Endometrial conditions

Question 1

Post menopausal bleeding- causes and investigations?

Answer 1

Defined as a bleed after 12 months of amenorrhea. Need to rule out malignancy.
Causes: vaginal atrophy, HRT, endometrial hyperplasia, cancer.
Women over 55 with PMB should be investigated under an USC pathway. Transvaginal USS to assess endometrial thickness- should be <5mm. Endometrial biopsy via hysteroscopy or pipelle biopsy.

Question 2

Endometrial cancer- risk factors, symptoms and management?

Answer 2

Risk factors: obesity, nulliparity, early menarche, late menopause, unopposed oestrogen use, diabetes, PCOS, HNPCC (lynch syndrome), tamoxifen use.
Symptoms: PMB, intermenstrual bleeding, pain, discharge.
Management: TAH + BSO +/- RT if high risk disease.
Progestogen therapy if surgery not suitable.

Question 3

Endometriosis

Answer 3

Ectopic growth of endometrial tissue.
Symptoms: chronic pelvic pain, dysmenorrhea, deep dyspareunia, subfertility, urinary and bowel symptoms, reduced organ mobility and nodularity in vaginal posterior fornix.

Question 4

Endometriosis- management?

Answer 4

NSAIDs and paracetamol. 
COCP or POP or IUS.
GnRH analogues to induce pseudo-menopause.
Laparoscopic excision.
Hysterectomy.

Question 5

Adenomyosis

Answer 5

Endometrial tissue growth within the myometrium.
Most common in multiparous women.
Symptoms: dysmenorrhea, menorrhagia, enlarged boggy uterus.
Management: GnRH agonists, hysterectomy.

Question 6

Fibroids

• symptoms
• tests
• management
• complications

Answer 6

Benign smooth muscle tumours.
Very common especially in black women.
Symptoms: none, pain, menorrhagia, bloating, subfertility. Rarely secondary polycythaemia due to autonomous erythropoietin production.
Tests: transvaginal USS.
Management: Surveillance, IUS insertion, NSAIDs, tranexamic acid.
Myomectomy to retain fertility, hysteroscopic ablation, hysterectomy.
Complications: subfertility, iron deficiency anaemia, red cell degeneration (haemorrhage into tumours, usually during pregnancy).