Uterine Fibroids — Viva

Opening (30 s)

"Uterine Fibroids — give a one-line definition and the single most important immediate risk."

Model: Uterine fibroids (leiomyomas) are benign, monoclonal, oestrogen- and progesterone-responsive smooth-muscle tumours of the myometrium — the commonest benign tumour of women (up to 70 to 80 per cent by age 50). Most are asymptomatic; when symptomatic the leading complaint is abnormal uterine bleeding (heavy/prolonged menses), followed by bulk/pressure symptoms (pelvic heaviness, urinary frequency, c [1]

Station 1 — Pathophysiology (2 min)

Explain the mechanism chain from cause to clinical features and one major complication.

Station 2 — Clinical diagnosis (2 min)

Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.

Red flag cue: Heavy menstrual bleeding with a uniformly enlarged, irregular, firm, mobile, non-tender uterus in a reproductive-age woman - uterine fibroids until proven otherwise [1]

Station 3 — Investigations (2 min)

First-line tests, definitive tests, and any named score with exact components.

Station 4 — Emergency management (3 min)

ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.

Station 5 — Definitive / long-term care (2 min)

Stepwise definitive therapy, monitoring, complications of treatment, follow-up.

Station 6 — Special populations (2 min)

Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.

Station 7 — Evidence & pitfalls (2 min)

Landmark trial or guideline name if standard; three classic exam traps.

Station 8 — Rapid-fire pearls (1 min)

Five high-yield facts a candidate must not forget under time pressure.

Examiner pass criteria

• Speaks in mechanisms and numbers, not vague lists
• Gives at least one exact dose or threshold
• Names escalation criteria
• Avoids dangerous delays (imaging when unstable, etc.)

References

1. [1]Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review BJOG, 2017.PMID 28296146
2. [2]Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future Hum Reprod Update, 2016.PMID 27466209
3. [3]Gupta JK, Daniels JP, Middleton LJ, et al. A randomised controlled trial of the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia: the ECLIPSE trial Health Technol Assess, 2015.PMID 26507206
4. [4]Edwards RD, Moss JG, Lumsden MA, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids N Engl J Med, 2007.PMID 17251532
5. [5]Al-Hendy A, Lukes AS, Stewart EA, et al. Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy N Engl J Med, 2021.PMID 33596357
6. [6]American College of Obstetricians and Gynecologists (ACOG) Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228 Obstet Gynecol, 2021.PMID 34011888
7. [7]Liver Injury with Ulipristal Acetate: Exploring the Underlying Pharmacological Basis Drug Saf, 2020.PMID 32748236
8. [8]Puri K, Famuyide AO, Erwin PJ, Stewart EA, Laughlin-Tommaso SK. Submucosal fibroids and the relation to heavy menstrual bleeding and anemia Am J Obstet Gynecol, 2014.PMID 24080304
9. [9]Islam MS, Protic O, Giannubilo SR, et al. Uterine leiomyoma: available medical treatments and new possible therapeutic options J Clin Endocrinol Metab, 2013.PMID 23393173