Degenerations types:
- Hyaline/Myxoid (MC)
- Cystic
- Fatty
- Calcareous
- Red (Pregnancy)
Special Features:
All type of degeneration MC seen in: SUBMUCOUS
Except: CALCAREOUS (MC in SUBSEROUS)
CALCAREOUS – Peripheral to Centre
All other: Centre to Peripheral
RED – PAINFUL
Others: painless
RED degeneration: MC in PREGNANCY (2nd Tri)
MC Sx: PAIN ABDOMEN
Special Fea: BEEFY RED/FISHY ODOR Hemorrhage in Myoma
Others: Fever, vomiting, inc WBC, ESR (non infective etioloogy)
Ddx: Abruption, preterm labor, appendicitis, Cholecystitis, Pyelonephritis
IOC: 12 wk: Transabdominal US
Tx: Symptomatic (NSAIDS, Antibiotics, fluids)
For all fibroid:
Gold standard: MRI (d/f b/w fibroid n adenomyosis
Mx: Expectant/medical/surgical
Expectant Mx: OBSERVE in
- Asymptomatic patients
- Post-menopausal fibroid
- Pregnancy (shrink in post-partum)
Surgery: MYOMECTOMY or HYSTERECTOMY
Choose either based on family completion
DEFINITIVE THERAPY – both
Recent advances:
- Uterine artery embolisation – POLYVENYL ALCOHOL inside UTERINE artery. (don’t use if desire future pregnancy)
- MRI guided focus ultrasound
HIFU – High intensity focused ultrasound
MEDICAL MX: CONTINUOUS GnRH analaogue
GnRH antogonists
Mifepristone – Progesterone receptor antagonist
Progesterone receptor modulator (ULIPRISTIL)
ASOPRISNIL
Mirena & Progesterone – REDCUE BLOOD LOSS (symptomatic relief but make fibroid grow)
All others: SHRINKS FIBROIDS
Other not in use: androgen analogue (Gestrinone), Danazol