benign conditions of uterus + cervix

Question 1

3 ps for development of ectropion

Answer 1

Pill
Pregnancy
Puberty

Question 2

Mx of ectropion

Answer 2

Changing hormone contraception - coming off oestrogen can help
Ablation
Swabs to rule out UTI

Question 3

What are nabothian follicles

Answer 3

columnar cells in transition zone get sealed over and you get mucous filled cysts on ectocervix

Question 4

How does haematometra present

Answer 4

cyclical dysmenorrhea w/ associated amenorrhea

Question 5

What are RF for endometrial polyps

Answer 5

Obesity
Late menopause
HRT 
Tamoxifen 
(basically anything that increases oestrogen exposure)

Question 6

Ix for endometrial polyps

Answer 6

Outpatient hysteroscopy and saline infusion sonography

Question 7

Causes of Asherman’s

Answer 7

excessive curettage after miscarriage
endometrial infecton –> endometriitis
Repair of PPH

Question 8

Symptoms of fibroids

Answer 8

HMB IMB
Subfertility
recurrent pregnancy loss
Abdo pain
Bladder + bowel dysfunction

Question 9

3 forms of fibroid degeneration

Answer 9

red
cystic
hyaline

Question 10

Why do fibroids enlarge during pregnancy

Answer 10

They’re oestrogen dependent

Question 11

Describe red degeneration of fibroid

Answer 11

Get haemorrhage + necrosis of fibroid
This presents as acute abdo pain
Often happens in 2nd trimester

Question 12

Hyaline degeneration

Answer 12

Fibroid just liquefies and degenerates - painless

Question 13

Cystic degeneration

Answer 13

Central necrosis leading to central cystic space
Can get calcium deposition
this RARELY develops into sarcomatous disease or malignancy

Question 14

Mx of subfertlity caused by fibroids

Answer 14

Remove submucosal fibroids

Don’t touch others as doing so reduces fertility cause of invasive operation

Question 15

effects of fibroid on pregnancy

Answer 15

Risk of miscarriage not increased once pregnancy established
Can cause abnormal lie in later stages
complications with PPH

Question 16

Medical mx of fibroid

Answer 16

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

Question 17

Sx management of fibroid

Answer 17

OPH for submucosal and fibroid polyps

For bulky fibroid uterus or refractory HMB 3 options

1. myomectomy (to preserve fertility)
2. hysteroscopic endometrial ablation
3. hysterectomy

Radiological:
uterine artery embolisation (risk is of ovarian failure)

Question 18

Symptoms of adenomysosis

Answer 18

increasingly painful dysmenorrhea
increased size of uterus
HMB

Question 19

Dx adenomysosis

Answer 19

US

MRI -gold standard

Question 20

Mx of asherman’s

Answer 20

hysteroscopic adhesiolysis + insertion of paediatric foley catheters
give 2 cycles of O+P to help endometrium

Question 21

Mx for polyp

Answer 21

polypectomy resolves symptoms and you can test for ca