Uterus Flashcards
Endometriosis - What is it?
Chronic inflammatory conditions
Oestrogen dpt
➤ Proliferation of functional endometrial tissue developing outside the uterine cavity (pelvic peritoneum + ovaries)
Endometriosis - S&S
Asymptomatic Chronic pelvic P LBP Dysmenorrhoea Dyspareunia Infertility Menorrhagia Urinary symptoms Cyclical GI
Endometriosis - Risk factors
Unknown ? Smoking ? Nulliparity ? Family Hx ? Age ? Pelvic infection ? White ethnicity
Endometriosis - Ix
Case Hx Increase CA125 Abdo / pelvic exam Pelvic US MRI Laparoscopy
Endometriosis - Staging
➤ Based on location, depth of infiltrates, severity of adhesions
1: minimal
2: mild
3: moderate
4: severe
Endometriosis - Tx
Analgesia - NSAIDs, neuromodulators
Hormone - OCP, progestogen, GnHR agonist & antagonist
Surgery - ablation, excision
Endometriosis - Cx
Endometrioma
Infertility
Ovarian CA
Ovarian cysts / adhesions
Fibroids / Leiomyomas - Age?
Childbeating years
Fibroids / Leiomyomas - Types
Intramural
Submucosal
Subserosal
Pedonculated submucosal
Fibroids / Leiomyomas - S&S
Anaemia Infertility Menorrhagia Dysmenorrhoea LBP Pressure Bowel & bladder pbs Asymptomatic
Fibroids / Leiomyomas - Risk factors
age
ethnicity
family Hx
early puberty
Fibroids / Leiomyomas - What decreases risk?
Progestogen only
Fibroids / Leiomyomas - Influenced by?
Female H
Fibroids / Leiomyomas - Ix
case Hx pelvic exam US MRI hysteroscopy bloods (FBC, Hb)
Fibroids / Leiomyomas - Tx
Decrease oestrogen ➤ be careful with fertility and osteoporosis
➤ Depends on age - Menopause ➤ shrinks
Decrease menorrhagia: levonorgestrel IU, tranexamic acid, OCP, anti-inflammatories, progesterone only
Decrease fibroids: gonadotropin releasing H analogues, ulipristal acetate (synthetic selective progesterone receptor modulator), surgery (hysterectomy, myomectomy)
Fibroids / Leiomyomas - Cx
menorrhagia malignancy infertility pregnancy degenerative fibroids
Abnormality of the uterus - Examples
absent unicornate double uterus bicornate septated uterus DES (T shape)
Abnormality of the uterus - Ix
case Hx pelvic exam US MRI laparoscopy hysteroscopy
Endometrial hyperplasia - S&S
abnormal bleeding - intermenstrual, postcoital, postmenopausal
Endometrial hyperplasia - Risk factors
increase BMI
unopposed oestrogen (tamoxifen)
an ovulation (PCOS)
some tumours
Endometrial hyperplasia - What does it progress to if left untreated?
CA
Endometrial hyperplasia - Ix
case Hx pelvic exam US CT MRI hysteroscopy endometrial biopsy
Endometrial hyperplasia - Tx
- Spontaneous regression if no atypia ➤ 75% cases. Regression increase with progestogen.
- Not wanting to maintain fertility ➤ total abdominal hysterectomy B salpingo-oophorectomy (TAHBSO)
- Atypia + want fertility ➤ monitor, ?H
Endometrial CA - S&S
postmenopausal bleeding dyspareunia intermenstrual bleeding abnormal watery discharge pelvic P
Endometrial CA - Risk factors
age
unopposed oestrogen ➤ M (tamoxifen), obesity, PCOS, DM, irregular ovulation, malignancy
length of years menstruating
nulliparity
endometrial hyperplasia
hereditary non-polyposis colorectal CA (HNPCC)
Endometrial CA - Stages
I: in uterus
II: uterus + cervix
III: spread beyond uterus but not reached rectus, bladder but involvement of pelvic LN
IV: spread past pelvis ➤ bladder, rectum, distant parts of the body
Endometrial CA - Tx
surgery - total abdominal hysterectomy
radiation
M - synthetic progestin
chemo
Uterine prolapse - Why?
Pelvic floor muscles & ligaments stretch & weaken ➤ inadequate support ➤ uterus protrude
Uterine prolapse - When?
Any age
Post-menopausal ++
Uterine prolapse - Causes
damage of supporting tissue ➤ pregnancy, childbirth gravity decrease oestrogen straining chronic cough
Uterine prolapse - S&S
sensation of heaviness in pelvis tissue protruding from vagina urinary pbs ➤ retention, incontinence LBP bowel pbs
Uterine prolapse - Risk factors
> 1 vaginal delivery large baby increase age - decrease oestrogen heavy lifting chronic coughing straining genetic conditions - obesity, COPD, constipation, Marfan's, hyper mobility, EDS
Uterine prolapse - Tx
vaginal pessary
surgery - repair, hysterectomy
exercises
no smoking
Uterine prolapse - Prevention
decrease weight
high fibre diet
pelvic floor ex
