Pathology of the uterus Flashcards
What are the ovarian and uterine cycles?
The ovarian and uterine cycles are two cycles that occur in the female reproductive system.
Location and phases of ovarian cycle?
The ovarian cycle occurs in the follicle of the ovary and consists of the follicular phase, ovulation, and luteal phase.
Location and phases of uterine cycle?
The uterine cycle occurs in the lining of the endometrium of the uterus and consists of the menstrual, proliferative and secretory phases
Proliferative phase of uterine cycle?
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
Secretory phase of uterine cycle?
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.
Menstrual phase of uterine cycle?
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.
What is the corpus luteum?
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.
What is the Grafiaan follicle?
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.
What is the basic unit of female reproductive biology?
Ovarian follicle (Grafiaan follicle in its mature state)
What is an oocyte?
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.
What are granulosa cells?
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).
What are some indications for endometrial sampling?
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
Menorrhagia meaning?
prolonged and increased menstrual flow
Metrorrhagia meaning?
regular intermenstrual bleeding
Polymenorrhoea and polymenorrhagia are the same. true/false?
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
What is Amenorrhea?
absence of menstruation > 6 months
What is abnormal uterine bleeding (AUB)?
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.
What is dysfunctional uterine bleeding (DUB)?
AUB with no organic cause
What is post-menopausal bleeding?
AUB > 1 year after cessation of menstruation
Causes of AUB in adolescence/early reproductive life?
DUB usually due to anovulatory cycles
Pregnancy/miscarriage
Endometritis (inflammation of endometrium)
Bleeding disorders
Causes of AUB in reproductive life/perimenopause (phase of life before menopause)?
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
Causes of AUB in post-menopause?
Atrophy
Endometrial polyp
Exogenous hormones: HRT, tamoxifen
Endometritis
Bleeding disorders
Hyperplasia
Endometrial carcinoma
Sarcoma
What is TVUS?
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
What is the endometrium?
the mucous membrane lining the uterus, which thickens during the menstrual cycle in preparation for possible implantation of an embryo.
Indication for biopsy after TVUS?
Endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy
Required history for uterine history taking?
Age
Date of LMP (last menstrual period) and length of cycle
Pattern of bleeding
Hormones
Recent pregnancy
What are anovulatory cycles?
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.
What is the myometrium?
Smooth muscle layer located between endometrium (inner layer of uterine wall) and perimetrium (outer layer of uterine wall).
Endometrial causes of AUB?
Endometritis
Polyp
Miscarriage
Myometrial causes of AUB?
Adenomyosis
Leiomyoma
What protects the endometrium from ascending infection?
Cervical mucous plug
How is endometritis diagnosed histologically?
recognising an abnormal pattern of inflammatory cells
Micro-organism causes of endometritis?
Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV
Growth of Leiomyoma is oestrogen dependent. true/false?
True
Endometrial polyps are usually asymptomatic but may present with bleeding or discharge. true/false?
True
Endometrial polyps often occur before menopause
Almost always malignant. true/false?
False
Endometrial polyps usually occur around or after menopause and are almost always benign.
What is a molar pregnancy?
Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus (or tube)
