Pathology of Uterine Bleeding Flashcards
In the menstrual phase of the menstrual cycle, what happens to the endometrium? Is this influenced by homones? If so, what ones?
Necrosis - no, not under the influence of hormones
In the proliferative phase of the menstrual cycle, what happens to the endometrium? Is this influenced by homones? If so, what ones?
Growth - influenced by oestrogen
In the secretory phase of the menstrual cycle, what happens to the endometrium? Is this influenced by homones? If so, what ones?
Secretion - influenced by progesterone
If an egg is fertilised during the menstrual cycle, what happens to the endometrium? What hormones cause this effect?
It becomes hypersecretory and decidualises - influenced by progesterone and HCG
What happens to the endometrium in a post-menopausal woman?
It is inactive and becomes atrophic
The action of which hormone builds up the endometrium and causes the glands and stroma to proliferate?
Oestrogen
What are the 4 main methods of assessing the endometrium?
Transvaginal ultrasound, hysteroscopy, endometrial pipelle and dilatation and curettage
TVUS is a good investigation to assess what?
The thickness of the endometrium
An endometrial thickness of what would be an indication for endometrial biopsy in a) postmenopausal women and b) premenopausal women?
a) > 3/4mm b) > 16mm
What are the advantages of using an endometrial pipelle for endometrial sampling?
No dilatation or anaesthetic is needed, outpatient procedure, very safe
What is the disadvantage of using an endometrial pipelle for endometrial sampling?
It only takes a very small sample from the surface of the uterus so this isn’t too reliable
What is the most common and thorough way of getting an endometrial biopsy?
Dilatation and curettage
What is the definition of post-menopausal bleeding?
Abnormal uterine bleeding > 1 year after cessation of menstruation
What are some examples of causes of abnormal uterine bleeding in adolescence?
Anovulatory cycles, pregnancy/miscarriage, endometriosis, bleeding disorders
Abnormal uterine bleeding in a post-menopausal women is more worrying as it can be a sign of what?
Endometrial hyperplasia or carcinoma
When are anovulatory cycles common causes of AUB?
At extremes of reproductive life
What is the pathology behind anovulatory cycles?
The corpus luteum does not form so there is continued growth of the functional layer of endometrium which leads to disordered proliferation
Anovulatory cycles can be caused by what?
Luteal phase deficiency
What happens in luteal phase deficiency?
There is insufficient progesterone or a poor response by the endometrium to progesterone which causes abnormal follicular development, leading to a poor corpus luteum
How is endometritis recognised histologically?
An abnormal pattern of inflammatory cells
What are two factors which make the endometrium relatively resistant to infection?
Cervical mucus plugs it from ascending infection, and cyclical shedding also makes it resistant
What are some organisms which may cause endometritis?
Neisseria, chlamydia, TB, CMV
What are some non-infective causes of endometritis?
IUCDs, postpartum, chronic, granulomatous
Endometritis is infective until proven otherwise, and can be associated with what?
PID
How can endometrial polyps present?
They are usually asymptomatic but can present with bleeding or discharge
When do endometrial polyps usually occur?
Around and after the menopause
Are endometrial polyps always benign?
Almost always, but sometimes an endometrial carcinoma can present as a polyp
What are some causes of abnormal uterine bleeding that affect the myometrium?
Adenomyosis and leiomyoma
What is adenomyosis?
Endometrial glands and stroma within the myometrium
How may adenomyosis present?
Menorrhagia and dysmenorrhoea
What is a leiomyoma?
Benign tumour of smooth muscle
What are some symptoms of a myometrial leiomyoma?
Menorrhagia, infertility, mass effect, pain
Growth of a myometrial leiomyoma is dependent on what?
Oestrogen
