• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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• Q. How common are fibroids in women?

  • Fibroids are present in 35-77% of reproductive age women, rising to 70-80% at menopause, depending on ethnicity, and are present in 5-10% of infertile patients

• Q. What are the clinical features of fibroids?

  • Dysfunction uterine bleeding
  • Pelvic pain
  • Poor implantation of the embryo
    • recurrent first-trimester abortion
  • Preterm labor
  • Obstruction of labor

• Q. How do fibroids impact fertility?

  • 1. Distortion of the uterine cavity
  • 2. Reduce endometrial receptivity
  • 3. They can block fallopian tubules

• Q. What is the role of hormones in the growth of fibroids?

  • Estrogen aids in the growth of fibroid via ER-alpha receptor
  • It has a permissive role to induce progesterone receptor, and it is progesterone that causes the actual growth

• Q. How are they diagnosed?

  • TAS or TVS
  • TVS- preferred

• Q. What are the surgical options for treatment?

  • Hysteroscopic or laparoscopic myomectomy

• Q. What is the role of hormonal therapy in fibroids?

  • GnRH agonist- short term use reduces vascularity of fibroid and anemia → aids resection
    • They shrink fibroids by 35-65% over three months
  • Antiprogesterone- Ulipristal acetate and Mifepristone are useful in the management of fibroid –underscore the role of Progesterone in fibroid

• #Clinicalpearl

  • Progesterone is the main culprit in fibroid, and hence anti-progesterone agents are beneficial in this condition

• Q. What is the role of Uterine artery embolization?

  • It is a helpful treatment for fibroids, however, they can lead to tissue necrosis
  • Hence it is not recommended for women wishing to get pregnant
  • The recurrence rate is also high (33%)

• Q. From a fertility perspective, what size of fibroids require myomectomy?

  • Myomectomy for Intramural fibroids >5 cm has benefits in terms of both natural as well as IVF conception

• Q. What types of fibroids are removed hysteroscopically?

  • Submucosal fibroids can be removed hysteroscopically

• Q. Does myomectomy improve fertility outcomes?

  • Yes
  • Myomectomy almost doubles the chances of a clinical pregnancy