Disorders of the Uterus Flashcards
Endometrial cells grow in other parts of the body causing pain, irregular bleeding, and infertility
endometriosis
When is postmenopausal endometriosis encountered?
in women who are on estrogen replacement therapy (ERT)
Possible etiology of endometriosis
retrograde menstruation
What are the three main symptoms of endometriosis?
dysmenorrhea, pelvic pain, dyspareunia
What are the top three most common areas of anatomic spread of endometriosis?
ovaries, anterior/posterior cul-de-sac, posterior broad ligaments
What is the classic lesion of endometriosis?
chocolate cyst of the ovary that contains old blood
When is tenderness best detected with endometriosis?
during menstruation
considered the primary diagnostic modality for endometriosis
pelvic laparoscopy
Can be used for 6 months to suppress ovulation and estrogen production. Hypoestrogenic effects are reversible upon dc’d of tx
GnRH agonists
Name the GnRH agonists
Leuprolide (Lupron)*, Nafarelin (Synarel), Goserelin (Zoladex)
What can you use to treat side effects of GnRH agonists?
Norethindrone acetate 5mg daily or Progestin only
benign smooth muscle tumors of the uterus
commonly called “fibroids.” most common indication for pelvic surgery
leiomyoma
Possible complications of leiomyomas during pregnancy
intrauterine growth restriction or spontaneous abortion
What symptoms would you expect for a patient who has fibroids inside the cavity of the uterus?
bleeding between periods and severe cramping
Fibroids in what location may be responsible for menorrhagia
submucosal
Located in the wall of the uterus. Can range in size from microscopic to larger than a grapefruit
intramural myomas
Partially in the uterine cavity. Can be removed by hysteroscopic resection
submucous myomas
Located on the outside wall of the uterus. Do not need treatment unless they grow large. Easiest to remove by laparoscopy
subserous myomas
Clinical findings of leiomyoma on pelvic exam
uterus is irregularly enlarged and somewhat asymmetrical. mass moves with uterus
Diagnostic test of choice for leiomyoma
Transvaginal ultrasound
Treatment for leiomyoma to try to shrink their size
Medroxyprogesterone or GnRH agonist
Surgical treatment for leiomyomas that are pedunculated, interfering w/fertility, causing pregnancy loss, or rapidly growing
myomectomy
the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge
adenomyosis
Treatment for adenomyosis
NSAIDs or a progesterone coated IUD
What is the difference between adenomyosis and fibroids on physical exam?
uterus is diffusely enlarged with adenomysis. won’t be able to feel asymmetry as with fibroids
indicated for severe, symptomatic adenomyosis with severe dysmenorrhea, menorrhagia, or uterus > 10 weeks size
hysterectomy
Pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus descends into the vaginal canal
uterine prolapse
Common causes of uterine prolapse
loss of estrogen due to aging and trauma of childbirth
bulges into the front part of the vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections
cystocele (prolapsed bladder)
resulting from weakness of connective tissue overlying the rectum may lead to difficulty having bowel movements
rectocele (prolapsed rectum)
Lifestyle changes for uterine prolapse
maintain healthy weight, Kegels, avoid heavy lifting
tx for uterine prolapse that fits inside the vagina and is designed to hold the uterus in place
vaginal pessary
Surgical tx for uterine prolapse that involves putting the uterus back into its normal position
uterine suspension
Removes the uterus and cervix (total) and the vagina (radical)
hysterectomy
What occurs due to Lack of the follicular development and formation of corpus luteum?
no progesterone and prolonged unopposed estrogen stimulation–> endometrial instability/erractic bleeding
What does recurrent anovulation increase the risk of?
endometrial cancer
What tests should you order to evaluate anovulatory bleeding?
B-Hcg, TSH, prolactin levels
Next step in evaluating anovulatory bleeding after H&P and lab tests if warranted
endometrial biopsy
Describe the bleeding assoicated with abnormal ovulatory uterine bleeding
Menorrhagia. Regular intervals but with excessive volume or lasting longer than 7 days
What tests should be ordered for ovulatory abnormal uterine bleeding?
B-Hcg, CBC, TSH
decrease prostaglandin levels and reduce menstrual bleeding by up to 46%
NSAIDs
antifibrinolytic that prevents activation of plasminogen. May be reserved for women with underlying bleeding disorders. Concern for thrombosis
Tranexamic acid (Lysteda)
Most common causes of postmenopausal bleeding
Endometrial atrophy and endometrial polyps
What is the primary goal in the diagnostic evaluation of postmenopausal women with uterine bleeding?
to exclude malignancy
