Presentation is loading. Please wait.

Presentation is loading. Please wait.

Uterine Fibroids Max Brinsmead PhD FRANZCOG January 2010.

Similar presentations


Presentation on theme: "Uterine Fibroids Max Brinsmead PhD FRANZCOG January 2010."— Presentation transcript:

1 Uterine Fibroids Max Brinsmead PhD FRANZCOG January 2010

2 Uterine Fibroids Benign tumours (leiomyomata) of uterine smooth muscle Benign tumours (leiomyomata) of uterine smooth muscle Common – 25% of women in a lifetime Common – 25% of women in a lifetime Usually multiple Usually multiple Various sizes Various sizes Genetic predisposition Genetic predisposition more common in black races more common in black races More common in the obese More common in the obese Less common in smokers Less common in smokers More common in nulliparas More common in nulliparas Accounts for ~30% of hysterectomies Accounts for ~30% of hysterectomies

3 Fibroid Locations Subserous Subserous –Project from the uterus into the peritoneal cavity –Sometimes pedunculated –Least likely to cause symptoms Submucous (~5% of all fibroids) Submucous (~5% of all fibroids) –Project into the uterine cavity –Sometimes pedunculated –Most likely to cause symptoms Intramural Intramural –Most common –Usually multiple

4 Intramural & Submucous Fibroids

5 Subserous Fibroid at Laparoscopy

6 Fibroid Symptoms Mostly asymptomatic Mostly asymptomatic Menorrhagia Menorrhagia –Heavy regular periods –Iron deficiency anaemia Pressure effects Pressure effects –Urine frequency –Pelvic tumour awareness –Difficulty initiating micturition Pain, Infertility & Irregular vaginal bleeding Pain, Infertility & Irregular vaginal bleeding –May be due to other pathology

7 Fibroids’ Natural History Oestrogen-dependent tumours that grow slowly: Oestrogen-dependent tumours that grow slowly: –Whilst cycling premenopausal –Probably whilst on COC –When taking E2 HRT Will regress with menopause Will regress with menopause Response to progestin-only contraception is uncertain Response to progestin-only contraception is uncertain Malignant change rare <1:1000 Malignant change rare <1:1000

8 Investigation of Fibroids Ultrasound 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 MRI better than CT Imaging Laparoscopy and Hysteroscopy Laparoscopy and Hysteroscopy Saline hysterography Saline hysterography –Useful for pedunculated submucous fibroids

9 Investigating a Submucous Fibroid

10

11 Treatment Options for Fibroids Hysterectomy Hysterectomy –If the uterus is >10w size –Or symptoms that are due to the fibroids –Rapid growth –Abdominal or vaginal Myomectomy Myomectomy –Best for single fibroid in a young woman –~50% come to hysterectomy within 5 years? Hysteroscopic resection Hysteroscopic resection Uterine artery embolisation (UAE) Uterine artery embolisation (UAE) Medical options Medical options –GnRH analogue –Mirena

12 NICE Recommendations for Uterine Fibroids For patients with heavy menstrual bleeding and fibroids >3 cm size (and especially those with pelvic pain or other symptoms) then… For patients with heavy menstrual bleeding and fibroids >3 cm size (and especially those with pelvic pain or other symptoms) then… –Hysterectomy, Uterine artery embolisation (UAE) and myomectomy should all be offered –Myomectomy recommended if fertility is desired –Hysteroscopic resection of the entire fibroid with endometrial resection is appropriate if the fibroid (s) are submucous Pre treatment with GnRH analogue for 3 - 4m is worthwhile before hysterectomy and myomectomy Pre treatment with GnRH analogue for 3 - 4m is worthwhile before hysterectomy and myomectomy –Reduces uterine size and makes surgery easier –Better HB pre op and less bleeding But GnRH analogues are contraindicated before UAE But GnRH analogues are contraindicated before UAE

13 Fibroids and Infertility In most women the association is result and not cause In most women the association is result and not cause It is said that ≈3% of infertility is due to fibroids It is said that ≈3% of infertility is due to fibroids Most infertility specialists will recommend removal of any fibroid with >50% of its surface in the uterine cavity Most infertility specialists will recommend removal of any fibroid with >50% of its surface in the uterine cavity The results from removal of a single submucous fibroid can be dramatic The results from removal of a single submucous fibroid can be dramatic And there is evidence that removal of intramural fibroids >5 cm diam will enhance fertility with IVF And there is evidence that removal of intramural fibroids >5 cm diam will enhance fertility with IVF

14 Fibroids and Pregnancy In most women there is no effect In most women there is no effect 80% remain unchanged in size 80% remain unchanged in size Rarely rapid growth and red degeneration Rarely rapid growth and red degeneration Increased risk of bleeding and threatened preterm delivery Increased risk of bleeding and threatened preterm delivery –But most deliver at term Fibroid in the lower segment can interfere with vaginal birth Fibroid in the lower segment can interfere with vaginal birth Myomectomy at the time of Caesarean is not wise Myomectomy at the time of Caesarean is not wise –30% require emergency hysterectomy


Download ppt "Uterine Fibroids Max Brinsmead PhD FRANZCOG January 2010."

Similar presentations


Ads by Google