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    Fibroids: DR F Hove

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    Kelvin Maikana
    Fibroids are benign smooth muscle tumors of the uterus that are very common among women. The risk of developing fibroids increases with age, peaks between ages 30-40, and is more common in black women and those with a family history. While fibroids often cause no symptoms, they can lead to heavy bleeding, anemia, pain, and infertility. Diagnosis involves ultrasound or MRI imaging. Treatment options include pain medication, oral contraceptives, hormone therapy, myomectomy, hysterectomy, or alternative minimally invasive procedures depending on a woman's symptoms and desire to maintain fertility. Fibroids generally do not affect pregnancy but can in rare cases lead to bleeding or preterm delivery.

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    Fibroids: DR F Hove

    Uploaded by

    Kelvin Maikana
    29 views18 pages
    Fibroids are benign smooth muscle tumors of the uterus that are very common among women. The risk of developing fibroids increases with age, peaks between ages 30-40, and is more common in black women and those with a family history. While fibroids often cause no symptoms, they can lead to heavy bleeding, anemia, pain, and infertility. Diagnosis involves ultrasound or MRI imaging. Treatment options include pain medication, oral contraceptives, hormone therapy, myomectomy, hysterectomy, or alternative minimally invasive procedures depending on a woman's symptoms and desire to maintain fertility. Fibroids generally do not affect pregnancy but can in rare cases lead to bleeding or preterm delivery.

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    008._FIBROIDS

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    Fibroids are benign smooth muscle tumors of the uterus that are very common among women. The risk of developing fibroids increases with age, peaks between ages 30-40, and is more common in black women and those with a family history. While fibroids often cause no symptoms, they can lead to heavy bleeding, anemia, pain, and infertility. Diagnosis involves ultrasound or MRI imaging. Treatment options include pain medication, oral contraceptives, hormone therapy, myomectomy, hysterectomy, or alternative minimally invasive procedures depending on a woman's symptoms and desire to maintain fertility. Fibroids generally do not affect pregnancy but can in rare cases lead to bleeding or preterm delivery.

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    © All Rights Reserved
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    29 views18 pages

    Fibroids: DR F Hove

    Uploaded by

    Kelvin Maikana
    Fibroids are benign smooth muscle tumors of the uterus that are very common among women. The risk of developing fibroids increases with age, peaks between ages 30-40, and is more common in black women and those with a family history. While fibroids often cause no symptoms, they can lead to heavy bleeding, anemia, pain, and infertility. Diagnosis involves ultrasound or MRI imaging. Treatment options include pain medication, oral contraceptives, hormone therapy, myomectomy, hysterectomy, or alternative minimally invasive procedures depending on a woman's symptoms and desire to maintain fertility. Fibroids generally do not affect pregnancy but can in rare cases lead to bleeding or preterm delivery.

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    Fibroids

    Dr F Hove
     benign smooth muscle tumors of the
    uterus
     The most common uterine tumor
     About 20% to 80% of women develop
    fibroids by the age of 50
     Occurring in about 30% of women
    above the age of 30 years.
    Risk Factors
     Age:
    ◦ 30-40 years.
    ◦ Rare before 30 or after 40 years
     Parity:
    ◦ Common in nulliparas, patients with low parity.
    ◦ It is rare in multiparas.
     Race:
    ◦ 3-9 times more common in black race
     Family history:
    ◦ Usually positive.
    Fibroids are more common in obese women.
    Smoking lowers the risk
    Current use of oral or injectable contraception is associated
    with a two thirds reduced risk.
    Pathogenesis
     The cause of remain unknown.
     arises from a single neoplastic cell within
    the smooth muscle of the myometrium.
     estrogen and progesterone have a
    mitogenic effect
     sex steroids promote development of
    leiomyomas by stimulating inappropriate
    expression of growth factors.
     progesterone that influences the
    proliferation of leiomyoma more than
    estrogen.
    classification
    Fibroids

    Uterine Extrauterine
    [99%] [1%]

    Corporeal Cervical
    Genital Extragenital
    [95%] [4%]

    Interstitial Parasitic
    [60%] Fibroid

    Submucous
    Others
    [ 20%]

