Fibroid Uterus
Define fibroid Uterus : It is a benign tumor of myometrium composed of non – striated (smooth) muscle with supported fibrous tissue enclosed in a pseudo capsule.
We have described :
what are the types of fibroid?
Risk factors of fibroid
Clinical features of fibroid uterus.
Investigations of fibroid uterus
Management of fibroid uterus
Complication of Fibroid Uterus
what are the types of fibroid?
Types of fibroids:
A. Body (corporeal) :
- Interstitial (intramural) : Those embedded within the myometrium.
- Subserous ( sub peritoneal) : Those occur beneath the covering serosa.
- Submucous : Those occur beneath the endometrium.
- Sessile
- Pedunculated
B. Cervical : It is usually confined to the supra vaginal part of cervix.
- Anterior
- Posterior
- Central
- Lateral
Risk factors of fibroid :
- Increased risk :
- Nulliparity.
- Obesity.
- Hyperoestrogenic state.
- Black women.
- High fat diet.
- Family history.
How will you manage a case of fibroid uterus?
Management of fibroid uterus :
Clinical features:
Symptoms:
- Asymptomatic-majority cases.
- Menstrual disturbance: Menorrhagia, Metrorrhagia, dysmenorrhoea
- Dyspareunia
- Infertility
- Pressure symptoms : Constipation, dysuria, retention of urine.
- Recurrent pregnancy loss : Miscarriage, preterm labour.
- Lower abdomen or pelvic pain
- Abdominal enlargement.
Sign :
A. General examination :
- Anaemia
- Rapid pulse.
- Decreased blood pressure.
- Varicosit
B. Abdominal examination :
- Inspection : Lower abdomen is swelling
- Palpation : A lump in the lower abdomen which is
- Rounded, smooth or lobulated
- Firm in consistency.
- Non tender
- Mobile from side to side but not from above downwards as fixed with ligaments.
3. Percussion : Dull on percussion.
C. per vaginal examination:
- A mass is felt which is smooth , hard or firm and non tender.
- The mass moves with the movement of the cervix.
- The mass cannot be separated from the uterus.
Investigations of Fibroid uterus:
- USG of the lower abdomen and pelvis.
- Colour Doppler (TVS)
- MRI
- Laparoscopy.
- Hysteroscopy
- Uterine curettage
Treatment of fibroid uterus:
Symptomatic treatment :
A. Medical treatment:
- Anti Progesterones : Mifepristone (25-30 mg) for 3 months.
- Danazol : Used only for a period of 3-6months.
- GnRH agonists : Gosereline, Luporeline, buserelin, naferelin.
- GnRH antagonists : Cetrorelix, ganireflix.
- Anti – fibrinolytics : Tranexamic acid.
- Prostaglandin synthetase inhibitors.
- Levonorgestrel – releasing intrauterine system.
B.Surgical treatment :
- Myomectomy : May be done by laparotomy, laparoscopy or hysteroscopy
- Embolotherapy.
- Myolysis.
- Hysterectomy : Best treatment for uterine fibroids in women age > 40 years and the family is complete.
Asymptomatic treatment :
- Observation: The judicious observation may be instituted in cases:
- Size <12 weeks.
- Diagnosis certain
- Follow up possible
2. Surgery: If the symptoms of fibroid appear and it grows and increases in size surgery is indicated.
Complication of Fibroid Uterus.
- Haemorrhage.
- Intracapsular.
- Intraperitoneal.
- Necrosis
- Infection
- Sarcomatous Changes
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