Uterine Disorders

Question 1

What is the other name for fibroids?

Answer 1

Leiomyomas

Question 2

What are the different types of fibroids?

Answer 2

Intramural (most common) - confined to myometrium
Submucosal - underneath endometrium, protrudes into uterine cavity
Subserosal - protrudes into and distorts outer surface of uterus, can be pedunculated

Question 3

What are the clinical features of fibroids?

Answer 3

Majority asymptomatic
Pressure symptoms +/- distension
- includes urinary frequency or chronic retention
Heavy menstrual bleeding
Subfertility
Pain (rare) –> red degeneration in pregnancy

Question 4

How are fibroids diagnosed?

Answer 4

Pelvis USS

Question 5

What is the medical management for fibroids?

Answer 5

Tranexamic or mefanamic acid
COCP, POP and IUS for menorrhagia
GnRH analogues - useful pre-op to reduce size of fibroid

Question 6

What are the surgical options for fibroids?

Answer 6

Hysteroscopy + transcervical resection of fibroid (TCRF)
- good for submucosal fibroids
Myomectomy 
- if wanting to preserve uterus
Uterine artery embolisation (UAE)
Hysterectomy

Question 7

What are the clinical features of endometriosis?

Answer 7

Cyclical pelvic pain
Dysmenorrhoea
Dyspareunia
Dysuria
Difficult, painful defecating
Subfertility

Question 8

What might be found on bimanual examination in endometriosis?

Answer 8

A fixed, retroverted uterus
Uterosacral ligament nodules
General tenderness

Question 9

How is endometriosis diagnosed and what are the findings?

Answer 9

Laparoscopy:

• chocolate cysts
• adhesions
• peritoneal deposits

Pelvic USS should be done before surgery - might show ‘kissing ovaries’

Question 10

What is the management for endometriosis?

Answer 10

Pain management e.g. paracetamol, NSAIDs
Ovulation suppression e.g. COCP, norethisterone, IUS
Surgery - laser ablation of ectopic tissue

Question 11

What is adenomyosis?

Answer 11

Presence of functional endometrial tissue within the myometrium of the uterus

Question 12

What are the clinical features of adenomyosis?

Answer 12

Menorrhagia
Dysmenorrhoea (progressive - begins cyclical but can become daily)
Deep dyspareunia
Irregular bleeding

On examination:
- symmetrically enlarged tender uterus

Question 13

How is adenomyosis investigated?

Answer 13

Transvaginal USS
MRI - thickening of the end-myometrial junctional zone

Definitive diagnosis is histology following hysterectomy

Question 14

How is adenomyosis managed?

Answer 14

NSAIDs for analgesia
Hormonal therapy for reduction of bleeding and cyclical control
Hysterectomy is the only definitive treatment
Uterine artery embolisation can be used in short/medium term if wanting to preserve fertility

Question 15

What is the most common type of endometrial cancer?

Answer 15

Adenocarcinoma

Question 16

What are the risk factors for endometrial cancer?

Answer 16

Unopposed oestrogen:
- early menarche and/or late menopause
- low parity
- PCOS (anovulatory)
- oestrogen only HRT
- Tamoxifen use
Age
Obesity
Lynch syndrome (hereditary non-polyposis colorectal cancer)

Question 17

What is the main clinical feature of endometrial cancer?

Answer 17

Post-menopausal bleeding

Question 18

What are the investigations for endometrial cancer?

Answer 18

Transvaginal USS to assess endometrial thickness
Endometrial pipelle biopsy
Dilatation + curettage (under GA)
- Hysteroscopy at the same time

Question 19

How is endometrial cancer managed?

Answer 19

Total hysterectomy (cervix also removed) + bilateral salpingo-oophorectomy (usually laparoscopic) with peritoneal washings

Pelvic lymphadenectomy in some cases