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Fibroids(Uterine leiomyomata)

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Epidemiology

25% of women

Perimenopause

Afro-Caribbean

Family history

Parous women COCP in!e"table pro#esto#ens

$ess "ommon

Common

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Sites of fibroids

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Aetiology

Oestro#en-epenent (probably pro#esterone)

Pre#nan"y (&'-)

COCP(&)

enopause (-)

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Symptoms of fibroids

enorrha#ia (*%)

+rrati" bleein# (,) . /ubmu"osal0

Pressure effe"ts . On blaer ' ureter

/ubfertility

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Natural history of fibroids

+nlar#ement "an be 1ery slow

/top #rowin# an often "al"ify after the

menopause

Oestro#en in 34 may stimulate further #rowth

ay enlar#e in mi-pre#nan"y

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Complications of fibroids

Uner#o torsion an "ause pain ay tort an infar"t urin# pre#nan"y

4orsion ofpeun"ulate

fibroi

4hrombosis of the fibroi bloo supply Abominal pain uterine tenerness

haemorrha#e an ne"rosis

3e e#enerations

(urin# pre#nan"y)

$eiomyosar"oma (*67%)ali#nan"y

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Fibroids and pregnancy

Premature labour

alpresentations

4rans1erse lie

Obstru"te labour

Postpartum haemorrha#e

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Investigation

Ultrasoun 3,'laparos"opy (to istin#uish the fibroi from

an o1arian mass'aenomyosis)

ysteros"opy'hysterosalpin#o#ram (to assess the

istortion of the uterine "a1ity . fertility issue)

aemo#lobin "on"entration (low-1a#inal

bleein#'hi#h-erythropoietin by fibrois)

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Treatment

Asymptomati" /ymptomati" ei"al treatment

/ur#i"al treatment

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Medical treatment

First-line treatment8 4rane9ami" a"i :/A,;/ orpro#esto#ens (often ineffe"ti1e when menorrha#ia

is ue to fibrois)

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Surgical treatment

ysteros"opy sur#ery8 Transcervical resection offibroid(Pretreatment with

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Other treatments

terine artery emboli!ation(reu"e 1olume offibrois by aroun 5*%)

Ablation(3,-#uie trans"utaneous fo"useultrasoun)

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terine artery emboli!ation "AE#

Main indication . /ymptomati" fibrois (

ysmenorrhea pain yspareunia pressure effe"ts onurinary'

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Complications of AE "continued#

,mmeiate (peri-pro"eural)

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4A: BOU