    Subserous
    [15%]
    Chracteristics
     Size
    ◦ from microscopic to very huge size filling the whole abdominal cavity
     Shape
    ◦ Spherical, flattened, or pointed according to the type.
     Cut section:
    ◦ On cut section,, whorly in appearance, and more pale than the surrounding
    uterine muscle.
     Consistency:
    ◦ firmer than the surrounding myometrium.
    ◦ Soft fibroid occurs in pregnancy, cystic changes, vascular, inflammatory, and
    malignant changes.
    ◦ Hard fibroid occurs in calcification.
     Capsule:
    ◦ Is a pseudo-capsule formed by compressed normal surrounding muscle fibres.
    ◦ the blood supply comes through it,
    ◦ it is the plain of cleavage during myomectomy
    ◦ its presence differentiate the myoma from adenomyosis.
     Blood supply:
    ◦ Nourishes the myoma from the periphery,
    ◦ The tumor itself is relatively avascular.
    presentation
     Asymptomatic:
    ◦ Accidentally discovered during examination.
    ◦ It is the commonest presentation, especially in subserous and
    interstitial fibroids.
     Vaginal bleeding: It is the commonest symptom,
    ◦ Menorrhagia or polymenorrhea: (commonest): This occurs due
    to:.
     Swelling:
    ◦ Either abdominal swelling due to large fibroid or vaginal swelling
    due to a polyp.
     Infertility
     Pain: uncommon
     Pressure symptoms
    examination
     General examination:
    ◦ signs of chronic anemia.
     Abdominal examination:
    ◦ large pelvi-abdominal swelling in huge
    fibroids.
     Pelvic examination:
    ◦ symmetrically or asymmetrically enlarged
    uterus.
     Speculum examination
    ◦ fibroid polyp.
    investigations
     Ultrasound
    ◦ Frequently misdiagnosed with this modality
    ◦ “Multiple small fibroids” is usually irrelevant
    ◦ Heterogenous echolucency is normal in a parous uterus
    ◦ Adenomyosis can look the same
    ◦ Size and location important
    ◦ Can be a “contraction wave” in pregnancy
     MRI better than CT Imaging
     Laparoscopy and Hysteroscopy
     Saline hysterography
    ◦ Useful for pedunculated submucous fibroids
    management
     Conservative Management
    ◦ small asymptomatic fibroid,
    ◦ fibroid in pregnancy or puerperium.
    Surgical Management
    Medical Management
    radiological
    Medical Managment
     NSAIDs can be used to reduce
    painful menstrual periods.
     Oral contraceptive pills may be
    prescribed to reduce uterine bleeding
    and cramps
     Anemia may be treated with iron
    supplementation.
     Levonorgestrel intrauterine devices
    are effective in limiting menstrual
    blood flow
     Gonadotropin-releasing hormone
    analogs cause temporary regression
    of fibroids by decreasing estrogen
    levels
     Danazol is an effective treatment to
    shrink fibroids and control symptoms.
     Ulipristal acetate is a synthetic
    selective progesterone receptor
    modulator (SPRM)
    Surgical management
    • Indications:
    • Symptomatic cases or uterus larger
    than 12 weeks size.
    • Suspected malignancy (rapidly
    enlarging or post-menopausal
    growth).
    • Multiple huge fibroids liable to
    complications.
    • Infertility.
    myomectomy
     Abdominal Myomectomy
     Vaginal Myomectomy
     Endoscopic Myomectomy
    ◦ Hysteroscopic
    ◦ Laparoscopic
     Myomectomy aims at
    ◦ removal of all the myomas,
    ◦ with conservation of a functioning uterus to
    preserve the reproductive function.
     Generallythe morbidity is higher than
    those with hysterectomy.
    ◦ It is associated with much blood loss
    ◦ Liability of recurrence of fibroid
    Hysterectomy
     Patient around 40 years, and completed
    her family.
     The number or site contraindicate
    myomectomy
     Severe bleeding during myomectomy.
     Major damage of the uterus by
    myomectomy which affects its function
    for pregnancy.
     Recurrent fibroids.
     Suspicious of malignancy
    Alterna tive thera py
     Radiofrequency ablation is a minimally invasive
    treatments for fibroids
     In this technique the fibroid is shrunk by inserting a needle-
    needle-like device into the fibroid through the abdomen and
    and heating it with radio-frequency (RF) electrical energy to
    energy to cause necrosis of cells.
     The treatment is a potential option for women who have
    fibroids, have completed child-bearing and want to avoid a
    avoid a hysterectomy.

     Magnetic resonance guided focused ultrasound, is a


    a non-invasive intervention (requiring no incision) that uses
    high intensity focused ultrasound waves to destroy tissue
     Uterine artery embolization (UAE) is a noninvasive
    procedure that blocks of blood flow to fibroids and thus can
    treat them
    Fibroids and pregnancy
     In most women there is no effect
     80% remain unchanged in size
     Rarely rapid growth and red degeneration
     Increased risk of bleeding and threatened
    preterm delivery
    ◦ But most deliver at term
     Fibroid in the lower segment can interfere with
    vaginal birth
     Myomectomy at the time of Caesarean is not
    wise
    ◦ 30% require emergency hysterectomy

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