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fibroid, aka
leiomyoma, uterine myoma
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define leiomyoma
- benign SM tumor
- MC solid pelvic tumor
- #1 cause of hysterectomies
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locations of leiomyoma
- 1. submucosal - beneath endometrium - most symptomatic
- 2. intramural
- 3. subserosal
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symptoms of leiomyoma
- 1. asxs (MC) -> monitor
- 2. bleeding - menorrhagia (MC symptom)
- 3. pain - pressure, low back pain, urinary frequency
- 4. infertility - compression of fallopian tubes
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define menorrhagia
- menses lasting >= 7 days
- anemia
- changes quality of life
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PE of leiomyoma
- non-tender pelvic mass moves contiguously w cervix
- (if fixed or fluctuant >> not fibroid)
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Dx leiomyoma
- pathological
- US - best test uterus and ovaries
- PE
- hysteroscopy
- sonohysterogram
- HSG (histerosalpingogram)- XR
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if bleeding, must r/o
- uterine CA
- endometrial polyp
- anovulation - MCC
- thinning lining
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treatment of leiomyoma
- NSAIDs - pain
- Progesterin - control bleeding
- GnRH agonists - shrink fibroids - max effect 3 months - enlarge again when stop tx
- Sx
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Tx of fibroids for F desiring future pregnancies
- myomectomy - removal fibroid
- uterine a. embolization
- endometrial ablation - control bleeding
- myolysis - coagulates fibroid w electricity
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Tx of fibroids for F who doesNOT desire future pregnancy
hysterectomy
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