Fibroids

Fibroids are benign growths arising from the myometrium. It's often asymptomatic, but the 25-50% that are symptomatic may have:

• Menorrhagia

• Dysmenorrhoea

• Abnormal uterine bleeding

• Pelvic/abdominal pain/pressure

• Deep dyspareunia

• Constipation

• Subfertility

• O/E - Enlarged, firm, non-tender uterus

It tends to regress after menopause as it’s oestrogen-sensitive.

Investigations

TVUS!

If still in doubt after the TVUS, a hysteroscopy should be done. A biopsy may be taken to differentiate it from endometrial cancer.

Management

A conservative approach is appropriate for women approaching menopause with minimal symptoms.

Medical - Symptomatic relief:

• Mirena coil (IUS) – This is 1st line if the patient has no intention for pregnancy

• Mefanamic acid - for pain + heavy bleeding

• Tranexamic acid - for bleeding

• COCP

Surgical:

• Myomectomy (removal of fibroid) – for those who want to preserve uterus and fertility

  • Goserelin (GnRH agonist) given to shrink fibroid before surgery

• Ablation – laser fired at fibroid to induce necrosis

• Uterine artery embolisation – for those who want to preserve uterus and fertility, and want to avoid surgery

• Hysterectomy – for those who don’t want to preserve uterus and fertility

Complications

• Anaemia

• Subfertility

• Malpresentation

• C-section

• Premature birth

• Urinary outflow obstruction and UTIs

If a pregnant woman with a hx of fibroids presents with severe abdominal pain and a low-grade fever, you should always think of Red degeneration of fibroids! This is where there's ischaemia, infarction and necrosis of the fibroid due to a disrupted blood supply by the uterus. This is more likely to occur in larger fibroids during the 2nd/3rd trimester as it outgrows its blood supply and the uterus expands and kinks the supplying vessels to it.