Uterine Disorders (NOT DONE) Flashcards
What is Endometrial hyperplasia?
May be defined as abnormal proliferation of the endometrium in excess of the normal proliferation which occurs during the menstrual cycle. (A precursor for Endometrial Cancer in the minority)
What are the Types of Endometrial Hyperplasia?
- Simple
- Complex
- Simple Atypical
- Complex Atypical
What are some of the signs of Endometrial hyperplasia?
Abnormal Vaginal Bleeding e.g. intermenstrual/ Post menopausal.
What is the management of Endometrial hyperplasia?
Simple: High dose progestetogens then re-sampling in 3/4 months. Some types may resolve spontaneously.
Atypical: Hysterectomy usually advised.
What is the mainstay of treatment of an Endometrial Adenocarcinoma in early disease?
Total hysterectomy and bilateral salpingo-oophorectomy.
Standard surgical Approach as its curative in the early stages of disease.
What are Fibroids (leiomyomas)?
Benign smooth muscle tumours originating from the myometrium of the uterus.
What are some risk factors for Fibroids?
Unknown - Thought to be influenced by genetic, hormonal and environmental factors.
What hormones are important in the growth of fibroids?
Oestrogen and progesterone
- They usually stimulate development of the uterine lining during each menstrual cycle and appear to promote growth of fibroids.
Do fibroids contain oestrogen and progesterone receptors?
Yes, they contain more than normal uterine muscle cells.
What are the different types of Fibroids?
- Subserosal, below the outer later of the uterus.
- Intramural, within the myometrium - the muscle of the uterus.
- Submucosal, Just below the lining of the uterus (endometrium)
- Pedunculated, on a stalk.
In which ethnic group are fibroids most common?
Black women over other ethnic groups.
How do Fibroids usually present?
Often Asymptomatic however, can also present with:
- Heavy menstrual bleeding (most common symptom)
- Prolonged menstruation
- Abdo pain worse during menstruation.
- Bloating or feeling full
- urinary or bowel symptoms due to pelvic pressure or fullness.
- Deep dyspareunia (pain during sex)
What physical examination is done in suspected fibroids?
Abdominal and Bimanual Palpation.
- May reveal palpable masses or an enlarged firm, non-tender uterus.
What is the initial investigation for submucosal fibroids presenting with menorrhagia?
Hysteroscopy.
What is the investigation of choice for larger fibroids?
Pelvic ultrasound.
When May MRI scanning be considered in the management of fibroids?
Before surgical options, where more information is needed on size, shape and blood supply.
How are fibroids less than 3cm managed?
The same as heavy menstrual bleeding:
- Mirena coil (1st line)
- Symptomatic Management (NSAIDs and Tranexamic acid)
- COCP
- Cyclical oral progestogens.
How are Fibroids >3cm Managed Medically?
Referral to Gynaecology for Ix and Tx.
Medical management options include:
- Symptomatic Management w NSAIDs and Tranexamic Acid.
- Mirena coil (depends on size + shape_
- COCP
- Cyclical oral progestogens.
How are fibroids >3cm managed surgically?
Surgical options for larger fibroids:
- Uterine artery embolisation
- Myomectomy
- Hysterectomy.
How are fibroids <3cm Managed Surgically?
Surgical options for smaller fibroids:
- Endometrial ablation
- Resection of submucosal fibroids during hysteroscopy
- Hysterectomy.
What drugs can be given to try reduce the size of fibroids before surgery?
GnRH antagonists (goserelin, Leuprorelin)
What does Red Degeneration of Fibroids refer to?
Ischaemia, infarction and Necrosis of the fibroid due to disrupted blood supply.
- Likely to occur in fibroids >5cm during 2nd and 3rd trimester of pregnancy.
Presents with severe abdo pain, low-grade fever, tachycardia and often vomiting.
Mx - supportive w rest and fluids + analgesia.
What is Adenomyosis?
Refers to Endometrial tissue inside the myometrium.
When is Adenomyosis more common?
- In later reproductive years
- In patients who have had several pregnancies. (Multiparous)
- Occurs in around 10% of women overall.
- May occur alone or with endometriosis or fibroids.
