Pathophysiology
What are 2 other names for uterine fibroids?
What are leiomyoma and myoma
When performing an abdominal & pelvic exam, the size of a uterine fibroid is compared to what?
Gravid uterus.
This medical treatment is contraindicated in patients with a type 0, 1, or 2 fibroid
What is a progesterone secreting IUD
A 29 y.o. woman presenting with a mass up to her umbilicus presents with complaints of missing her period for 4-5 months and pressure. What test do you order and what is the likely diagnosis?
Pregnancy test and pregnant
This minimally invasive intervention is well suited for women who no longer desire fertility but wish to preserve their uterus
What is uterine artery embolization?
Symptoms of fibroids are classified into these three categories.
What are AUB, bulk symptoms (pain or pressure), or reproductive dysfunction.
The preferred first line imaging for patients with suspected fibroids
Pelvic ultrasound.
This medical treatment that reduces HMB by 50% in patients with fibroids has the advantage of not providing contraception.
Tranexamic Acid
A 35 y.o. multip presents with complaints of dysmenorrhea and an enlarged boggy uterus is palpated on exam. What do you suspect?
Adenomyosis
After the spread of leiomyosarcoma during Dr. Amy Reed's laparoscopic hysterectomy in Boston, the FDA recommended limited use of this technique for tissue extraction.
What is uncontained power/electromechanical morcellation?
In pregnancy, fibroids have the least effect on which of the following: placental abruption, postpartum hemorrhage, cesarean delivery, or fetal growth restriction.
What is fetal growth restriction?
Of methods used to evaluate the extent of submucosal invasion, this modality is the most sensitive.
Pelvic MRI
GnRH agonists usually reduce fibroid size by up to 50% within this time frame?
What is three months?
A 45 y.o. afebrile patient presents to ER with excruciating pain of acute onset, neg. pregnancy test and an enlarged pelvic mass. What do you suspect?
Ovarian torsion
Generally considered safe with low risk of re-intervention and in future pregnancy for the treatment of heavy menstrual bleeding
Hysteroscopic myomectomy
This steroid hormone is considered to have the most important effect on fibroid development and growth.
What is progesterone?
A submucosal fibroid that is exactly 50% invading the cavity is considered this subtype in the FIGO subclassification system.
Type 2
Along with improvement in vasomotor symptoms, add back therapy reduces the risk of this side effect in patients taking elagolix.
What is decreased bone mineral density?
In potential causes of abnormal uterine bleeding, what does the PALM stand for?
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Class of drugs usually given preop to reduce bleeding by inducing anemia and volume reduction to facilitate smaller incision
GnRH agonists
According to the standardized leiomyoma subclassification system, submucosal fibroids are FIGO types what?
What are types 0,1, and 2?
In patients with fibroids and AUB, endometrial biopsy is indicated for any of these three reasons.
What are
1) irregular bleeding
2) abnormal bleeding not responsive to medical treatment
3) suspected sarcoma or other malignancy
Ulipristal acetate while widely used in Europe to decrease both bulk and bleeding symptoms for fibroids, did not receive FDA approval due to this adverse event.
What is hepatic failure?
In potential causes of abnormal uterine bleeding, what does COEIN stand for?
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not otherwise classified
Fibroids causing this often asymptomatic finding require surgical treatment, usually hysterectomy.
Hydronephrosis