Endometrial Disorders Flashcards
What is the normal loss of blood during one menstrual cycle?
Less than 80ml
What is defined as a frequent menstral cycle?
<24 days
What is defined as a prolonged period?
> 8 days
What uterine and ovarian pathologies can cause heavy menstrual bleeding?
Uterine fibroids Endometrial polyps Endometriosis and adenomyosis Pelvic inflammatory disease and pelvic infection Endometrial hyperplasia or carcinoma Polycystic ovary syndrome
What systemic diseases and disorders can causes heavy menstral bleeding?
Coagulation disorders
Hypothyroidism
Liver or renal disease
What are uterine fibroids made of?
Non-cancerous growths made of muscle and fibroid tissue, also called Myoma or lieomyoma
What are the symptoms of uterine fibroids?
May be asymptomatic. Heavy menstrual bleeding, pelvic pain, urinary symptoms, pressure, backache, infertility, miscarriage.
What investigation is used to locate uterine fibroids?
Ultrasound
What is a myomectomy?
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
When is a hysterectomy used instead of a myomectomy in the management of uterine fibroids?
Declined or failed medical treatment and fertility preservation not required
What is the pathophysiology of endometriosis?
Endometrial tissue present outside the lining of the uterus. During menstration, the ectopic tissue behaves the same as endometrium and bleeds
What are the possible sites for endometriosis?
Ovaries Fallopian tubes Ligament that support the uterus Posterior fornix Anterior fornix Outer surface of uterus Bladder
What are the common symptoms of endometriosis?
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
How is endometriosis investigated?
Pelvic examination, US scan, diagnostic laparoscopy.
Describe stage one of endometriosis.
Stage 1: minimal
Surface lesions or inflammation on or around organs in the pelvic cavity
Describe stage 2 endometriosis.
Stage 2: MILD
More widespread and starting to infiltrate pelvic organs
Describe stage 3 endometriosis.
Stage 3: moderate
Peritoneum (pelvic side walls) or other structure. Sometimes also scarring and adhesions.
Describe stage 4 endometriosis.
Stage 4: severe
Infiltrative and affecting many pelvic organs and ovaries, often with distortion of the anatomy and adhesions
What is a hysterectomy?
Surgical removal of the uterus
Total hysterectomy: cervix and uterus removed
Subtotal hysterectomy: uterus removed: cervix left
What is a salpingo-oophrectomy?
Removal of Fallopian tubes plus ovaries
What happens after a salpingo-oophrectomy?
Immediate menopause
What are the non-hormonal medical treatments of heavy menstral bleeding?
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.
What are the hormonal treatments for heavy menstrual bleeding?
Combined contraceptive pill (COPC)
LNG IUS and depo-provera: reduces bleeding:may cause irregular bleeding, somehow men will be ammenorhoeic.
Oral progesterone
What is endometrial ablation?
Permanent destruction of endometrium using different energy sources
First generation ablation: under hysteroscopic vision: uses diathermy
Second generation ablation: thermal balloon, radio frequency
What are the pre-requisites for endometrial ablation?
- uterine cavity length <11cm
- sub mucous fibroids< 3cm
- previous moral endometrial biopsy
What is adenomyosis?
A condition where endometrium becomes embedded in myometrium
What are the symptoms of adenomyosis?
Heavy menstrual bleed. May have significant dysmenorrhea
What are endometrial polyps?
Overgrowth of endometrial lining can lead to formation of pediculated strucutres called polyps which extend into endometrium. Mostly benign
What are the causes of oligo/amenorrhoea?
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
