Uterine disorders Flashcards
What is endometriosis?
Endometrial glands & stroma outside endometrial cavity & uterine musculature
What is the cause of endometriosis?
Unknown, but maybe:
- Retrograde menstruation
- Deficient cellular immunity
- Hereditary
What are RFs of endometriosis?
- Nulliparity
- Prolonged exposure to endogenous estrogen
- Heavy menstrual bleeding
- Obstruction of outflow
- DES exposure in utero
- Height > 68 in
- Low BMI
- High consumption of unsaturated fat
What is the clinical presentation of endometriosis?
- Premenstrual pelvic pain (SUBSIDES AFTER MENSES)
- Infertility
- Dysmenorrhea
- Dyspareunia
What does endometriosis look like on PE?
- Tenderness/nodules at posterior cul-de-sac
- Fixed or retroverted uterus
- Endometriomas –> adnexal masses or tenderness
How do you dx endometriosis?
CA-125
Imaging
Laparoscopy
What is seen on laparoscopy in endometriosis?
- Erythematous, petechial lesions on peritoneum
- Peritoneum thickened/scarred
- Endometriomas on ovaries
- Adhesions
How do you treat mild endometriosis?
Expectant management w/ NSAIDs +/- OCPs
What meds help to interrupt stimulation of endometrial tissue?
OCPs
Progestins
GnRH agonists
What are more drastic tx options for endometriosis?
Danazol
Aromatase inhibitors
Laparoscopic excision
Hysterectomy w/ B/L salpingo-oophorectomy
Where do uterine fibroids arise?
From SM cells within te uterine wall
What are uterine fibroids made of?
Collagen, SM, & elastin surrounded by pseudocapsule
What population experiences uterine fibroids?
20% childbearing age
MC in black women
What causes uterine fibroids?
Unknown
- Estrogen is implicated in growth
- Progesterone increases mitotic activity & possibly suppresses apoptosis within the tumor
How are uterine fibroids classified? (3)
By anatomic location within myometrium
- Submucosal: beneath endometrium
- Subserosal: at serosal surface
- Intramural: within uterine wall
What is the clinical presentation of uterine fibroids?
Sx present in 35-50%
Sx occur due to location & size
- Abnormal uterine bleeding
- Pain
- Pelvic pressure
- Infertility
- Spontaneous abortion
What uterine abnormalities are seen on the bimanual exam w/ respect to uterine fibroids?
Enlargement
Irregular shape
Masses
What labs & imaging are used to dx uterine fibroids?
Transvaginal u/s
Saline-infused sonohysterogram
Hysteroscopy
MRI
H&H
How do you treat uterine fibroids?
No standard of care. Sx drive tx of choice
Medical & surgical options available. See slide 27
What are 3 medical options for uterine fibroid tx?
- Depot Lupron
- Steroidal therapy
- Lysteda
What are surgical options for tx of uterine fibroids?
- Myomectomy (Laparoscopic or abdominal/mini-laparotomy)
- Hysteroscopy
- Endometrial ablation
- Uterine artery embolization
Describe Depot Lupron
GnRH agonist
Decreases fibroid size
Decreases blood loss during surgery & improves anemia prior to surgery
Don’t use over 6mos
Steroidal therapies & Lysteda are indicated for patients w/…
prolonged, heavy menses w/ no submucosal fibroids
Describe Lysteda
Oral antifibrinolytic
50% decrease in menorrhagia
Use only during menstrual cycle
What is the benefit of a myomectomy or hysteroscopy?
Both PRESERVE FERTILITY/UTERUS