Pathology of the uterus

Question 1

What are the ovarian and uterine cycles?

Answer 1

The ovarian and uterine cycles are two cycles that occur in the female reproductive system.

Question 2

Location and phases of ovarian cycle?

Answer 2

The ovarian cycle occurs in the follicle of the ovary and consists of the follicular phase, ovulation, and luteal phase.

Question 3

Location and phases of uterine cycle?

Answer 3

The uterine cycle occurs in the lining of the endometrium of the uterus and consists of the menstrual, proliferative and secretory phases

Question 4

Proliferative phase of uterine cycle?

Answer 4

During the proliferative phase, the endometrium is exposed to increasing levels of oestrogen as a result of FSH and LH stimulating its production.

Oestrogen stimulates repair and growth of the functional endometrial layer allowing recovery from the recent menstruation

Question 5

Secretory phase of uterine cycle?

Answer 5

The secretory phase begins once ovulation has occurred.

This phase is driven by progesterone produced by the corpus luteum and results in the secretion of various substances by the endometrial glands, making the uterus a more welcoming environment for an embryo to implant.

Question 6

Menstrual phase of uterine cycle?

Answer 6

At the end of the luteal phase, the corpus luteum degenerates (if no implantation occurs).

The loss of the corpus luteum results in DECREASED progesterone production.

The decreasing levels of progesterone cause the spiral arteries in the functional endometrium to contract.

The loss of blood supply causes the functional endometrium to become ischaemic and necrotic.

As a result, the functional endometrium is shed and exits through the vagina as menstruation.

Question 7

What is the corpus luteum?

Answer 7

A hormone-secreting structure that develops in an ovary after an ovum has been discharged but degenerates after a few days unless pregnancy has begun.

Question 8

What is the Grafiaan follicle?

Answer 8

An ovarian follicle (also known as a Graafian follicle in its mature state) is the basic unit of female reproductive biology and is composed of roughly spherical aggregations of cells and contains a single oocyte.

Question 9

What is the basic unit of female reproductive biology?

Answer 9

Ovarian follicle (Grafiaan follicle in its mature state)

Question 10

What is an oocyte?

Answer 10

A female germ cell in the process of development.

The oocyte is produced in the ovary by an ancestral cell called an oogonium and gives rise to the ovum (the egg), which can be fertilized.

Question 11

What are granulosa cells?

Answer 11

also known as follicular cells, are somatic cells of the sex cord that are closely associated with the developing female gamete (called an oocyte or egg).

Question 12

What are some indications for endometrial sampling?

Answer 12

Abnormal uterine bleeding

Investigation for infertility

Spontaneous and therapeutic abortion

Assessment of response to hormonal therapy

Endometrial ablation

Work up prior to hysterectomy for benign indications

Incidental finding of thickened endometrium on scan

Endometrial cancer screening in high risk patients

Question 13

Menorrhagia meaning?

Answer 13

prolonged and increased menstrual flow

Question 14

Metrorrhagia meaning?

Answer 14

regular intermenstrual bleeding

Question 15

Polymenorrhoea and polymenorrhagia are the same. true/false?

Answer 15

False

Polymenorrhea refers to frequent menstrual bleeding.
Polymenorrhea is a type of menorrhagia

polymenorrhagia refers to a combination of frequent menstrual bleeding and heavy menstrual bleeding

Question 16

What is Amenorrhea?

Answer 16

absence of menstruation > 6 months

Question 17

What is abnormal uterine bleeding (AUB)?

Answer 17

Abnormal uterine bleeding (AUB), also known as (AVB) or as atypical vaginal bleeding, is vaginal bleeding from the uterus that is abnormally frequent, lasts excessively long, is heavier than normal, or is irregular.

Question 18

What is dysfunctional uterine bleeding (DUB)?

Answer 18

AUB with no organic cause

Question 19

What is post-menopausal bleeding?

Answer 19

AUB > 1 year after cessation of menstruation

Question 20

Causes of AUB in adolescence/early reproductive life?

Answer 20

DUB usually due to anovulatory cycles

Pregnancy/miscarriage

Endometritis (inflammation of endometrium)

Bleeding disorders

Question 21

Causes of AUB in reproductive life/perimenopause (phase of life before menopause)?

Answer 21

Pregnancy/miscarriage

DUB: anovulatory cycles, luteal phase defects,

Endometritis

Endometrial/endocervical polyp

Leiomyoma (A benign smooth muscle tumour, usually in the uterus or gastrointestinal tract. Also called fibroid)

Adenomyosis (growth of cells that proliferate on the inside of the uterus atypically located among the cells of the uterine wall, as a result, thickening of the uterus occurs)

Exogenous hormone effects

Bleeding disorders

Hyperplasia

Neoplasia: cervical, endometrial

Question 22

Causes of AUB in post-menopause?

Answer 22

Atrophy

Endometrial polyp

Exogenous hormones: HRT, tamoxifen

Endometritis

Bleeding disorders

Hyperplasia

Endometrial carcinoma

Sarcoma

Question 23

What is TVUS?

Answer 23

Transvaginal ultrasound

Used to assess endometrium

a procedure where an ultrasound probe is inserted about two or three inches into the vagina to thoroughly examine the female reproductive organs, including the uterus, fallopian tubes, ovaries, cervix, and the pelvic area

Question 24

What is the endometrium?

Answer 24

the mucous membrane lining the uterus, which thickens during the menstrual cycle in preparation for possible implantation of an embryo.

Question 25

Indication for biopsy after TVUS?

Answer 25

Endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy

Question 26

Required history for uterine history taking?

Answer 26

Age
Date of LMP (last menstrual period) and length of cycle
Pattern of bleeding
Hormones
Recent pregnancy

Question 27

What are anovulatory cycles?

Answer 27

An anovulatory cycle is a menstrual cycle in which the release of an egg from the ovaries does not occur. This means that a woman cannot get pregnant during this time

Anovulatory cycles can vary in length, but are normally between 21 to 35 days. Anovulation can be a common cause of infertility if it persists for a year or longer.

Question 28

What is the myometrium?

Answer 28

Smooth muscle layer located between endometrium (inner layer of uterine wall) and perimetrium (outer layer of uterine wall).

Question 29

Endometrial causes of AUB?

Answer 29

Endometritis
Polyp
Miscarriage

Question 30

Myometrial causes of AUB?

Answer 30

Adenomyosis
Leiomyoma

Question 31

What protects the endometrium from ascending infection?

Answer 31

Cervical mucous plug

Question 32

How is endometritis diagnosed histologically?

Answer 32

recognising an abnormal pattern of inflammatory cells

Question 33

Micro-organism causes of endometritis?

Answer 33

Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV

Question 34

Growth of Leiomyoma is oestrogen dependent. true/false?

Answer 34

True

Question 35

Endometrial polyps are usually asymptomatic but may present with bleeding or discharge. true/false?

Answer 35

True

Question 36

Endometrial polyps often occur before menopause
Almost always malignant. true/false?

Answer 36

False

Endometrial polyps usually occur around or after menopause and are almost always benign.

Question 37

What is a molar pregnancy?

Answer 37

Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus (or tube)