Fibroids

Fibroids are benign smooth muscle tumours of the uterus, also known as leiomyomas. They are classified based on their location within the uterus.

Types

1. Submucosal: Projects into the uterine cavity, best approached with hysteroscopic myomectomy.
2. Subserosal: Projects outside the uterus, typically approached with laparoscopic surgery.
3. Intramural: Located within the muscle layer of the uterus, this is the most common type.

Characteristics

i. Prevalence: More common in Afro-Caribbean women and rare before puberty.
ii. Hormonal Influence: Develop in response to oestrogen and usually do not progress after menopause.

Symptoms

i. Menorrhagia (heavy menstrual bleeding)
ii. Lower abdominal pain and cramping, often during menstruation
iii. Bloating
iv. Urinary symptoms like frequency
v. Potential subfertility
vi. Many cases are asymptomatic

Diagnosis

Primary Method: Transvaginal ultrasound

Management Option

For Women Not Currently Wanting Pregnancy:
. Mirena (IUS): Helps shrink fibroids and manage bleeding.

Avoid: COCP, Mirena, and Depo-Provera if there is a history of thromboembolism or migraine with aura.

For Women Desiring Future Pregnancy:

. Myomectomy: Preserves fertility.
. Subserosal Fibroids: Laparoscopic approach.
. Submucosal Fibroids: Hysteroscopic approach.

Other Treatments:

. Hysterectomy: Most definitive option.
. Uterine Artery Embolization: Reduces fibroid size and may preserve fertility.
. Endometrial Ablation: For fibroids < 3 cm, not suitable for women desiring future pregnancies.
. GnRH Agonists: Used preoperatively to shrink fibroids and reduce perioperative bleeding.

Special Considerations

. Risk Factors: Include being of Afro-Caribbean descent, family history, and obesity.
. Complications: Potential for anaemia due to heavy menstrual bleeding and impact on fertility.
. Monitoring: Regular follow-up with ultrasound to monitor fibroid size and symptoms.