Uterine Disorders Flashcards
Endometriosis is a risk factor for what type of cancer
epithelial ovarian cancer
Endometriosis: risk factors
- No pregnancies
- Prolonged endogenous estrogen
- Heavy menses
- DES exposure in utero
- Taller than 68 inches
- Lower BMI
Endometriosis: clinical presentation
Premenstrual pelvic pain, that subsides after menses**
Endometriosis: Physical exam
- Tenderness/nodules at posterior cul-de-sac*
- Fixed or retroverted uterus (from adhesions)
What cancer marker may be elevated in the blood with endometriosis
CA-125
can help diagnosis, but not definitive
What is the best method for diagnosing endometriosis?
Laproscopy
Where is the most common site of endometriomas (“chocolate cysts”)
ovaries
For a patient with mild endometriosis, what is the preferred management?
- Be observant
- NSAIDS +/- oral contraception
For a patient with moderate to severe endometriosis what is the preferred treatment?
Oral contraception** (continuous cycle)
or
- Progestins (PO, IM, IUD)
- GnRH agonists (ex. Lupron, Norethindrone (6-12 month therapy to prevent bone loss))
Uterine fibroids: etiology
- black women (2-3x more common)
- 50% of all women by 50s
What influences the growth of the myoma?
estrogens implicated in growth since this tissue has more estrogen receptors than normal
Fibroid classifications (3)
- Submucosal (inner)
- Intramural (within uterine wall)
- Subserosal (outer)
Fibroids: clinical presenation
- Abnormal uterine bleeding *** (esp. submucosal)
- Pain* (compression of surrounding organs)
- Infertility* (submucosal)
- Spontaneous abortion
If on bimanual examination of the uterus you appreciate irregular hard mass what imaging is most appropriate initially?
Transvaginal ultrasound**
Fibroids: Medical tx
- GnRH analogs (Lupron)
- decrease fibroid size
- improve anemia prior to surgery
- NOT approved for over 6 months of use - Tranexamic Acid (Lysteda)
- for heavy menses
- ONLY use during menstrual cycle
Fibroid: Surgerical Tx
- Myomectomy (preserves fertility)
- Perform on all but submucosal
- MUST have C-section to avoid uterine rupture** - Hysteroscopy
-Preserves fertility
-Only perform on submucosal
ADE: can cause fluid overload and hyponatremia
Endometrial ablation: key points
- Good tx for menorrhagia
- No future childbearing
- Must continue contraceptive (to avoid placenta accreta - placenta can’t separate from uterine wall
Uterine Artery Embolization: Key points
contraindication: numerous or large fibroids
- No future childbearing
Adenomyosis: clinical presentation
- History of previous C-section or a myomectomy***
- Severe menorrhagia**
Adenomyosis: PE
-Diffuse uterine enlargement**
Adenomyosis: Tx
- Hormonal contraception
2. Hysterectomy
What are the main risk factors for endometrial hyperplasia?
-basically too much estrogen
OBESITY
What will a patient most often present with if they have endometrial hyperplasia?
- post-menopausal bleeding
- menorrhagia*
- Intermenstrual bleeding
- Prolonged bleeding
If an obese patient presents with heavy bleeds, more frequent bleeds and prolonged bleeding what imaging will help you best rule out malignancy?
Pelvic ultrasound
if endometrium is <4mm malignancy is unlikely
What are the treatments for endometrial hyperplasia?
If no atypia –>oral or IUD Progestin (reassess in 3 months)
If atypia –>hysterectomy
What is the most common pelvic genital cancer?
endometrial cancer
- MC between 50-69
- MC in whites
What are the risk factors?
same as hyperplasia, too much estrogen
Obesity
Endometrial Cancer: Type I
due to unopposed endogenous/exogenous estrogen
- favorable prognosis
- well-differentiated
Endometrial cancer: Type II
Independent of estrogen
- Poorly differentiated
- Poor prognosis
What is the most common type of endometrial cancer?
Adenocarcinoma (~80%)
-associated with estrogen type 1
Type II: serous, clear cell
What is the most common clinical presentation for Endometrial cancer?
Abnormal vaginal bleeding
-Screen for Lynch Syndrome (Colaris testing)
