Uterine Disorders

Question 1

What are uterine fibroids?

Answer 1

Benign smooth muscle tumours of the yometrium

Risk of a fibroid becoming malignant is 0.1%

Question 2

How are uterine fibroids classified?

Answer 2

Intramural (most common) = confined to myometrium of the uterus

Submucosal = develops immediately underneath the endometrium of the uterus, and protrudes into the uterine cavity

Subserosal = protrudes into and distort the serosal (outer) surface of the uterus. They may be pedunculated (on a stalk)

Question 3

How do uterine fibroids present?

Answer 3

Majority asymptomatic

Urinary frequency

Chronic retention

Abdo distention

Heavy menstrual bleeding

Subfertility

Acute pelvic pain

Question 4

Outline how uterine fibroids should be investigated

Answer 4

TV/abdo pelvic USS

MRI if USS inconclusive

Question 5

What is the management for uterine fibroids?

Answer 5

No Tx if minimal symptoms

Tranexamic or mefanamic acid = bleeding

Hormonal contraceptives = COCP, POP, IUS

GnRH analogues = supress ovulation, reduce fibroid size, can be used for 6m only

Selective Progesterone Receptor Modulators = reduce size

Hysteroscopy and Transcervical Resection of Fibroid

Myomectomy = preserve uterus

Uterine Artery Embolization (UAE)

Hysterectomy

Question 6

What sites can endometriosis occur?

Answer 6

Anywhere other than the uterine cavity

Ovaries, pouch of Douglas, uterosacral ligaments, pelvic peritoneum, bladder, umbilicus and lungs

Question 7

List the clinical features of endometriosis

Answer 7

Cyclical pelvic pain with menstruation

Dysmenorrhoea

Dyspareunia

Dysuria

Dyschezia (painful defecation)

Subfertility

Haemothorax

Fixed, retroverted uterus

Uterosacral ligament nodules

General tenderness

Question 8

How should endometriosis be investigated?

Answer 8

Diagnostic Laparoscopy:

• Active = chocolate cysts, powder burn spots
• Inactive = scars

Pelvic USS

MRI - visualise bladder/bowel/ureter involvement

Bloods - Hb (anaemia), CRP/WBC (PID)

Question 9

How is endometriosis managed?

Answer 9

Pain = analgesic ladder (para, NSAIDs, neuropathic)

Suppress ovulation = 6-12m, low dose COCP, IUS (mirena), GnRH analogues, mefenamic acid/tranexamic acid

Surgery = laparoscopic diathermy or laser, TAH + BSO

Question 10

Define adenomyosis, how it typically presents and its Mx

Answer 10

Endometrial tissue within the myometrium

Symmetrical, enlarged boggy uterus, chronic pain, older women, dysuria

• Analgesia = NSAIDs
• Hormonal = COC, progestogens (oral, IUS), GrHA, aromatase inhibs
• Surgery = uterine A embolisation, hysterectomy