Abnormalities Of The Uterus Flashcards
How can fibroids be classified according to their position?
Intramural- the majority
Sub mucosal- growing into the uterine cavity, and may become pedunculated
Subserosal - growing outward from uterus, and may be uterine, cervical, interligamental or pedunculated
What is a fibroid?
A fibroid is a benign tumour of the myometrium- also known as a leiomyomata
Stimulated by oestrogen to grow in size
May eventually become calcified or undergo benign degeneration
How common are fibroids?
Occur in 25% of women
What risk are risk factors for fibroids?
Afrocaribbean Approaching the menopause- most common in 30s and 40s Family history Obese Early menarche
How do fibroids present?
Asymptomatic in 50%
Excessive or prolonged periods
Intermenstrual bleeding
Urinary symptoms or constipation due to pressure on bladder/bowel
Lower abdominal discomfort and heaviness due to pressure effects
Sub mucous fibroids can decrease fertility
On examination- enlarged, irregular, firm, non tender uterus on BE
What are the complications of fibroids?
Pedunculated fibroids may undergo torsion, causing pain
Degenerations due to inadequate blood supply- ‘red’ degeneration may cause pain and uterine tenderness due to haemorrhage and necrosis
A small minority of fibroids may undergo malignant change to sarcoma
How should fibroids be investigated?
Full blood count for anaemia
USS to assess size, location
Endometrial sampling may be necessary to assess the abnormal bleeding- may require hysteroscopy
How are fibroids managed?
Asymptomatic patients with small fibroids require no treatment
If larger the fibroid may require monitoring by BE or USS
NSAIDs, tranexamic acid or mirena coil may be used to manage menorrhagia
Gnrh aginists may be used to reduce six of the fibroid, but can only be used for nine months due to menopausal side effects and osteoporosis
Surgery hysteroscopic for small fibroids Total hysterectomy Myomyectomy Uterine artery embolisation
What is endometriosis?
Chronic oestrogen dependent condition characterised by the growth of endometrial tissue in sites other than the uterine cavity
Where is endometriosis usually located?
Uterosacral ligaments On or behind ovaries Umbilicus Wound scars Vagina Bladder Rectum
How common is endometriosis?
5-10% of women, but many women are asymptomatic
Diagnosis is usually in a women’s thirties
What are the risk factors for endometriosis?
Early menarche Late menopause Delayed childbearing Obstruction to vaginal outflow Family history
How does endometriosis present?
Dysmenorrhea
Deep dyspareunia
Cyclical or chronic pelvic pain
Sub fertility
Others include: bloating, lethargy, constipation, low back pain
Examination: tenderness or thickening behind uterus or adnexa
How is endometriosis investigated?
Laparoscopy is the gold standard
This may show;
Red vesicles or punctuate marks on the peritoneum
White scars or brown powder burn spots
Adhesions or endometriomata
What is the management of endometriosis?
Treatment not always necessary! Think about risk if progression
NSAIDs for symptomatic relief
COCP for younger patients with mild symptoms
Gnrh analogues - for six months, to relieve pain from endometriosis
Danazol- androgenic side effects
IUS
Surgery:
Laparoscopic excision or ablation
Endometriomata excision
Hysterectomy with BSO as last resort
