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Endometrial Disorders Flashcards

1
Q

What is the normal loss of blood during one menstrual cycle?

A

Less than 80ml

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2
Q

What is defined as a frequent menstral cycle?

A

<24 days

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3
Q

What is defined as a prolonged period?

A

> 8 days

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4
Q

What uterine and ovarian pathologies can cause heavy menstrual bleeding?

A 
Uterine fibroids
Endometrial polyps
Endometriosis and adenomyosis 
Pelvic inflammatory disease and pelvic infection 
Endometrial hyperplasia or carcinoma 
Polycystic ovary syndrome
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5
Q

What systemic diseases and disorders can causes heavy menstral bleeding?

A

Coagulation disorders
Hypothyroidism
Liver or renal disease

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6
Q

What are uterine fibroids made of?

A

Non-cancerous growths made of muscle and fibroid tissue, also called Myoma or lieomyoma

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7
Q

What are the symptoms of uterine fibroids?

A

May be asymptomatic. Heavy menstrual bleeding, pelvic pain, urinary symptoms, pressure, backache, infertility, miscarriage.

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8
Q

What investigation is used to locate uterine fibroids?

A

Ultrasound

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9
Q

What is a myomectomy?

A

The surgery to remove the fibroids from the wall of the womb. Alternative to a hysterectomy. Not suitable for all types of fibroid. Involves making an incision through the skin on the lower abdomen and removing the fibroids from the wall of the uterus

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10
Q

When is a hysterectomy used instead of a myomectomy in the management of uterine fibroids?

A

Declined or failed medical treatment and fertility preservation not required

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11
Q

What is the pathophysiology of endometriosis?

A

Endometrial tissue present outside the lining of the uterus. During menstration, the ectopic tissue behaves the same as endometrium and bleeds

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12
Q

What are the possible sites for endometriosis?

A 
Ovaries
Fallopian tubes
Ligament that support the uterus
Posterior fornix
Anterior fornix
Outer surface of uterus 
Bladder
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13
Q

What are the common symptoms of endometriosis?

A 
Heavy menstral bleeding,
 pelvic pain,
 painful menstral cramps,
 lower back pain,
 pain during and after intercourse,
 Painful bowel movements or urination
Diarrhoea, nausea and bloating 
Fatigue
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14
Q

How is endometriosis investigated?

A

Pelvic examination, US scan, diagnostic laparoscopy.

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15
Q

Describe stage one of endometriosis.

A

Stage 1: minimal

Surface lesions or inflammation on or around organs in the pelvic cavity

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16
Q

Describe stage 2 endometriosis.

A

Stage 2: MILD

More widespread and starting to infiltrate pelvic organs

17
Q

Describe stage 3 endometriosis.

A

Stage 3: moderate

Peritoneum (pelvic side walls) or other structure. Sometimes also scarring and adhesions.

18
Q

Describe stage 4 endometriosis.

A

Stage 4: severe

Infiltrative and affecting many pelvic organs and ovaries, often with distortion of the anatomy and adhesions

19
Q

What is a hysterectomy?

A

Surgical removal of the uterus
Total hysterectomy: cervix and uterus removed
Subtotal hysterectomy: uterus removed: cervix left

20
Q

What is a salpingo-oophrectomy?

A

Removal of Fallopian tubes plus ovaries

21
Q

What happens after a salpingo-oophrectomy?

A

Immediate menopause

22
Q

What are the non-hormonal medical treatments of heavy menstral bleeding?

A 
Tranexamic acid: reduces blood loss 60%. Taken at time of period
Mefenamic acid (prostaglandin inhibitor) reduces blood loss and pain. GnRh analogues. Endometrial ablation. Fibroid embolisation. Hysterectomy.
23
Q

What are the hormonal treatments for heavy menstrual bleeding?

A

Combined contraceptive pill (COPC)

LNG IUS and depo-provera: reduces bleeding:may cause irregular bleeding, somehow men will be ammenorhoeic.

Oral progesterone

24
Q

What is endometrial ablation?

A

Permanent destruction of endometrium using different energy sources

First generation ablation: under hysteroscopic vision: uses diathermy

Second generation ablation: thermal balloon, radio frequency

25
Q

What are the pre-requisites for endometrial ablation?

A
  • uterine cavity length <11cm
  • sub mucous fibroids< 3cm
  • previous moral endometrial biopsy
26
Q

What is adenomyosis?

A

A condition where endometrium becomes embedded in myometrium

27
Q

What are the symptoms of adenomyosis?

A

Heavy menstrual bleed. May have significant dysmenorrhea

28
Q

What are endometrial polyps?

A

Overgrowth of endometrial lining can lead to formation of pediculated strucutres called polyps which extend into endometrium. Mostly benign

29
Q

What are the causes of oligo/amenorrhoea?

A 
Life changes:stress, eating disorders/malnourishment, obesity, Intense exercise 
Hormones: POP, mirena, depot injection
Primary ovarian insufficiency 
Polycystic ovarian syndrome 
Hyper prolactinoma 
Prolactinomas
Thyroid disorders
Obstructions of the uterus, cervix, and or vagina

Reproduction (13 decks)

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