Uterine Disorders

Question 1

Dysmenorrhea definition

Answer 1

Painful periods
Crampy abdominal pain that starts at the onset of the period

Question 2

Dysmenorrhea classification

Answer 2

Primary = menstrual pain with no underlying pelvic pathology
Secondary = menstrual pain with associated pelvic pathology

Question 3

Causes of abnormal uterine bleeding

Answer 3

PALM COEIN
Structural
Polyps
Adenomyosis
Leiomyoma
Malignancy + hyperplasia

Non-structural
Coagulopathies
Ovarian dysfunction
Endometrial
Iatrogenic
Not yet classified

Question 4

What is a leiomyomata?

Answer 4

Fibroid

Question 5

Anatomical location of fibroids

Answer 5

Myometrium of uterus

Question 6

Fibroids classification

Answer 6

Intramural = confined to myometrium of uterus
Submucosal = develops immediately underneath the endometrium of the uterus and protrudes into the uterine cavity
Subserosal = protrudes into and distorts serosal surface of uterus +/- pedunculation

Question 7

Fibroids pathogensesis

Answer 7

Currently unknown
Thought to be due to oestrogen stimulation

Question 8

Fibroids risk factors

Answer 8

Obesity
Early menarche
Increasing age
Family history
Ethnicity (Black)

Question 9

Fibroids clinical features

Answer 9

Abdominal symptoms
Heavy menstrual bleeding
Subfertility
Acute pelvic pain

Question 10

Fibroids management

Answer 10

Medical: transexamic acid, mefanamic acid, COCP, GnRH analogues, Selective progesterone receptor modulators
Surgical: Hysteroscopy, myomectomy, uterine artery embolisation, hysterectomy

Question 11

Fibroids complications

Answer 11

Iron def anaemia
Compression of pelvic organs (UTI, incontinence, hydronephrosis, UR)
subfertility / infertility
Degeneration
Torsion

Question 12

Uterine fibroids are a benign tumour of which tissue?

Answer 12

Smooth muscle

Question 13

What is the most common type of uterine fibroid?

Answer 13

Intramural

Question 14

Fibroids surgical management for women who still want to have children

Answer 14

Myomectomy

Question 15

Endometriosis pathophysiology

Answer 15

Unknown
? Retrograde menstruation
Cyclical pain due to oestrogen stimulation from menstrual cycle
Repeated inflammation and scarring > adhesions

Question 16

Endometriosis risk factors

Answer 16

Early menarche
Fx
Short menstrual cycles
Long duration of menstrual bleeding
Heavy menstrual bleeding
Defects in uterus / Fallopian tubes

Question 17

Endometriosis clinical features

Answer 17

Cyclical pelvic pain (at time of menstruation)
Dysmenorrhea
Dysparenunia
Dysuria
Dyschezja
Subfertility
Haemothorax (distant sites)

Question 18

What is adenomyosis?

Answer 18

presence of endometrial tissue within myometrium of uterus
benign invasion
possible variant of endometriosis

Question 19

Adenomyosis clinical features

Answer 19

Menorrhagia
Dysmenorrhoea
+/- fibroids

Question 20

adenomyosis pathophysiology

Answer 20

endometrial stroma communication with myometrium following uterine damage

Question 21

Most common site of adenomyosis

Answer 21

posterior wall of uterus

Question 22

Risk factors of adenomyosis

Answer 22

high parity
uterine surgery (endometrial ablation / curettage)
previous caesarian section
Fx

Question 23

endometriosis investigations

Answer 23

laparoscopy (gold standard)
- chocolate cysts, adhesions, peritoneal deposits
TVUS
pelvic MRI (to assess extent of endometrial involving bladder, bowel, ureters)