Uterine disorders

Question 1

Defintion of Endometriosis?

Answer 1

The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature causes an inflammatory response

Question 2

What is Endometriosis a risk factor for?

Answer 2

Ovarian cancers

Question 3

What is the pathophysiology (reasoning) for endometriosis?

Answer 3

Retrograde menstruation
o Retrograde flow of endometrial tissue through fallopian tubes and peritoneum

Deficient cell immunity
Hereditary

Question 4

Risk factors for Endometriosis?

Answer 4

−Nulliparity (never pregnant)
−Prolonged exposure to endogenous estrogen
−Heavy menstrual bleeding
−Obstruction of menstrual outflow
−DES exposure in utero (Diethyst..)
−Height greater than 68 inches
−Lower BMI
−High consumption of unsaturated fat

Question 5

Clinical presentation of Endometriosis?

Answer 5

1. Premenstrual pelvic pain–> pain subsides after menses
2. Infertility in 30-40%
3. Dysmenorrhea
4. Dypareunia (pain with intercourse)

Question 6

What are physical exam findings found in endometriosis?

Answer 6

Tenderness / nodules at posterior cul-de-sac

Fixed or retroverted uterus (2o to adhesions)
o Cervix displaced laterally

Endometriomas cause adnexal masses or tenderness

Question 7

How is Endometriosis diagnosed definitively.

Answer 7

Need to see lesions with Laparoscopy

Question 8

What is seen on Laparoscopy when diagnosing endometriosis?

Answer 8

MC site will be the ovaries

Chocolate cysts

Question 9

Which tumor marker can support the diagnosis of endometriosis?

Answer 9

CA-125

Question 10

Treatments for Endometriosis in mild diseases?

Answer 10

NSAIDS and OCPs

Question 11

Treatment for MOderate to severe Endometriosis?

Answer 11

OCPs
Progestiins
GnRH agonists

Question 12

Which population is most likely to have Uterine Fibroids?

Answer 12

African american women

Question 13

Clinical presentation of Uterine fibroids

Answer 13

Abnormal uterine bleeding

Question 14

What is Adenomyosis?

Answer 14

overgrowht of the endometrial glands and stroma into the uterine myometrium

Question 15

Clinical Presentation of Adenomyosis?

Answer 15

Menorrhagia (more severe than fibroids)
 Dysmenorrhea
 Pelvic pain
 History of previous uterine surgery (C - section)
 Prior myomectomy

Question 16

Physical exam findings of Adenomyosis?

Answer 16

Bimanuel exams reveals diffuse unterine enlargement

Question 17

What is needed to make a definitive diagnosis for Adenomyosis?

Answer 17

histologic examination after hysterectomy

Question 18

Treatments for Adenomyosis?

Answer 18

Hysterectomy - definitive treatment

Question 19

Risk factors for Endometrial Hyperplasia?

Answer 19

−Early menarche (<12yo)
−Late menopause (>52yo)
−Infertility, nulliparous
−OBESITY, OBESITY, OBESITY–> more estrogen conversion from fat
−Unopposed estrogen replacement therapy
-Diabetes
-Family history of Lynch Syndrome (colon cancer)

Question 20

WHO Classifications for Endometrial Hyperplasia

Answer 20

Hyperplasia without atypia (non-neoplastic)
Atypical hyperplasia (endometrial intraepithelial neoplasia)

Question 21

Clinical presentation of Endometrial Hyperplasia?

Answer 21

Asymptomatic
Post-menopausal bleeding
Menorrhagia (heavy bleeding)
Intermenstrual bleeding Prolonged menses (> 7d)
Decreased menstrual interval (< 21d)
Oligomenorrhea / Amenorrhea D&C, hysteroscopy (if stenosis of cervical os)

Question 22

What physical exam procedures need to be done for women with Endometrial hyperplasia?

Answer 22

Pelvic Exam
Pelvic Ultrasound
Endometrial biopsy

Question 23

Treatment of Hyperplasia without atypia?

Answer 23

− Mirena IUD
− Provera 10mg QD for 3 - 6mos, continuously or last 10 days of each month
− Reassess in another few months with EMB to ensure resolution

Question 24

Treatment for Hyperplasia with atypia

Answer 24

−Hysterectomy is treatment of choice
o Completed childbearing
o Up to 50% have underlying endometrial cancer