Theme 6: Uterine pathology and polycystic ovarian syndrome Flashcards
What is endometriosis?
- ectopic endometrial tissue
- normal tissue in an abnormal location
- most commonly in pelvis but can be found in chest cavity/lungs
- extra-uterine endometrial tissue can occur virtually anywhere
Who gets endometriosis?
6-10% of women aged 30-40 years
What is the aetiology behind endometriosis?
unknown but:
-regurgitation theory –> during the menstrual cycle, tissue is shed through the fallopian tubes into the pelvic cavity
- metaplasia theory - normal tissue undergoes metaplastic transformation
- stem cell theory - stem cells at different locations differentiate into endometrial tissue
- metastasis theory - spreads along lymphatic system
What is the pathogenesis of endometriosis?
bleeding into tissues then fibrosis
What are the clinical features of endometriosis?
- 25% asymptomatic
- dysmenorrhoea (painful menstruation)
- dyspareunia (pain during sex)
- subfertility
- pain on passing stool
- dysuria
What is the gold standard test for endometriosis?
laparoscopy
How do we treat endometriosis?
- NSAIDs are first line (as endometriosis can be asymptomatic, cause minor problems or be debilitating)
- progesterone only or combined contraceptive pills
- surgical ablation of lesions is definitive treatment
What is endometrial polyps?
localised, sessile (immobile) overgrowth of endometrial tissue that projects into the uterine cavity
Explain the aetiology of endometrial polyps
<10% of women aged 40-50 but incidence rises with age (the risk of malignancy of polyps also rises with age although still rare)
Explain the aetiology and pathogenesis of endometrial polyps
aetiology: unknown
pathogenesis: inappropriate reaction of foci of endometrium to oestrogenic stimulation
What are the clinical features of endometrial polyps?
often asymptomatic
- intermenstrual/post-menopausal bleeding
- menorrhagia (heavy periods)
- dysmenorrhoea (painful periods)
What is the standard investigation for endometrial polyps?
USS
What would most gynacologists recommend if a patient with endometrial polyps presents with symptoms
removal of polyps
What are the 3 layers of the uterus (from inner to outer)
- endometrium
- myometrium
- perimetrium
What are the two layers of the endometrium?
- stratum functionalis - the inner functional layer
2. stratum basalis - the outer layer that regenerates to form the functional layer after each menstrual cycle
What is endometrial hyperplasia?
- results when the endometrium is exposed to high levels of oestrogen for a long period of time
- leads to an excessive growth of endometrial glands relative to stroma
What are the levels of oestrogen and progesterone like in endometrial hyperplasia?
- high oestrogen
- low progesterone
What is the epidemiology of endometrial hyperplasia?
> 40 years
3x higher incidence than endometrial cancer
What pre-disposing factors can cause endometrial hyperplasia
obesity estrogen secreting tumours PCOS Early menarche late menopause nulliparous oestrogen pills tamoxifen PTEN mutation
What is the pathogenesis of endometrial hyperplasia?
unopposed estrogenic stimulation of the endometrium