Lesson 5 (Part 3) Flashcards
What are normal postmenopausal endometrium measurements with bleeding from a symptomatic patient?
5mm or less
- even with bleeding
What is normal postmenopausal endometrium bleeding caused by?
An atrophic endometrium
What are PMB postmenopausal endometrium measurements with bleeding from a symptomatic patient?
> 5mm is considered abnormal
What does bleeding indicate?
That the patient is symptomatic
What does it mean if you are over 5mm in a normal symptomatic bleeding patient?
You go for a biopsy
What are normal postmenopausal endometrium measurements from an asymptomatic patient?
8mm or less is considered normal
- no bleeding
What is the abnormal postmenopausal endometrium measurements from an asymptomatic patient?
9-11mm
When does an asymptomatic patient get a biopsy?
If 11mm or greater
What are the causes of metrorrhagia? (6)
- Hormone imbalance
- Abnormal growths
- Pregnancy complications
- Infection
- Systemic diseases
- Endometrial polyps
What are some causes for abnormal bleeding that are not specifically caused by the myometrium or endometrium? (6)
- Bleeding from the vulva/vagina
- laceration, infection or cancer - Cervix
- polyps, fibroids or cancer - Fallopian tubes
- salpingitis, tumours or tubal pregnant and ovarian pathology - Estrogen producing tumours
- Cancer
- Functional ovarian cysts
What are the effects of hormones on the postmenopausal endometrium and the endometrium appearances?
Leads to a thin atrophic appearing endometrium
Endometrial adhesions
Post traumatic, post infection post surgical in nature and may even cause infertility or re-occurrent pregnancy lost
they may bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the uterus
Asherman’s syndrome
Is an acquired condition that refers to the existence of scar tissue in the uterus
- formation of intrauterine adhesions
- posttraumatic or postsurgical
What are the symptoms of ashermans syndrome? (2)
- Light or no periods
2. Trouble getting pregnant
Is ultrasound good at seeing synechiae?
Not the best at seeing it
- synechiae is a fact word for adhesion = bands of tissue sticking together
What is attributed with postmenopausal women on HRT?
Increased thickness
What is unopposed estrogen linked to? (2)
- Increase risk of endometrial cancer
2. Hyperplasia
Tamoxifen
Is a nonsteroidal, antiestrogen compound that is used in therapy for premenopausal and postmenopausal women with Breast Cancer
What happens to premenopausal women?
They have a decrease in estrogen
What happens to postmenopausal women?
Their estrogen can increase therefore increase their risk of endometrial cancer
What is the sonographic appearance of tamoxifen? (5)
- Cystic changes
- Polyps
- Correlation between the endometrial thickness and 5 year duration of Tamoxifen treatment
- Cystic changes can be subendometrial
- adenomyosis-like changes - Can appear the same as hyperplasia
What is not effective in early detection of endometrial cancer?
Routine US screening on an asymptomatic patient on Tamoxifen
What is another term for endometrial adhesions?
Ashermans syndrome
What can Endometrial adhesions cause?
Infertility or recurrent pregnancy loss
Septate appearance
Wedge of fibrous tissue dividing uterine cavity
Ashermans syndrome appearance
Adhesions (band like formations) crossing the lining of the uterus
Bicornate uterus
Incomplete uniting of the uterus
What is the etiology of ashermans syndrome? (2)
- Occurs in women who have had several dilatation and curettage procedures
- A severe pelvic infection unrelated to surgery
What affect does ashermans syndrome have on a patient? (5)
- Infertility
- Painful periods
- Miscarriages
- Absence of period
- Pelvic pain
What are S/S of ashermans syndrome? (5)
- Amenorrhea
- Repeated miscarriages
- Infertility
- Menstrual irregularities
- very light periods or absence of periods - Cyclic pelvic pain
- scar tissue blocks the outflow of the menstrual blood, causing uterine cramping and pelvic discomfort or pain
When are S/S for ashermans syndrome more likely to occur?
If they occur suddenly after a D&C or other uterine surgery
