Uterine Disorders Flashcards
What is endometriosis?
Give some examples of sites which may be affected
The presence of endometrial tissue at sites other than the uterine cavity, for example:
- Ovaries
- Pouch of Douglas
- Pelvic peritoneum
- Bladder
- Bowel
Describe the pathophysiology of endometriosis
Exact mechanism is unknown - several theories have been proposed:
- Retrograde menstruation theory
- Metaplastic theory (cells of peritoneum undergo spontaneous metaplasia to form endometrial cells)
- Benign metastases theory (endometrial cells can travel to distant organs, e.g. lungs, via blood/lymphatics)
Give some risk factors for developing endometriosis
- Family history
- Early menarche
- Nulliparity
What are the clinical features of endometriosis?
- Pelvic pain (cyclical - worse at time of menstruation)
- Dysmenorrhoea
- Dyspareunia
- Dysuria
- Dyschezia
- Subfertility
What is the ‘gold standard’ investigation for diagnosing endometriosis?
Laparoscopy
Describe the medical and surgical management of endometriosis
Medical:
- Analgesia
- Hormonal therapy, i.e. COCP
Surgical:
- Only in severe cases
- Excision/fulguration of ectopic endometrial tissue (relapses are common)
- Alternatively if the woman does not want to have children, total hysterectomy + BSO (with subsequent HRT until age of menopause if necessary)
What is adenomyosis?
The presence of endometrial tissue within the myometrium of the uterus
Give some risk factors for adenomyosis
Associated with uterine damage:
- C-section
- Uterine surgery
- Surgical management of miscarriage or abortion
What is the most common symptom of adenomyosis?
Dysmenorrhoea
Describe the investigation of adenomyosis
Imaging:
- Transvaginal USS
- MRI
The definitive diagnosis is histological following hysterectomy
Describe the medical and surgical management of adenomyosis
Medical:
- Analgesia
- Hormonal therapy, i.e. OCP
Surgical:
- Curative therapy is hysterectomy
What are fibroids?
Fibroids are benign smooth muscle tumours arising from the myometrium
How can fibroids be classified?
Fibroids can be classified according to their position within the uterine wall:
- Intramural: confined to myometrium
- Submucosal: develops immediately beneath the endometrium and protrudes inwards (into uterine cavity)
- Subserosal: develops immediately under serosa and protrudes outwards (may be ‘pedunculated’ - on a stalk)
Give some risk factors for developing fibroids
- Family history
- Early menarche
- Increasing age
- Obesity
What are the clinical features of fibroids?
- Majority of women with fibroids are asymptomatic
Potential symptoms include:
- Menorrhagia
- Subfertility
If fibroids are particularly large:
- Pressure symptoms, e.g. urinary frequency, urinary retention
- Abdominal distension
Describe the investigation of fibroids
Pelvis USS
Describe the conservative, medical and surgical management of fibroids
Conservative:
- Watchful waiting
Medical:
- IUS (1st line, if indicated) or tranexamic acid for menorrhagia
- Hormonal therapy, i.e. COCP to lessen symptoms (menorrhagia)
- GnRH analogues can be used to reduce fibroid size pre-operatively
Surgical:
There are a few options:
- Myomectomy: for those wishing to preserve fertility
- Hysteroscopy with TCRF (transcervical resection of fibroid): useful to remove submucosal fibroids
- Hysterectomy: for those who do not wish to preserve fertility
What are uterine polyps?
Uterine polyps are benign growths arising from the endometrium
What are the clinical features of uterine polyps?
Abnormal vaginal bleeding:
- Irregular menstrual bleeding
- Inter-menstrual bleeding (IMB)
- Post-menopausal bleeding (PMB)
- Menorrhagia
Can also cause subfertility
Describe the investigation of uterine polyps
Transvaginal USS then hysteroscopy and biopsy
Describe the management of uterine polyps
Endometrial polyps have a small chance of undergoing malignant transformation therefore management is removal by hysteroscopy with TCRP (transcervical resection of polyp)
i) The most common form of endometrial cancer is… (+ definition)
ii) What is the pathophysiology?
i) Adenocarcinoma (malignant neoplasm of epithelial tissue)
ii) Stimulation of the endometrium by oestrogen, without the protective effects of progesterone (‘unopposed’ oestrogen)
Give some risk factors for developing endometrial cancer
Exposure to ‘unopposed’ oestrogen:
- Anovulation: early menarche/late menopause (cycles more likely to be anovulatory at extremes of age) and PCOS (with oligomenorrhoea, cycles more likely to be anovulatory)
- Iatrogenic (HRT with oestrogen only, tamoxifen use)
- Obesity: the greater the amount of subcutaneous fat, the faster the rate of peripheral aromatisation of androgens to oestrogen (increased levels of ‘unopposed’ oestrogen)
Age is also a risk factor (peak incidence is 65-75 years)
What are the clinical features of endometrial cancer?
Post menopausal bleeding = endometrial cancer until proven otherwise!
