrogen-dependent tumours that grow slowly:grow slowly:– Whilst cycling premenopausalWhilst cycling premenopausal– Probably whilst on COCProbably whilst on COC– When taking E2 HRTWhen taking E2 HRT
Will regress with menopauseWill regress with menopause Response to progestin-only Response to progestin-only
contraception is uncertaincontraception is uncertain Malignant change rare <1:1000Malignant change rare <1:1000
Investigation of Investigation of FibroidsFibroids
UltrasoundUltrasound– Frequently misdiagnosed with this modalityFrequently misdiagnosed with this modality– ““Multiple small fibroids” is usually irrelevantMultiple small fibroids” is usually irrelevant– Heterogenous echolucency is normal in a parous Heterogenous echolucency is normal in a parous
uterusuterus– Adenomyosis can look the sameAdenomyosis can look the same– Size and location importantSize and location important– Can be a “contraction wave” in pregnancyCan be a “contraction wave” in pregnancy
MRI better than CT ImagingMRI better than CT Imaging Laparoscopy and HysteroscopyLaparoscopy and Hysteroscopy Saline hysterographySaline hysterography
– Useful for pedunculated submucous fibroidsUseful for pedunculated submucous fibroids
Treatment Options for Treatment Options for FibroidsFibroids
HysterectomyHysterectomy– If the uterus is >10w sizeIf the uterus is >10w size– Or symptoms that are due to the fibroidsOr symptoms that are due to the fibroids– Rapid growthRapid growth– Abdominal or vaginalAbdominal or vaginal
MyomectomyMyomectomy– Best for single fibroid in a young womanBest for single fibroid in a young woman– ~50% come to hysterectomy within 5 years?~50% come to hysterectomy within 5 years?
Hysteroscopic resectionHysteroscopic resection Uterine artery embolisation (UAE)Uterine artery embolisation (UAE) Medical optionsMedical options
– GnRH analogueGnRH analogue– MirenaMirena
Fibroids and InfertilityFibroids and Infertility In most women the association is result In most women the association is result
and not causeand not cause It is said that ≈3% of infertility is due to It is said that ≈3% of infertility is due to
fibroidsfibroids Most infertility specialists will Most infertility specialists will
recommend removal of any fibroid with recommend removal of any fibroid with >50% of its surface in the uterine cavity>50% of its surface in the uterine cavity
The results from removal of a single The results from removal of a single submucous fibroid can be dramatic submucous fibroid can be dramatic
And there is evidence that removal of And there is evidence that removal of intramural fibroids >5 cm diam will intramural fibroids >5 cm diam will enhance fertility with IVFenhance fertility with IVF
Fibroids and Fibroids and PregnancyPregnancy
In most women there is no effectIn most women there is no effect 80% remain unchanged in size80% remain unchanged in size Rarely rapid growth and red Rarely rapid growth and red
degenerationdegeneration Increased risk of bleeding and Increased risk of bleeding and
threatened preterm deliverythreatened preterm delivery– But most deliver at termBut most deliver at term
Fibroid in the lower segment can Fibroid in the lower segment can interfere with vaginal birthinterfere with vaginal birth
Myomectomy at the time of Caesarean Myomectomy at the time of Caesarean is not wiseis not wise– 30% require emergency hysterectomy30% require emergency hysterectomy
Any Questions or Any Questions or Comments?Comments?
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