Uterine Disorders Flashcards
What is adenomyosis?
Functional endometrial tissue in the myometrium of the uterus
(variant of endometriosis)
What are the main symptoms of adenomyosis?
Menorrhagia
Dysmenorrhoea
Dyspareunia
Irregular bleedings
Outline the pathophysiology of adenomyosis?
Endometrial stroma is allowed to make contact and communicate with the underlying myometrium after uterine damage
Which scenarios may allow communication of the endo and myometrium?
Pregnancy and childbirth
C-sec
Uterine surgery
Surgical management of miscarriage or TOP
Where is the invasion of the myometrium commonly found in adenomyosis?
Posterior wall of uterus
What is the term given to endometrial glands which form visible nodules?
Adenomyoma
What are the main risk factors for adenomyosis?
High parity
Uterine surgery
Prev C-sec
FHx
What is felt on examination in adenomyosis?
Symmetrically enlarged tender uterus
How is adenomyosis investigated?
Histological hysterectomy
TV USS
MRI
How is adenomyosis cured?
Only cure is hysterectomy
How is adenomyosis managed?
NSAIDs COCP IUS/IUD GnRH agonist Aromatase inhibitors
Which surgical treatment can be offered in adenomyosis in women who wish to keep fertility?
Uterine artery embolisation
When is the peak incidence of endometrial cancer?
65-75
What is the most common form of endometrial cancer?
Adenocarcinoma
What is the main cause of adenocarcinoma?
Stimulation of endometrium by unopposed oestrogen
What are the risk factors for endometrial cancer?
Early menarche/late menopause Nulliparity Age PCOS HRT Obesity Lynch syndrome
What are the clinical features of endometrial cancer?
Post-menopausal bleeding Discharge (Irregular bleeding is premenopausal) Weight loss Abdo pain
Which examinations are performed on suspicion of endometrial cancers?
Abdo
Speculum
Bimanual
How is endometrial cancer investigated?
TV USS
Biopsy
What is a stage I endometrial carcinoma?
Confined to uterine body
What is a stage II endometrial carcinoma?
Extends to cervix but not beyond uterus
What is a stage III endometrial carcinoma?
Extends beyond uterus but still in pelvis
What is a stage IV endometrial carcinoma?
Involves bladder or bowel
Mets
How is endometrial hyperplasia treated?
Progestogens
IUS
How is atypical endometrial hyperplasia treated?
Total abdominal hysterectomy
Bilateral salpingo-oophrectomy
How are stage I and II endometrial cancers treated?
Total abdominal hysterectomy
Bilateral salpingo-oophrectomy
Stage II also take tissue around cervix away
How is stage III endometrial carcinoma treated?
De-bulking surgery
Chemo/radio
How is stage IV endometrial cancer treated?
De-bulking surgery
Palliative
What is endometriosis?
Chronic condition in which endometrial tissue is located outwith the endometrium
Who is most commonly affected by endometriosis?
women 25-50
Which hormone is endometrial tissue sensitive to?
Oestrogen
What are the main risk factors for endometriosis?
Early menarche FHs Short men cycles Long duration of bleeding HMB Structural defect
How does endometriosis commonly present?
Cyclical pelvic pain Dysmenorrhoea Dyspareuia Dysuria Dyschezia
How is endometriosis investigated?
Laparoscopy gold standard
Pelvic USS
What are the typical laparoscopic findings on laparoscopy of endometriosis?
Chocolate cysts
Adhesions
Peritoneal deposits
How is endometriosis managed?
Analgesics
COCP
Norethisterone
Surgical removal or laser ablation
How do COCP, IUD, IUS and norethisterone work in the management of endometriosis?
Supressing ovulation for 6-12 months can cause atrophy of the endometriosis lesions
What are uterine fibroids?
Benign smooth muscle tumours
What are uterine fibroids also known as?
Leiomyomas
What is the most common type of fibroid?
Intramural
Where is an intramural fibroid?
Confined to myometrium
Where is a submucosal fibroid?
Develops immediately underneath the endometrium and projects into cavity
Where is a subserosal fibroid?
Protudes into and distorts the surface of the uterus
Which hormone stimulates the growth of fibroids?
Oestrogen
What are common risk factors for fibroids?
Obesity Early menarche Increasing age FHs African-American
How do fibroids present?
Usually asymptomatic May have pressure symptoms Bloating HMB Acute pelvic pain - rare
How are fibroids investigated?
Pelvis USS
MRI
How are fibroids managed medically?
Tranexamic or mefenamic acid
COCP
GnRH analogue
Ulipristal
How are fibroids managed surgically?
Myomectomy
Uterine artery embolisation
Hysterectomy
TCRF
What is Ulipristal?
Selective progesterone receptor modulator
Why can GnRH analogues only be used for 6 months in fibroid management?
Risk of osteoporosis (due to temporary menopausal state)
What is the role of Zolidex in fibroid management?
(GnRH)
Induces temporary menopausal state to reduce fibroid size before surgery
Which surgical option is the choice for submucosal fibroids?
Transcervical resection of the fibroid (TCRF)
