endometrial disorders Flashcards
endometrial hyperplasia
endometrial gland proliferation (precursor to endometrial carcinoma)
*due to unopposed estrogen w/o progesterone
common cuases of endom. hyperplasia
chronic anovulation, PCOS, perimenopause, obesity (conversion of androgen to estrogen in adipose tissue)
how soon after does hyperplasia occur with estrogen only treatment?
3 yrs
what time of life do most women get hyperplasia?
after menopause
s/sx of hyperplasia?
bleeding–> menorrhagia, metorrhagia, postmenopausal bleeding
+/- vag d/c
dx of hyperplasia
transvaginal US : endometrial stripe > 4mm *screening
what is the definitive dx for hyperplasia?
endometrial bx
indications for an endometrial bx?
> 35 yrs, ↑endometrial stripe seen on TVUS, patients on unopposed estrogen tx, Tamoxifen, AGS on Pap smear or persistent bleeding w/endometrial stripe >4mm
tx of endometrial hyperplasia w/o atypia
Progestin (PO or IUD Mirena) → Stops estrogen from being unopposed, limiting endometrial growth
Repeat endometrial bx in 3-6 mos
tx of endometrial hyperplasia w/ atypia
hysterectomy, but can just use progesterone
endometiral cancer
mos common gyn malignancy in US
*MC in postmenopausal
RF for endo CA
↑Estrogen Exposure, nulliparity, chronic anovulation, PCOS, obesity, estrogen replacement therapy, late menopause, Tamoxifen (estrogen stimulates endometrial growth), HTN, diabetes
OCPs and ovarian /endometrial cancers
protective againse
s/sx of endo ca
abnormal uterine bleeding, postmenopausal bleed
menorrhagia or metrorrhagia
what is metrorrhagia?
bleeding that occurs btw periods
dx of edno CA
biopsy
US: endometrial strip > 4mm –> may r/o other causes of bleeding
what ist the MC endo CA?
adenocarcinoma, then sarcoma
how is stage I endo CA tx?
hysterectomy, post-op radiation
*one of the most curable of gyn cancers
stage 2/3 tx
TAH-BSO + lymph node escision
Stage IV
systmeic chemo
endometriosis
Presence of endometrial tissue (stroma & gland) outside the endometrial (uterine) cavity
The ectopic endometrial tissue responds to cyclical hormone changes
where is the most common site for endometriosis?
ovaries! but can alos be seen in the posterior cul de sac, broad anmd uteroal sacral ligments, rectosigmoid colon, bladder
RF for endometriosis
Nulliparity, family history, early menarche
Onset usually < 35 yrs
what is the classic triad of s/sx of endometritis?
Cyclic Premenstrual Pelvic Pain + low back pain
Dysmenorrhea → Painful menstruation
Dyspareunia → Painful intercourse
what other sx may be seen w/ endometritis
dyschezia
+/- post metstrau spotting
asx
what can endometritis be a main cause of?
infertility
dx of endometriosis?
Physical exam usually normal + fixed tender adnexal masses
Laparoscopy with Bx → Definitive Dx → Used to visualize structures for presence of tissue
what may you see on laparoscopy w/ bx of endometriosis?
Raised patches of thickened, discolored, scarred or ‘powder burn’ appearing implants of tissue
what is an endometrioma
Endometriosis involving the ovaries, large enough to be considered a tumor, usually filled with old blood appearing chocolate-colored (CHOCOLATE CYST)
medical managment of endometriosis
Ovulation Suppression
Premenstrual Pain → Combined OCPs + NSAIDs
Progesterone → Suppresses GnRH → Causes endometrial tissue atrophy, suppresses ovulation
Leuprolide → GnRH analog causes pituitary FSH/LH suppression
Danazol → Testosterone → Induced pseudomenopause → Suppresses FSH & LH & mid-cycle surge
surgical management of endometriosis
Conservative Laparoscopy with Ablation → Used if fertility desired → Preserves uterus & ovaries
Total Abdominal Hysterectomy with Salpingo-oophorectomy (TAH-BSO) → If no desire to conceive
