Disorders of the Uterus Flashcards
irregular uterine bleeding that occurs in the absence of a recognizable
pelvic pathology, general medical disease, or pregnancy
Considered a diagnosis of exclusion
Reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
Bleeding is unpredictable and can be light, heavy, prolonged, frequent, or random
Most commonly occurs when the ovaries do not release an egg, but it can be ovulatory
Dysfunctional Uterine Bleeding
About what percentage of women with improperly managed anovulatory bleeding eventually may develop endometrial cancer?
1-2%
Prolonged endometrial proliferation is precursor to what?
cancer
What is the most common cause of DUB?
PCOS
Rule out endometrial carcinoma in patients with the following high
risk factors:
Morbid obesity
Diabetes
Chronic hypertension
Age over 35 years
Longstanding chronic eugonadal anovulation
This medical management of DUB is used to re-establish predictable bleeding patterns, decrease menstrual flow, and lower the risk of iron deficiency anemia
Oral Contraceptives
Chronic management of DUB requires episodic or continuous exposure to what to treat proliferative endometrium?
a progestin
A synthetic analogue of arginine vasopressin, this has been used as a last resort to treat abnormal uterine bleeding in patients with documented coagulation disorders
Desmopressin
What are some complications of DUB?
Infertility
Severe anemia/volume loss
Increased risk of endometrial cancer
Localized proliferation of smooth muscle – typically large, midline,
irregularly contoured, mobile pelvic mass with hard, solid quality
Leiomyoma
What is another name for Leiomyoma?
Fibroids
What is the most common presenting symptom of a leiomyoma?
bleeding
High levels of what hormone can lead to growth of a leiomyoma?
estrogen
This condition is the most common indication for hysterectomy
Leiomyoma
Distorted endometrial stripe on pelvic ultrasound should make you think of what diagnosis?
Leiomyoma
Presence of endometrial glands and stroma not in uterus
Aberrant growth of endometrium outside the uterus cavity
Endometriosis
Only true diagnosis for this condition is through a biopsy
Endometriosis
What is the most common cause of secondary dysmenorrhea?
Endometriosis
In endometriosis, what is the most common site?
Most common in ovaries – often bilateral
The following is the clinical presentation of what disorder?
Progressive dysmenorrhea and deep dyspareunia that worsens over time
Dysmenorrhea - Pain precedes and lasts through menses
Dyspareunia
Infertility
Pelvic pain
Abnormal bleeding
Endometriosis
The following is a typical physical examination for what condition?
Usually a normal pelvic exam
May have “tender nodularity in the cul de sac”
Adnexal mass
Endometriosis
Pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus
Uterine Prolapse
What are some risk factors for uterine prolapse?
Genetic predisposition
Connective tissue disorders
Prior pelvic surgery
Advanced age
Parity (vaginal births)
Menopause
Elevated intra-abdominal pressure
Uterine prolapse staging: Which stage is described below?
no prolapse
Stage 0
Uterine prolapse staging: Which stage is described below?
> 1cm above hymen
Stage 1
Uterine prolapse staging: Which stage is described below?
1cm or less above or below the hymen
Stage 2
Uterine prolapse staging: Which stage is described below?
> 1cm below the hymen
Stage 3
Uterine prolapse staging: Which stage is described below?
complete eversion
Stage 4
Most common gynecologic cancer in women in US
Endometrial Cancer
Arises from endometrial hyperplasia
Have to have hyperplasia before cancer
Endometrial Cancer
The majority of endometrial cancer types are which type?
adenocarcinomas
What percentage of endometrial cancers are estrogen dependent?
90%
What are the risk factors for endometrial cancer?
Age
Obesity
Nulliparity
Late menopause
Tamoxifen therapy
PCOS
Diabetes
Hypertension
Genetics (BRCA and Lynch syndrome)
Which type of endometrial cancer is described below?
90% of cases
Better prognosis
Estrogen dependent (90% of cases caused by unopposed estrogen)
Low grade atypia
Adenocarcinoma origin
Type I
Which type of endometrial cancer is described below?
Poor prognosis
Aggressive, more dangerous
Estrogen independent
10% cases
spontaneous
Common in thin, older, post-menopausal women
Arises in atrophic endometrium rather than a hyperplastic one
Less well-differentiated
Type II
Post menopausal bleeding is considered what until proven
otherwise?
cancer
What is the first test in suspected endometrial cancer?
Pelvic ultrasound – transvaginal
Gives information on size and shape of uterus, thickness, and contour of the endometrium
What endometrial thickness is considered abnormal?
> 5mm
What is the gold standard for diagnosing endometrial cancer?
endometrial biopsy
Which patients should have annual screening for endometrial cancer because they have a 10-fold increased lifetime risk?
Patients with HNPCC Syndrome
Hysterectomy is appropriate after completion of childbearing due to
a lifetime risk of endometrial cancer of what percentage?
60%
What is the number one prognostic factor in endometrial cancer?
Histological grade
What is the number two prognostic factor in endometrial cancer?
Depth of myometrial invasion
What are some modifiable risks in endometrial cancer?
Obesity
Diabetes
HTN
What type of therapy in endometrial cancer is contraindicated and why?
HRT post treatment of endometrial carcinoma is considered
contraindicated due to risk of activating occult metastatic disease
