Uterine disorders Flashcards
Defintion of Endometriosis?
The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature causes an inflammatory response
What is Endometriosis a risk factor for?
Ovarian cancers
What is the pathophysiology (reasoning) for endometriosis?
Retrograde menstruation
o Retrograde flow of endometrial tissue through fallopian tubes and peritoneum
Deficient cell immunity
Hereditary
Risk factors for Endometriosis?
−Nulliparity (never pregnant) −Prolonged exposure to endogenous estrogen −Heavy menstrual bleeding −Obstruction of menstrual outflow −DES exposure in utero (Diethyst..) −Height greater than 68 inches −Lower BMI −High consumption of unsaturated fat
Clinical presentation of Endometriosis?
- Premenstrual pelvic pain–> pain subsides after menses
- Infertility in 30-40%
- Dysmenorrhea
- Dypareunia (pain with intercourse)
What are physical exam findings found in endometriosis?
Tenderness / nodules at posterior cul-de-sac
Fixed or retroverted uterus (2o to adhesions)
o Cervix displaced laterally
Endometriomas cause adnexal masses or tenderness
How is Endometriosis diagnosed definitively.
Need to see lesions with Laparoscopy
What is seen on Laparoscopy when diagnosing endometriosis?
MC site will be the ovaries
Chocolate cysts
Which tumor marker can support the diagnosis of endometriosis?
CA-125
Treatments for Endometriosis in mild diseases?
NSAIDS and OCPs
Treatment for MOderate to severe Endometriosis?
OCPs
Progestiins
GnRH agonists
Which population is most likely to have Uterine Fibroids?
African american women
Clinical presentation of Uterine fibroids
Abnormal uterine bleeding
What is Adenomyosis?
overgrowht of the endometrial glands and stroma into the uterine myometrium
Clinical Presentation of Adenomyosis?
Menorrhagia (more severe than fibroids) Dysmenorrhea Pelvic pain History of previous uterine surgery (C - section) Prior myomectomy
Physical exam findings of Adenomyosis?
Bimanuel exams reveals diffuse unterine enlargement
What is needed to make a definitive diagnosis for Adenomyosis?
histologic examination after hysterectomy
Treatments for Adenomyosis?
Hysterectomy - definitive treatment
Risk factors for Endometrial Hyperplasia?
−Early menarche (<12yo)
−Late menopause (>52yo)
−Infertility, nulliparous
−OBESITY, OBESITY, OBESITY–> more estrogen conversion from fat
−Unopposed estrogen replacement therapy
-Diabetes
-Family history of Lynch Syndrome (colon cancer)
WHO Classifications for Endometrial Hyperplasia
Hyperplasia without atypia (non-neoplastic) Atypical hyperplasia (endometrial intraepithelial neoplasia)
Clinical presentation of Endometrial Hyperplasia?
Asymptomatic
Post-menopausal bleeding
Menorrhagia (heavy bleeding)
Intermenstrual bleeding Prolonged menses (> 7d)
Decreased menstrual interval (< 21d)
Oligomenorrhea / Amenorrhea D&C, hysteroscopy (if stenosis of cervical os)
What physical exam procedures need to be done for women with Endometrial hyperplasia?
Pelvic Exam
Pelvic Ultrasound
Endometrial biopsy
Treatment of Hyperplasia without atypia?
− Mirena IUD
− Provera 10mg QD for 3 - 6mos, continuously or last 10 days of each month
− Reassess in another few months with EMB to ensure resolution
Treatment for Hyperplasia with atypia
−Hysterectomy is treatment of choice
o Completed childbearing
o Up to 50% have underlying endometrial cancer
