Benign Disorders of the Upper Genital Tract Flashcards
Mullerian anomalies are more common in which epidemiologic group
Women who have taken Diethylstilbestrol - nonsteroidal estrogen indicated for vaginitis, miscarriage prevention, prostate/breast cancer
Classic anomaly is T-shaped uterus
Uterine septa can result in which trimester pregnancy loss and why?
1st trimester because the septa lack an adequate blood supply to facilitate placentation and growth.
Bicornate and unicornate uteri are associated with which conditions?
2nd trimester pregnancy loss, malpresentation, preterm labor due to the size of the uterine horn
What is the most common indication for surgery for women in the US?
Uterine fibroids (leiomyoma) - proliferations of smooth muscle cells
What are the classifications for uterine fibroids
Based on location in uterus:
- Submucosal
- Intramural (most common)
- Subserosal
Characteristics of uterine fibroids?
Lots of ECM, surrounded by pseudocapsule
can outgrow blood supply and degenerate = causing pain
risk decreases with OCP use, increasing parity, and depot medroxyprogesterone acetate (depo-provera)
Most common presentation of uterine fibroids
Most women have no clinical symptoms
Abnormal uterine bleeding is most common symptoms, usually menorrhagia (heavier and longer bleeding
Fibroid mnemonic: Frequency and retention of urine, hydronephrosis Iron deficiency anemia Bleeding abnormalities, bloating Reproductive difficulties Obstipation and rectal pressure Infertility Dysmenorrhea, dyspareunia Symptomless
Treatment for uterine fibroids?
Medical: GO PAN AM
GNRH agonists (decrease circulating estrogen)
OCPs
Progestins (Mirena IUD, norethindrone acetate)
Antifibrinolytics (tranexamic acid)
NSAIDs
Androgenic steroids (danazol, gestrinone)
Mifepristone
Uterine artery embolization
MRI-guided high-intensity US
Myomectomy - fibroids recur in more than 60% patients after 5 years
Hysterectomy is definitive
Women taking tamoxifen are at risk for what?
Endometrial polyps, cysts, and cancer
thromboembolic events
cataracts
What is the management for endometrial polyps?
premalignant or malignant in 5% post-menopausal and 1-2% premenopausal women
removal in any post-menopausal woman
removal in pre-menopausal women with symptoms
What is the significance of endometrial hyperplasia?
Source of abnormal uterine bleeding
link to endometrial cancer
Occurs due to continuous endogenous (excess adipose tissue, PCOS) or exogenous (hormonal replacement) estrogen stimulation in the absence of progesterone
What are the types of endometrial hyperplasia and what risk of endometrial cancer is there?
Simple hyperplasia - 1%
complex - 3%
Atypical simple - 10%
Atypical complex - 30%
What is the method of choice for evaluation of abnormal uterine bleeding?
Endometrial biopsies (EMB) Then D&C
Treatment of endometrial hyperplasia?
Simple/complex: progestin therapy for 3-6 months then repeat EMB
Atypical:D&C following EMB because 30% risk of coexistant endometrial cancer. Hysterectomy is treatment of choice if not desiring future fertility.
If younger, longer progestin and weight loss, repeat EMB at 3 months
What are the types of ovarian masses?
Functional cysts (smoking increases risk 2x) - Follicular cysts (most common) - Corpus luteum cysts Theca lutein cysts Endometriomas (chocolate cyst) Neoplastic growths
