endometrial pathology Flashcards
causes PMB
vaginal atrophy // HRT // endometrial hyperpalsia // endometiral cancer // cervical, ovarian, vaginal cancer
most common cause PMB
vaginal atrophy
invx for all women over 55 + PMB
2 week USS for endometrial thickness
what endometrial thickness is worrying for cancer
5mm+
what are fibroids
benign smooth muscle tumours of uterus
who gets fibroids
black women, middle aged, in response to oestrogen
features fibroids
heavy periods (iron def) // lower abdo pain, painful periods, bloating // urinary if big // POLYCYTHAEMIA from EPO (rare)
invx fibroids
transvag USS
types of fibroid
submucosa (into uterine cavity) // subserosal (grow into abdomen on edge of uterus) // intramural (in myometrium)
mx asymptomatic fibroids
none needed - review
mx of menorrhagia from fibroids
levonestrogel IUS // mefenamic acid (NSAID) or tranexamic acid // COCP, POP, injection
medical mx fibroids
GnRH agonist to shrink (before surgery)
SE fibroid medical mx
menopausal symtpoms eg flushes, vaginal dryness // loss of bone mineral density
surgical mx fibroids
fibroid ablation // myomectomy (for childbearing) // hysterectomy // uterine artery embolism
complications fibroids
subfertility, iron def, red degeneration , torsion
when does fibroid degeneration tend to occur
in pregnancy (grows with oestroegen) –> baby outstrips their blood supply –> degeneration
symptoms fibroid degeneration
low fever, pain, vomiting
mx fibroid degeneration
bed rest and analgesia 4-7 days
what is endometriosis
growth of endometrial tissue outside uterus
symptoms endometriosis
pevic pain // secondary dysmennorhea (pain before period) // deep dyspareunia // subfertile // urinary symptoms // painful bowel
invx endometriosis
(USS not v useful) // laparoscopy = gold
1st line mx endometriosis
NSAIDs +/- paracetamol
2nd line mx endometriosis
COCP or progesterones
3rd line mx endometriosis
GnRh analogues (eg goserelin, danazol)
surgical mx endometriosis
lap excision or ablation + adhesiolysis (good for conception also)
only curative mx endometriosus
total hysterctomy
what is adenomyosis
endometrial tissue in myometrium
symptoms adenomyosis
dysmenorrhoea // menorrhagia // large, boggy uterus
invx adenomyosis
MRI
who usually gets adenomyosis
women with children in their 40s
mx adenomyosis
tranexamic acid // GnRH // uterine artery embolism // hysterectomy (definitive mx)
features endometrial hyperplasia
abnormal bleeding eg intermenstrual, post menopausal
mx simple endometrial hyperplasia w/o atypia
high dose progesterone (or IUS) –> repeat 3-4 months
mx endometrial hyperplasia + atypia
hysterectomy
types of endometrial hyperplasia
simple, complex, atypical
hormonal RF endometrial cancer
increased oestrogen - no kids, early menarche, late menopause,
meds RF endometrial cancer
unopposed oestrogen (eg HRT without progesterone) , tamoxifen
metabolic RF endometrial cancer
obesity // DM // PCOS
protective factors endometrial cancer
kids // COCP // smoking
symptoms endometrial cancer
PMB!!! // premenopausal = menorrhagia or intermentrual bleeding
invx for endometrial cancer
TVUS endometrial thickness (<4mm) // hysteroscopy with endometrial biopsy
mx endometrial cancer
TAH + BSO +/- post-op radio
complications hysterectomy
acute urianry retention // enterocele or vaginal vault prolapse
