benign conditions of uterus + cervix Flashcards
3 ps for development of ectropion
Pill
Pregnancy
Puberty
Mx of ectropion
Changing hormone contraception - coming off oestrogen can help
Ablation
Swabs to rule out UTI
What are nabothian follicles
columnar cells in transition zone get sealed over and you get mucous filled cysts on ectocervix
How does haematometra present
cyclical dysmenorrhea w/ associated amenorrhea
What are RF for endometrial polyps
Obesity Late menopause HRT Tamoxifen (basically anything that increases oestrogen exposure)
Ix for endometrial polyps
Outpatient hysteroscopy and saline infusion sonography
Causes of Asherman’s
excessive curettage after miscarriage
endometrial infecton –> endometriitis
Repair of PPH
Symptoms of fibroids
HMB IMB Subfertility recurrent pregnancy loss Abdo pain Bladder + bowel dysfunction
3 forms of fibroid degeneration
red
cystic
hyaline
Why do fibroids enlarge during pregnancy
They’re oestrogen dependent
Describe red degeneration of fibroid
Get haemorrhage + necrosis of fibroid
This presents as acute abdo pain
Often happens in 2nd trimester
Hyaline degeneration
Fibroid just liquefies and degenerates - painless
Cystic degeneration
Central necrosis leading to central cystic space
Can get calcium deposition
this RARELY develops into sarcomatous disease or malignancy
Mx of subfertlity caused by fibroids
Remove submucosal fibroids
Don’t touch others as doing so reduces fertility cause of invasive operation
effects of fibroid on pregnancy
Risk of miscarriage not increased once pregnancy established
Can cause abnormal lie in later stages
complications with PPH
Medical mx of fibroid
LNG - IUS
Tranexamic acid
COCP
GnRH agonist - induces iatrogenic menopause and stops ovarian oestrogen production - get menopausal s/e
(Ulipristal acetate (prog receptor modulator) - as effective as GnRH in reducing HMB) - under review
NB - Last two are short term as when you stop taking it then fibroids start growing again
Sx management of fibroid
OPH for submucosal and fibroid polyps
For bulky fibroid uterus or refractory HMB 3 options
- myomectomy (to preserve fertility)
- hysteroscopic endometrial ablation
- hysterectomy
Radiological:
uterine artery embolisation (risk is of ovarian failure)
Symptoms of adenomysosis
increasingly painful dysmenorrhea
increased size of uterus
HMB
Dx adenomysosis
US
MRI -gold standard
Mx of asherman’s
hysteroscopic adhesiolysis + insertion of paediatric foley catheters
give 2 cycles of O+P to help endometrium
Mx for polyp
polypectomy resolves symptoms and you can test for ca
