Benign Conditions of Cervix, Uterus, Endometrium Flashcards
What are the three components of the cervix
Ectocervix
External os
Endocervical canal
What is the ectocervix?
Vaginal part of the cervix
Lined in thick non-keratinised stratified squamous epithelium
Where is the external os visible?
At the centre of the ectocervix as a dark circular area
What is the endocervical canal lined in?
Simple columnar epithelium
What is a cervical ectropion?
A visible columnar epithelium on the endocervix
Appears as a round, red area
Physiologycal
What are triggers for a cervical ectropion?
3Ps
Pill
Puberty
Pregnancy
What are symptoms of a cervical ectropion?
Intermentstrual, poistoctal bleeding
Mucous (excessive, clear, odourless)
How do you (ix+) manage a cervical ectropion?
CONSIDER SMEAR / BIOSPY FOR CERVICAL CANCER
Cervical and lower genital tract swabs to exclude STI
Change from oestrogen based hormonal contraceptive
Cervical ablation
What should you double check when investigating cervical ectropion?
Cervical, lower genital tract swab - STI
Smear - cervical malignancy
What is a nabothian follicle?
When columnar glands in transformation zone seal over, forming small cysts on ectocervix
How do you treat nabothian follicles?
NO treatment required
What are cervical polyps?
Benign tumours from endocervical epithelium
What do cervical polyps look like?
Smooth reddish protrusions
How are cervical polyps removed?
By avulsion, with polyp forceps
What is cervical stenosis?
Pathological narrowing of endocervical canal
What causes cervical stenosis?
Iatrogenic
What does cervical stenosis cause?
Entrapment of blood within uterus (haematometra) causing cyclical dysmenorrhoea with no menstrual bleeding
How do you treat cerbical stenosis?
Surgical dilatation of cervix
What are endometrial polyps?
Focal endometrial outgrowths
What are RF for endometrial polyps?
Obesity
Late menopause
Tamoxifen, HRT
How do polyps respond to hormonal changes?
They DONT
How do you investigate polyps’
TVUSS
Hysteroscopy
How do you manage endometrial polyps?
Polypectomy (surgical) - through hysteroscopy (day case)
Small one resolve alone
What is Asherman Syndrome?
Fibrosis and adhesion formation within the endometrial cavity following irreversible damage of the single layer of thick basal epithelium (which Does not regenerate)
What is a complication of Asherman syndrome?
Subfertility
What are causes of Asherman Syndrome?
Surgery
Overzealous curettage in TOP
Pregnancy w uterine infection (endometritis)
How do you manage Asherman syndrome?
Adhesiolysis (surgical breakdown of intrauterine adhesions)
What are fibroids?
Leiomyoma
Benign tumour of uterine smooth muscle
What are RF for fibroids?
Nulliparous
Obese
Afro carribean ethnicity
What are the four locations of fibroids
SICS
Subserosal
Cervical
Intramural
Submucosal
What are symptoms of fibroids?
HMB, IMB Subfertility, recurrent pregnancy loss, Pressure and pain Bladder and bowel dysfunction Abdominal distension
How do fibroids reacts to oestrogen=?
They are OESTROGEN DEPENDENT
- enlarge during pregnancy
- shrink after menopause
How do fibroids cause sub fertility?
mechanical distortion of endometrial tissue, preventing implantation / occlusion of FT
What are investigations for fibroids?
FBC (anaemia)
USS (TVUSS, TAUSS)
Saline infusion sonography
RMI
Hysteroscopy
What is the medical mx of fibroids?
For HMB:
- LNG-IUS
- Tranexamic acids
- COCP
- Injection f GnRH agonist (induces temporary menopause)
- Ulipristal acetate
What is Ulipristal Acetate
Selective Progesterone Receptor Modulator
What is surgical mx for fibroids?
Myomectomy (surgical resection of fibroids, preserves fertility)
Transcervical fibroid resection
Hysterectomy
Uterine artery embolisation
What must you give prior to myomectomy / hysterectomy?
GnRH agonist pre-treatment for 3 months
This reduces bulk and vascularity of fibroids
What is radiological tx for fibroids=
Uterine artery embolisation
What is adenomyosis?
Endometrial glands and storm are found deep within the myometrium
How does adenomyoisis present?
Secondary dysmenorrhoea
Uterine enlargement
HMB
What is the gold standard investigation for adenomyosis?
MRI
How do you manage adenomyosis?
Progesterone containing LARC
Hysterectomy - permanent tx
Are fibroids associated to leiomyosarcoma?
very few women with fibroids then develop leiomyosarcoma
Likely to be only because they are similar (confusing for dx) or coincidental as fibroids are very common
Little evidence for causation
What is the main RF for fibroids?
OESTROGEN
What are possible triggers for fibroid growth?
PREGNANCY
also high BMI
Why is high BMI a trigger for fibroid growth?
Adipose tissue converts testosterone to oestrogen
What are the four types of fibroid you can get?
Submucosal
Cervical
intramural
Subseerosal
Where do submucosal fibroids sit?
Below the mucosa
They bulge out into the endometrial cavity
Where do cervical fibroids sit?
At the cervix
Where do intramural fibroids sit?
Within the myometral wall
Where do subsrosal fibroids sit?
Just below serous layer, on outer edge of uterus
What is another term for dysmenorrhoea?
UTERINE ANGINA
Essentially because contractions during periods cause reduced blood supply, leading to pain
WHAT DO symptoms for fibroids depend on?
ON the LOCATION of the fibroid
What are common symptoms with fibroids and why do they occur?
- HMB (increased surface area means increased bleeding)
- Dysmenorrhoea (increased uterine angina)
- Anaemia (from excess bleeding)
- Subfertility (if submucosal, makes it hard for implantation)
- Pain and pressure sx (if very large(
How do fibroids affect pregnancy?
Early miscarriage
Late miscarriage
Premature birth
Because fibroids stretch the myometrium, triggering early labour
What is red degeneration of fibroids?
Fibroid grows excessively during pregnancy
It outgrows the blood supply
DIes
What factors should you consider when managing fibroids?
Effect on quality of life
Fertility
Cultural wishes
