COMPLICATIONS OF FIBROIDS And degenerations

1. COMPLICATIONS
OF
FIBROIDS
And
degenerations

2. COMPLICATIONS OF FIBROIDS
 Severe dysmenorrhoea
 Menorrhagia and intermenstrual bleeding
 Postmenopausal bleeding
 Pregnancy losses and infertility
 Torsion and hemorrhage
 Infection / ulceration
 Inversion of uterus
 Endometrial carcinoma with fibromyoma
 Parasitic fibroid
 Endometrial and myohyperplasia
 Accompanying adenomyosis

3. SEVERE DYSMENORRHOEA
• Sometimes, Severe dysmenorrhoea needs
emergency surgery
• Congestive and spasmodic dysmenorrhoea may be
associated with pelvic diseases
• Acute pain is seen when a fibroid is complicated by
torsion, haemorrhage and red degeneration
• May be complicated as a Sarcoma in elderly
woman

4. Menorrhagia and
intermenstrual bleeding
Seen in intramural and submucous myoma
due to
• Increased vascularity
• Endometrial hyperplasia
• Enlarged uterine cavity
Postmenopausal bleeding can occur due to
ulceration of the surface of the fibroid
Hysteroscopic view of
Ulcerations on
submucosal fibroid

5. Pregnancy losses and infertility
Submucous myoma bigger than 4cm in size can cause
infertility and recurrent pregnant loss
Infertility is either due to associated with
 PID
 endometriosis
 anovulatory cycles
 distortion of uterine cavity
• causing obstruction to sperm ascent
• poor nidation
• cornual tubal block
Pathological specimen
showing Foetus in uterus,
with large fibroid tumour

6. Torsion and Parasitic fibroid
Sub serous pedunculated myoma undergo rotation at the
site of its attachment to the uterus
Veins are occluded and tumour becomes engorged with
blood
Severe abdominal pain
is experienced
Detached completely or attach
to visceral organ
withdraw its nutrition from it
WANDERING or PARASITIC
fibroid

7. Torsion of sub serosal fibroid

8. Infection
• Common in submucous and myomatous polyps if they
project into the cervical canal or into the vagina
• This cause blood stained discharge
• If the tumour causes PPH or puerperal sepsis it should be
removed vaginally

9. Inversion of uterus
Caused by submucous fundal myoma

10. Endometrial carcinoma with fibromyoma
Endometrial carcinoma is associated with
fibromyoma in women over 40 years of
age in 3% cases

11. DEGEneRATIONS AND
SECONDARY CHANGES IN
FibROID
 Calcareous degeneration
 Red degeneration
 Atrophy
 Sarcomatous change

12. CALCAREOUS DEGENERATION
Phosphates and carbonates of lime are
deposited in the periphery along the course
of the vessel
Common in old patients with long standing
myomas
identified by radiography
Calcium deposits in
fibroid

13. • Develops frequently during pregnancy
• Myoma becomes tense and tender and causes severe abdominal
pain with pain
• It assumes peculiar purple red colour and develops fishy odour
• Patient is febrile with moderate leucocytosis and raised ESR.
• Ultrasound is useful in diagnosis
Red degeneration

14. atrophy
Due to diminished vascularity – results in
shrinkage of size of tumour and becomes
firmer and more fibrotic
Hyaline, cystic and fatty degenerations
occur in central areas in large fibromyomas

15. Sarcomatous change
• Extremely rare and highly malignant
• Intramural and submucous tumours have higher potential for
sarcomatous change than serous tumours
• Develop under the age of 40years and common in postmenopausal
woman
• Tumours grow suddenly, causing pain and postmenopausal bleeding
• Tumour is yellowish grey and haemorrhagic, soft and friable in
consistency and non encapsulated