Pathology of Uterine Bleeding

Question 1

In the menstrual phase of the menstrual cycle, what happens to the endometrium? Is this influenced by homones? If so, what ones?

Answer 1

Necrosis - no, not under the influence of hormones

Question 2

In the proliferative phase of the menstrual cycle, what happens to the endometrium? Is this influenced by homones? If so, what ones?

Answer 2

Growth - influenced by oestrogen

Question 3

In the secretory phase of the menstrual cycle, what happens to the endometrium? Is this influenced by homones? If so, what ones?

Answer 3

Secretion - influenced by progesterone

Question 4

If an egg is fertilised during the menstrual cycle, what happens to the endometrium? What hormones cause this effect?

Answer 4

It becomes hypersecretory and decidualises - influenced by progesterone and HCG

Question 5

What happens to the endometrium in a post-menopausal woman?

Answer 5

It is inactive and becomes atrophic

Question 6

The action of which hormone builds up the endometrium and causes the glands and stroma to proliferate?

Answer 6

Oestrogen

Question 7

What are the 4 main methods of assessing the endometrium?

Answer 7

Transvaginal ultrasound, hysteroscopy, endometrial pipelle and dilatation and curettage

Question 8

TVUS is a good investigation to assess what?

Answer 8

The thickness of the endometrium

Question 9

An endometrial thickness of what would be an indication for endometrial biopsy in a) postmenopausal women and b) premenopausal women?

Answer 9

a) > 3/4mm b) > 16mm

Question 10

What are the advantages of using an endometrial pipelle for endometrial sampling?

Answer 10

No dilatation or anaesthetic is needed, outpatient procedure, very safe

Question 11

What is the disadvantage of using an endometrial pipelle for endometrial sampling?

Answer 11

It only takes a very small sample from the surface of the uterus so this isn’t too reliable

Question 12

What is the most common and thorough way of getting an endometrial biopsy?

Answer 12

Dilatation and curettage

Question 13

What is the definition of post-menopausal bleeding?

Answer 13

Abnormal uterine bleeding > 1 year after cessation of menstruation

Question 14

What are some examples of causes of abnormal uterine bleeding in adolescence?

Answer 14

Anovulatory cycles, pregnancy/miscarriage, endometriosis, bleeding disorders

Question 15

Abnormal uterine bleeding in a post-menopausal women is more worrying as it can be a sign of what?

Answer 15

Endometrial hyperplasia or carcinoma

Question 16

When are anovulatory cycles common causes of AUB?

Answer 16

At extremes of reproductive life

Question 17

What is the pathology behind anovulatory cycles?

Answer 17

The corpus luteum does not form so there is continued growth of the functional layer of endometrium which leads to disordered proliferation

Question 18

Anovulatory cycles can be caused by what?

Answer 18

Luteal phase deficiency

Question 19

What happens in luteal phase deficiency?

Answer 19

There is insufficient progesterone or a poor response by the endometrium to progesterone which causes abnormal follicular development, leading to a poor corpus luteum

Question 20

How is endometritis recognised histologically?

Answer 20

An abnormal pattern of inflammatory cells

Question 21

What are two factors which make the endometrium relatively resistant to infection?

Answer 21

Cervical mucus plugs it from ascending infection, and cyclical shedding also makes it resistant

Question 22

What are some organisms which may cause endometritis?

Answer 22

Neisseria, chlamydia, TB, CMV

Question 23

What are some non-infective causes of endometritis?

Answer 23

IUCDs, postpartum, chronic, granulomatous

Question 24

Endometritis is infective until proven otherwise, and can be associated with what?

Answer 24

PID

Question 25

How can endometrial polyps present?

Answer 25

They are usually asymptomatic but can present with bleeding or discharge

Question 26

When do endometrial polyps usually occur?

Answer 26

Around and after the menopause

Question 27

Are endometrial polyps always benign?

Answer 27

Almost always, but sometimes an endometrial carcinoma can present as a polyp

Question 28

What are some causes of abnormal uterine bleeding that affect the myometrium?

Answer 28

Adenomyosis and leiomyoma

Question 29

What is adenomyosis?

Answer 29

Endometrial glands and stroma within the myometrium

Question 30

How may adenomyosis present?

Answer 30

Menorrhagia and dysmenorrhoea

Question 31

What is a leiomyoma?

Answer 31

Benign tumour of smooth muscle

Question 32

What are some symptoms of a myometrial leiomyoma?

Answer 32

Menorrhagia, infertility, mass effect, pain

Question 33

Growth of a myometrial leiomyoma is dependent on what?

Answer 33

Oestrogen