Uterine Pathologies Flashcards Preview

Adult Patient 3 > Uterine Pathologies > Flashcards

Flashcards in Uterine Pathologies Deck (9)
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1
Q

What would be advised for a woman with a fibroid larger than a 14 week pregnancy, If she wanted to preserve fertility?

A

Local excision to remove the fibroid

2
Q

When is surgery indicated for fibroids?

A

Excessively enlarged uterine size
Pressure symptoms
Medical management not controlling symptoms
Submucosal fibroid and fertility reduced

3
Q

When is laparoscopic myomectomy indicated?

What are the benefits of this treatment?

A

Symptomatic women
Subserous fibroids
Wish to maintain fertility

Less pain
Shorter hospital stay
Reduced recovery time

4
Q

Management of women with asymptomatic fibroids?

A

No further investigations, unless there is rapid growth or reason to suspect malignancy
Annual follow up to access size and growth

5
Q

Management of women with menorrhagia associated with fibroids?
Fibroids <3cm and no distortion of the uterine cavity

A

in the following order:

levonorgestrel-releasing intrauterine system (LNG-IUS), provided long term use is anticipated

Tranexamic acid, or NSAIDs, or COCs

Norethisterone daily from days 5-26 (temporary) or long-acting progesterone (injectable)

6
Q

Management of women with menorrhagia associated with fibroids?
Fibroids >3cm and heavy menstrual bleeding

A

ulipristal acetate 5mg

7
Q

When to refer woman with fibroids?

A

Symptoms (for example, heavy menstrual bleeding) have not improved despite initial treatments.

  • Use of NSAIDs and/or tranexamic acid should be stopped if symptoms have not improved within 3 menstrual cycles.

Complications, such as compressive symptoms from large fibroids (for example dyspareunia, pelvic pain or discomfort, constipation, or urinary symptoms).

Fertility or obstetric problems associated with fibroids

A clinical or radiological suspicion of malignancy.

Fibroids which are palpable abdominally, or intracavity fibroids and/or whose uterine length is measured at ultrasound, or hysteroscopy, >12 cm.

8
Q

Contraception for women with fibroids?

A

without distortion of the uterine cavity: all fine

With distortion: barrier, Combined hormonal pill/patch/ring
Progesterone only pill/implant/injection

9
Q

Medical treatment of fibroids

A

GnRH agonists - shrink, but return to size quickly after stopping. GnRH may be combined with HRT

Mifeprestone - anti progesterone, shrink

Ulipristal acetate - severe, pre-operative