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Endo Repro Exam > Benign Uterine Abnormalities > Flashcards

Benign Uterine Abnormalities Flashcards

1
Q

endometrial polyps - overview

A

*well-circumscribed, localized collection of the endometrial tissue within the uterine wall
*can be sessile or pedunculated
*common
*peak incidence: 40-49 years
*risk factors: age, hypertension, obesity, tamoxifen use

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2
Q

endometrial polyps - clinical presentation

A

*may be asymptomatic and just seen on exam
*may present with heavy menstrual bleeding, intermenstrual spotting, post-coital bleeding, infertility, or post-menopausal bleeding
*note - always on ddx for vaginal bleeding

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3
Q

endometrial polyps - physical exam

A

*sometimes can protrude from cervical os, making them visible on speculum exam

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4
Q

endometrial polyps - diagnosis

A

*hysteroscopy = gold standard
*transvaginal ultrasound
*saline infusion ultrasound

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5
Q

endometrial polyps - treatment

A

*hysteroscopic polypectomy (hysteroscope inserted into uterus, remove the polyp) +/- D&C (dilation & curettage)
*note - we treat because vaginal bleeding / spotting is associated with increased incidence of malignancy

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6
Q

hematometra - overview

A

*uterus distended with blood, secondary to obstruction of a portion of the lower genital tract
*etiologies:
1. congenital uterine abnormalities: imperforate hymen, vaginal septum
2. acquired:
-senile atrophy
-post procedure synechia (scarring)
-cervical stenosis as a result of surgery / cryotherapy, endometrial ablation, cervical cancer, radiation

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7
Q

hematometra - presentation

A

*decreased menstrual bleeding
*increased pain after uterine or surgical procedure
*intermenstrual spotting

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8
Q

hematometra - diagnosis

A

*clinical + ultrasound: often enlarged/dilated uterus filled with echogenic material

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9
Q

hematometra - treatment

A

*hormonal suppression of endometrial activity
*excision of scar tissue & drainage of blood (hysteroscopy / D&C)
*hysterectomy

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10
Q

adenomyosis - overview

A

*extension of glandular endometrial tissue from the basalis layer of endometrium into the uterine myometrium
*common
*risk factors: parity (multiple pregnancies, uterine surgery, trauma)
*can be diffuse or local

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11
Q

adenomyosis - clinical presentation & physical exam

A

*usually present with dysmenorrhea (pain with menses), menorrhagia (heavy periods), or dyspareunia (pain with penetration)
*physical exam:
-bimanual exam with diffusely enlarged uterus
-tender exam during menstrual cycle

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12
Q

adenomyosis - diagnosis

A

*often coexistent with leiomyoma, endometriosis, endometrial hyperplasia
*imaging:
-transvaginal ultrasound
-MRI = gold standard

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13
Q

adenomyosis - treatment

A
  1. non-hormonal:
    -NSAIDs
    -tranexamic acid (antifibrinolytic)
  2. hormonal:
    -pill/patch/ring
    -medroxyprogesterone acetate
    -mirena
  3. hysterectomy
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14
Q

leiomyoma (fibroids) - overview

A

**benign smooth muscle tumor of the myometrium
*most common tumor in females
*can cause infertility in younger women
*risk factors: age, early menarche, low parity, tamoxifen use, obesity, heredity

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15
Q

leiomyoma (fibroids) - presentation

A

*heavy or abnormal menstrual bleeding
*dysmenorrhea (pain with menses)
*abdominal pressure/bloating
*low back / leg pain
*urinary symptoms

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16
Q

leiomyoma (fibroids) - diagnosis

A

*physical exam: abdominal / bimanual exam - enlarged, firm, irregular uterus
*imaging: ultrasound

17
Q

leiomyoma (fibroids) - treatment

A
  1. NSAIDs
  2. levonorgestrel IUD
  3. hormonal suppression: estrogen / progesterone receptors found in higher concentrations in myomas
  4. myomectomy
  5. hysterectomy
18
Q

endometrial hyperplasia - overview

A

*abnormal endometrial gland proliferation usually caused by excess estrogen stimulation relative to progesterone
*increased risk of endometrial carcinoma
*risk factors: anovulatory cycles, menopausal hormone therapy, PCOS, granulosa cell tumor

19
Q

post menopausal bleeding

A

*bleeding after menopause is NOT normal and requires an evaluation - must rule out endometrial carcinoma
*recall: menopause = 12 months of amenorrhea in a female 40-60 yo
*evaluation:
-history
-physical exam with pap smear & HPV testing
-transvaginal ultrasound vs. endometrial biopsy vs. D&C

20
Q

endometriosis - overview

A

*endometrial glands / stroma outside the uterine cavity
*usually in the pelvis/ovary (endometrioma)
*can also occur in multiple sites outside the pelvis such as bowel, diaphragm, peritoneum (“powder burn lesions”) and even pleural cavity
*benign
*estrogen-dependent

21
Q

endometriosis - etiology

A

*unclear
*theories include:
-retrograde menstrual flow
-transportation of endometrial tissue via lymphatic system
-transformation of multipotent cells

22
Q

endometriosis - risk factors

A

*incidence: 10% of reproductive age women
*risk factors:
-nulliparity
-prolonged exposure to endogenous estrogen (early menarche / late menopause)
-shorter menstrual cycles
-heavy menstrual bleeding
-obstruction of menstrual outflow
-low BMI, tall height
-physical/sexual abuse in childhood or adolescence

23
Q

endometriosis - presentation

A

*usually presents during reproductive years
*pelvic pain (dysmenorrhea, dyspareunia, dyschezia) - usually cyclic monthly pain, beginning 1-2 days before menses, persists during menses, improves after menses
*infertility
*ovarian mass
*sometimes incidental finding during surgey
*heavy menstrual bleeding

24
Q

endometriosis - physical exam

A

*variable
*tender vaginal exam
*nodules in posterior fornix
*adnexal masses
*rarely visualized on cervix / vaginal mucosa

25
Q

endometriosis - diagnosis

A

*definitively diagnosed by histological evaluation of a lesion biopsied during surgery (usually laparoscopic)
*nonsurgical evidence of endometriosis:
-ultrasound
-visual identification or other PE findings
-cystoscopic evaluation / biopsy of detrusor lesions

26
Q

endometriomas - overview

A

*ovarian cyst formed when endometrial tissue within ovary bleeds, resulting in a hematoma
*often found bilaterally
*endometriomas have fibrotic walls, filled with chocolate-colored material (aka “chocolate cysts”)
*can observe or remove surgically (cyst alone vs. oophorectomy)

27
Q

endometriosis - treatment

A

*medical: NSAIDs, tranexamic acid, GnRH agonists, danazol
*hormonal: combined OCPs, depo provera, levonogestrel IUDs
*surgical: hysterectomy, laparoscopic removal of lesions / lysis of adhesions

Endo Repro Exam (31 decks)

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