Fibroids


(fibromyomata, leiomyoma)

  • occur in 20% women
  • more common in nulliparous and one child mothers

Pathology

  • whitish-grey colour, whorled appearance when cut
  • thin capsule
  • spindle-shaped muscle cells
  • may outgrow blood supply leading to hyaline, cystic or red degeneration

Symptoms

  • dependent on size and position
  • menorrhagia
  • anaemia
  • crampy pains
  • persistent bloody discharge
  • pressure symptoms
    • frequency
    • constipation
    • backache
  • dyspareunia

Diagnosis

  • mass on examination
  • USS

Management

  • leave
  • myomectomy
  • hysterectomy
  • GnRH analogues +/- mirena

Complications

  • 0.1% undergo sarcomatous change

Treatment

Myomectomy

  • Excision of fibroids for menorrhagia, etc.
  • Complications
    • risk of TAH
    • risk haemorrhage
    • abdominal adhesions
    • endometrial adhesions
    • risk of uterine rupture in subsequent pregnancy
  • Results
    • recurrence after surgery 15%