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%