Gynae - Endometrial Flashcards
what is adenomyosis?
endometrial tissue in the myometrium (muscle)
who is more common to get adenomyosis?
later life
multiple pregnancies
features of adenomyosis?
dysmenorrhoea menorrhagia dysparaeunia inferility enlarged tender uterus
Ix for adenomyosis?
TVUS
Tx for adenomyosis?
tranxemic acid
mefanamic acid
COCP/mirena coil
what happens in endometriosis?
endometrial tissue located at sites other than the uterine cavity
common sites of endometriosis?
pouch of douglas
peritoneum
bladder
umbilicus
features of endometriosis?
menorrhagia dysmenorrhoea dyspareunia chronic pain cyclic pain suberfertility pelvic mass bloating distension
Ix for endometriosis?
PV (fixed retroverted uterus)
swabs
TVUS
laparoscopy
Tx for endometriosis?
NSAIDs COCP GnRH agonists (goserulin) surgery - ablation/hysterectomy fertility Tx
what are fibroids?
benign tumours of the smooth muscle of the uterus (uterine leiomyomas)
what types of fibroids exist?
submucosal (endometrial)
subserosal (outer layer)
intramural (in myometrium)
pedunculated
features of fibroids?
menorrhagia abdo pain worse during period bloating urinary/bowel symptoms deep dysparunia infertility
Ix for fibroids?
abdo exam
PV (firm non tender uterus)
hysteroscopy
pelvic US
Tx for fibroids?
mirena/COCP (<3cm no distortion)
GnRH
to reduce size before surgery
myomectomy
hysterectomy
uterine artery embolisation
who can get fibroids with red degeneration? features?
pregnancy
abdo pain
low grade fever
risk factors for endometrial cancer?
50-60yrs obese HNPCC oestrogens PCOS nullparity
features of endometrial cancer?
post menopausal bleed
irregular bleed
pelvic pain
irregular discharge
what is the most common type of endometrial cancer? how does it occur?
endometrial adenocarcinoma
hyperplasia due to unopposed oestrogens
Ix for endometrial cancer?
TVUS + biopsy
D+C
hysteroscopy
CT/MRI
what are the normal endometrial mm size?
> 4 in postmenopausal
5 in HRT
16 in premenopausal
Tx for endometrial cancer?
hyserectomy + bilateral salphingoopherectomy
+ radio
+ chemo
Tx for endometrial hyperplasia?
mirena/progestogens
hysterectomy
what is HNPCC?
lynch syndrome
colorectal + ovarian (endometriod/clear cell) + endometrial (adenocarcinoma)
