Disorders of the Uterus

Question 1

Endometrial cells grow in other parts of the body causing pain, irregular bleeding, and infertility

Answer 1

endometriosis

Question 2

When is postmenopausal endometriosis encountered?

Answer 2

in women who are on estrogen replacement therapy (ERT)

Question 3

Possible etiology of endometriosis

Answer 3

retrograde menstruation

Question 4

What are the three main symptoms of endometriosis?

Answer 4

dysmenorrhea, pelvic pain, dyspareunia

Question 5

What are the top three most common areas of anatomic spread of endometriosis?

Answer 5

ovaries, anterior/posterior cul-de-sac, posterior broad ligaments

Question 6

What is the classic lesion of endometriosis?

Answer 6

chocolate cyst of the ovary that contains old blood

Question 7

When is tenderness best detected with endometriosis?

Answer 7

during menstruation

Question 8

considered the primary diagnostic modality for endometriosis

Answer 8

pelvic laparoscopy

Question 9

Can be used for 6 months to suppress ovulation and estrogen production. Hypoestrogenic effects are reversible upon dc’d of tx

Answer 9

GnRH agonists

Question 10

Name the GnRH agonists

Answer 10

Leuprolide (Lupron)*, Nafarelin (Synarel), Goserelin (Zoladex)

Question 11

What can you use to treat side effects of GnRH agonists?

Answer 11

Norethindrone acetate 5mg daily or Progestin only

Question 12

benign smooth muscle tumors of the uterus

commonly called “fibroids.” most common indication for pelvic surgery

Answer 12

leiomyoma

Question 13

Possible complications of leiomyomas during pregnancy

Answer 13

intrauterine growth restriction or spontaneous abortion

Question 14

What symptoms would you expect for a patient who has fibroids inside the cavity of the uterus?

Answer 14

bleeding between periods and severe cramping

Question 15

Fibroids in what location may be responsible for menorrhagia

Answer 15

submucosal

Question 16

Located in the wall of the uterus. Can range in size from microscopic to larger than a grapefruit

Answer 16

intramural myomas

Question 17

Partially in the uterine cavity. Can be removed by hysteroscopic resection

Answer 17

submucous myomas

Question 18

Located on the outside wall of the uterus. Do not need treatment unless they grow large. Easiest to remove by laparoscopy

Answer 18

subserous myomas

Question 19

Clinical findings of leiomyoma on pelvic exam

Answer 19

uterus is irregularly enlarged and somewhat asymmetrical. mass moves with uterus

Question 20

Diagnostic test of choice for leiomyoma

Answer 20

Transvaginal ultrasound

Question 21

Treatment for leiomyoma to try to shrink their size

Answer 21

Medroxyprogesterone or GnRH agonist

Question 22

Surgical treatment for leiomyomas that are pedunculated, interfering w/fertility, causing pregnancy loss, or rapidly growing

Answer 22

myomectomy

Question 23

the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge

Answer 23

adenomyosis

Question 24

Treatment for adenomyosis

Answer 24

NSAIDs or a progesterone coated IUD

Question 25

What is the difference between adenomyosis and fibroids on physical exam?

Answer 25

uterus is diffusely enlarged with adenomysis. won't be able to feel asymmetry as with fibroids

Question 26

indicated for severe, symptomatic adenomyosis with severe dysmenorrhea, menorrhagia, or uterus > 10 weeks size

Answer 26

hysterectomy

Question 27

Pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus descends into the vaginal canal

Answer 27

uterine prolapse

Question 28

Common causes of uterine prolapse

Answer 28

loss of estrogen due to aging and trauma of childbirth

Question 29

bulges into the front part of the vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections

Answer 29

cystocele (prolapsed bladder)

Question 30

resulting from weakness of connective tissue overlying the rectum may lead to difficulty having bowel movements

Answer 30

rectocele (prolapsed rectum)

Question 31

Lifestyle changes for uterine prolapse

Answer 31

maintain healthy weight, Kegels, avoid heavy lifting

Question 32

tx for uterine prolapse that fits inside the vagina and is designed to hold the uterus in place

Answer 32

vaginal pessary

Question 33

Surgical tx for uterine prolapse that involves putting the uterus back into its normal position

Answer 33

uterine suspension

Question 34

Removes the uterus and cervix (total) and the vagina (radical)

Answer 34

hysterectomy

Question 35

What occurs due to Lack of the follicular development and formation of corpus luteum?

Answer 35

no progesterone and prolonged unopposed estrogen stimulation--> endometrial instability/erractic bleeding

Question 36

What does recurrent anovulation increase the risk of?

Answer 36

endometrial cancer

Question 37

What tests should you order to evaluate anovulatory bleeding?

Answer 37

B-Hcg, TSH, prolactin levels

Question 38

Next step in evaluating anovulatory bleeding after H&P and lab tests if warranted

Answer 38

endometrial biopsy

Question 39

Describe the bleeding assoicated with abnormal ovulatory uterine bleeding

Answer 39

Menorrhagia. Regular intervals but with excessive volume or lasting longer than 7 days

Question 40

What tests should be ordered for ovulatory abnormal uterine bleeding?

Answer 40

B-Hcg, CBC, TSH

Question 41

decrease prostaglandin levels and reduce menstrual bleeding by up to 46%

Answer 41

NSAIDs

Question 42

antifibrinolytic that prevents activation of plasminogen. May be reserved for women with underlying bleeding disorders. Concern for thrombosis

Answer 42

Tranexamic acid (Lysteda)

Question 43

Most common causes of postmenopausal bleeding

Answer 43

Endometrial atrophy and endometrial polyps

Question 44

What is the primary goal in the diagnostic evaluation of postmenopausal women with uterine bleeding?

Answer 44

to exclude malignancy