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Women's Health > Benign conditions of the uterus > Flashcards

Benign conditions of the uterus Flashcards

1
Q

What is endometriosis?

A

A chronic condition

The presence of endometrial tissue outside of the uterus

Its driven by oestrogen

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2
Q

Who gets endometriosis?

A

People who are exposed to oestrogen

Pre-menopausal women, often nulliparous

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3
Q

Where can endometrial tissue be found in endometriosis?

Where is it most commonly found?

A

Anywhere in the body except the brain

It the pelvis, most commonly in the pouch of Douglas

In scars, such as the umbilicus

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4
Q

What is the pouch of Douglas?

Why is endometriosis most likely to occur here?

A

The area between the rectum and the vagina

Because of retrograde menstruation, blood containing endometrial cells flows back through F tubes and into the pelvic cavity

The pouch of Douglas is the lowest point in the pelvic cavity so blood flows down there.

The endometrial cells invade and start to grow there

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5
Q

In what ways do endometrial cells spread around the body?

A

Via retrograde menstruation

Metaplasia: cells transform into endometrial cells b/c of genetic predisposition and oestrogen

Haematogenous dissemination

Via lymph system

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6
Q

Women will have endometriosis for life. True or false?

A

False

They’ll suffer with it until they go through the menopause

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7
Q

Presentation of endometriosis?

A

Sometimes asymptomatic

Pain:

  • cyclical
  • deep dyspareunia
  • pain on defaecation

Infertility

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8
Q

Why does endometriosis cause cyclical pain?

A

Because during the follicular phase of menstrual cycle, the endometrium proliferates

The endometrial tissue becomes swollen and painful

Endometrium proliferates even if its in the wrong place

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9
Q

When is the follicular phase of the cycle?

A

After the period up to ovulation, as the endometrium is proliferating

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10
Q

Why do women with endometriosis sometimes get referred with suspected ovarian cancer?

A

Because a lump is found in the ovary, which is endometrial tissue

Also their Ca 125 levels are raised

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11
Q

Investigations of women with suspected endometriosis?

A

Trans-vaginal USS
MRI

Laparoscopy

Can also make them temporarily menopausal with GnRH analogues, if symptoms don’t improve it’s not endometriosis

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12
Q

What are the management options for a 21 yr old woman with endometriosis who doesn’t want children now but may in the future?

How does these work?

A

The OCP taken triphasically (back to back for 3 months)
Removes the cyclic nature of oestrogen levels, so no cyclic pain

A progesterone contraceptive: pill, Depo, Mirena
Works by thinning endometrium

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13
Q

What is the downside of using a progesterone contraceptive (pill, depo, mirena) as a treatment for endometriosis?

A

Can cause irregular spotting

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14
Q

What are the management options for a 30 yr old woman with endometriosis who wants to start a family now?

A

Laparoscopic surgery

Ablation or excision of endometrial tissue

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15
Q

What are the management options for a pre-menopausal 47yr old woman with endometriosis who’s completed her family?

Would it change your management if she’d had lots of pelvic surgery in the past?

A

Hysterectomy

If pelvic surgery in the past, surgery not recommended b/c adhesions increase risk of complications

Give GnRH analogues and ‘add back’ therapy of HRT

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16
Q

How do GnRH analogues work as treatment for endometriosis?

A

The hypothalamus releases GnRH in pulses to stimulate the pituitary to release FSH + LH. The time between pulses allows the pituitary to make and store up FSH and LH ready for release after a pulse.

Giving GnRH analogues means the pituitary is constantly being stimulated to release FSH and LH, so there’s no time between pulses to make FSH + LH.

So no FSH and LH is produced, so they’re effectively menopausal

17
Q

Why do you give ‘add back’ therapy when giving GnRH analogues?

Do you give OE alone or OE + P?

A

To alleviate the symptoms of menopause

Give OE + P if they have a uterus, as unopposed OE can lead to excessive endometrial thickening and endometrial cancer

18
Q

You see a 46 yr old lady who has 3 children. She has endometriosis-like symptoms.

What do you think it could be?

A

Less likely to be endometriosis because of her age and her parity

Could be adenomyosis

(Always rule out endometrial cancer)

19
Q

What is adenomyosis?

A

The presence of endometrial tissue in the myometrium

Affects older, multiparous women

20
Q

Presentation of adenomyosis?

A

Constant pain
Menorrhagia
Dyspareunia

21
Q

Management of adenomyosis?

A

Hysterectomy

22
Q

What is removed in a hysterectomy?

A

The uterus

And commonly the ovaries, fallopian tubes and cervix

23
Q

What are fibroids?

A

Benign smooth muscle tumours in the uterus

24
Q

What causes fibroids?

A

Oestrogen causes the growth of fibroids

25
Q

Who is affected by fibroids?

A

Women exposed to oestrogen

Common over the age of 30

26
Q

List some types of fibroids?

A

Classified on location:

  • Intracavitary: inside the uterus
  • Pedunculated: on the outside wall of the uterus
  • Submucosal: in the muscular wall, bulging into uterus
  • Subserosal: within muscular wall, bulging on outside of uterus
27
Q

Presentation of fibroids?

A

Depends on where it is.

Menorrhagia

Fertility problems and miscarriage (fibroid in the way)

Pain (uterus trying to expel fibroid)

Palpable mass, you can’t get below

Urinary frequency and constipation due to increased pressure

28
Q

Management of fibroids?

A

Get rid of oestrogen, so use GnRH analogues, or OCP

Fibriodectomy

MRI guided US, which uses high power US waves to destroy fibroid

29
Q

What are endometrial polpys?

A

Lumps/polyps in endometrium

30
Q

Presentation of endometrial polyps?

A

Bleeding
Pain
Infertility and miscarriage

31
Q

Which benign uterine conditions are caused by oestrogen?

A

Endometriosis

Fibroids

32
Q

What management options are there for endometriosis?

A 
OCP
Progesterone drugs (mirena, depo)
GnRH analogue (goserelin)
Androgenic drug (danazol)
Surgery: ablation of areas, TAH

Women's Health (23 decks)

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