Uterine Disorders Flashcards
What is another name for leiomyoma
Uterine fibroids
What is a benign tumor of localized proliferation of smooth muscle cells surrounded by a pseudo capsule of compressed muscle fibers
Leiomyoma
Are Leiomyoma hormoally resonsive
Yes they come with a rapid growth if high estrogen and will often go away with menapause
Name the dx.
32 y/o Patient comes to you with bleeding from the vagina. Recently she has noticed her menses are getting heavier and longer and she has been trying to get pregnant over the past 2 years with no success.
On exam there is an irregular mobile hard mass. That has a cobblestone feel to it.
Leiomyoma
What is used to confirm the dx of Leiomyoma
Ultrasound
What is the treatment of Leiomyoma
NSAIDS and iron supplements if anemic
What can be used to minimize the bleeding of a Leiomyoma
Progesterone, GnRH agonist, and Danazol
What are the surgical options for Leiomyoma
Myomectomy: preserves pregnancy
Hysterectomy: No longer desire pregnancy
What is the definitive treatment of a Leiomyoma
Hysterectomy
What is the most common indication for a hysterectomy
Leiomyoma
What is known as an abnormal proliferation of endometrial tissue
Endometrial hyperplasia
Can endometrial hyperplasia go to cancer? And if so what kind?
Yes, Endometrial cancer
What hormone can cause endometrial hyperplasia
It is due to unopposed estrogen, there is no progesterone to balance out the estrogen
What is simple endometrial hyperplasia
Abnormal proliferation of both stromal and glandular tissue, basic structure not changed
What is complex endometrial hyperplasia
Abnormal proliferation of glandular tissue, abnormal structure with crowding of glands
What is atypical simple endometrial hyperplasia
Abnormal proliferation of both stromal and glandular tissue, basic structure not changed + atypia-large nuclei hyperchromatic
What is atypical complex endometrial hyperplasia
Abnormal proliferation of glandular tissue, abnormal structure with crowding of glands + atypia-large nuclei hyperchromatic
60 y/o women presents to you with abnormal bleeding. On exam the uterus feels enlarged and on US you find 6mm of thickness of endometrium. What is the next best step
Possibly cancer or endometrial hyperplasia need an endometrial biopsy to diagnose
What is the treatment of endometrial hyperplasia
Progestin for simple
Hysterectomy if atypia present due to high rate of possible cancer
When do you want to repeat an EMB after starting Progestin for endometrial hyperplasia
3 months
What is the most common type of endometrial cancer
Adenocarcinoma
What is the most common GYN cancer
Endometrial cancer
What can reduce the risk of developing endometrial cancer
OCP
What is the most common symptom of endometrial cancer
Abnormal bleeding typically post-menopausal
How do you diagnose endometrial cancer
EMB
Where is endometrial cancer most likely to spread to
Direct extension downward to cervix and outward through myometrium
What is the treatment of endometrial cancer
Total hysterectomy and bilateral salpingo-oophorectomy with peritoneal cytology and LN sampling
What is the presence of endometrial tissue in any extrauterine site
Endometriosis
Where is endometriosis most commonly found
Ovaries
What can endometriosis lead to
Scarring and adhesions
When is endometriosis seen most likely age wise
Reproductive years
Name the dx.
38 y/o G0P0 female comes to you with pelvic pain. Patient stated that she has a lot of pain with intercourse and her pelvic pain is getting worse. On exam you find uterosacral nodularity and otherwise the pelvic exam is normal.
Endometriosis
How do you confirm the diagnosis of endometriosis
Endometrial tissue biopsy
What is the treatment for endometriosis
NSAIDS and OCP’s for pain
What is the most definitive treatment of endometriosis
TAH-BSO
What is irregular bleeding unrelated to anatomic lesions of the uterus
Anovulatory uterine bleeding
What is due to the high levels of estrogen without progesterone, so the endometrium will continually grow leading to irregular bleeding
Anovilatory uterine bleeding
What will you find if you check a patient with anovilatory uterine bleeding, progesterone during the literal phase
Will be low because she is not ovulating
What is the treatment for anovulatory uterine bleeding
Progesterone for 10-14 days
OCP
What is it called if you have pain with menstruation
Dysmenorrhea
What kind of dysmenorrhea has no underlying pathology
Primary Dysmenorrhea
What kind of dysmenorrhea is associated with an underlying pathology
Secondary dysmenorrhea
What disorder is due to increased prostaglandins during menses and causing uterine contractions
Dysmenorrhea
During what time of the menses does dysmenorrhea normally occur
1st and 2nd day of menses
Do you want to suspect primary or secondary dysmenorrhea if onset is well after menarche
Secondary, primary will normally be within 1-2 years of menarche
What is the treatment for dysmenorrhea
NSAIDS-start them 1-2 days before period OR
OCP’s
What is the constellation of sx that recur 4 days prior to onset of menses and stop within 4 days after the start of menses
Premenstrual syndrome
Name the dx.
A 28 y/o female presents to you because she is tired of feeling bloated, breast pain, irritatbilty, fatigue and food cravings around the time of her period. THis is beginning to severely affect her life and she wants something to be done.
Premenstrual Syndrome
How do you treat a patient with premenstral syndrome
No single treatment
Patient education: good diet and exercise
OCP’s or NSAIDS for pain
SSRI if mood symptoms
What is a severe form of PMS
Premenstrual dysphoric disorder
Name the dx.
A patient comes to you with mood swings, and sudden sadness around the time of her period. She has food cravings, difficulty concentrating, feeling overwhelmed, tired, and has breast tenderness. This normally all goes away a few days after her period starts. What is the diagnosis and treatment of this patient
Premenstral dysphoric disorder
Treat with SSRI (Fluoxetine, Paroxetine, Sertiline) OR
OCP’s which inhibit ovulation and reduce sx.
Your patient comes to you who has premenstral dysphoric disorder. SHe is currently taking an SSRI daily for this disorder. She wants to know if there is anyway she can just take the SSRI a couple times a month rather than everyday because the side effects are starting to bother her some. Is this possible to do and if so when can she take it?
The patient can just take in during the luteal phase of her cycle (so day 14-start of next cycle)
