Benign Conditions of Cervix, Uterus, Endometrium

Question 1

What are the three components of the cervix

Answer 1

Ectocervix
External os
Endocervical canal

Question 2

What is the ectocervix?

Answer 2

Vaginal part of the cervix

Lined in thick non-keratinised stratified squamous epithelium

Question 3

Where is the external os visible?

Answer 3

At the centre of the ectocervix as a dark circular area

Question 4

What is the endocervical canal lined in?

Answer 4

Simple columnar epithelium

Question 5

What is a cervical ectropion?

Answer 5

A visible columnar epithelium on the endocervix
Appears as a round, red area
Physiologycal

Question 6

What are triggers for a cervical ectropion?

Answer 6

3Ps
Pill
Puberty
Pregnancy

Question 7

What are symptoms of a cervical ectropion?

Answer 7

Intermentstrual, poistoctal bleeding

Mucous (excessive, clear, odourless)

Question 8

How do you (ix+) manage a cervical ectropion?

Answer 8

CONSIDER SMEAR / BIOSPY FOR CERVICAL CANCER
Cervical and lower genital tract swabs to exclude STI

Change from oestrogen based hormonal contraceptive
Cervical ablation

Question 9

What should you double check when investigating cervical ectropion?

Answer 9

Cervical, lower genital tract swab - STI

Smear - cervical malignancy

Question 10

What is a nabothian follicle?

Answer 10

When columnar glands in transformation zone seal over, forming small cysts on ectocervix

Question 11

How do you treat nabothian follicles?

Answer 11

NO treatment required

Question 12

What are cervical polyps?

Answer 12

Benign tumours from endocervical epithelium

Question 13

What do cervical polyps look like?

Answer 13

Smooth reddish protrusions

Question 14

How are cervical polyps removed?

Answer 14

By avulsion, with polyp forceps

Question 15

What is cervical stenosis?

Answer 15

Pathological narrowing of endocervical canal

Question 16

What causes cervical stenosis?

Answer 16

Iatrogenic

Question 17

What does cervical stenosis cause?

Answer 17

Entrapment of blood within uterus (haematometra) causing cyclical dysmenorrhoea with no menstrual bleeding

Question 18

How do you treat cerbical stenosis?

Answer 18

Surgical dilatation of cervix

Question 19

What are endometrial polyps?

Answer 19

Focal endometrial outgrowths

Question 20

What are RF for endometrial polyps?

Answer 20

Obesity
Late menopause
Tamoxifen, HRT

Question 21

How do polyps respond to hormonal changes?

Answer 21

They DONT

Question 22

How do you investigate polyps’

Answer 22

TVUSS

Hysteroscopy

Question 23

How do you manage endometrial polyps?

Answer 23

Polypectomy (surgical) - through hysteroscopy (day case)

Small one resolve alone

Question 24

What is Asherman Syndrome?

Answer 24

Fibrosis and adhesion formation within the endometrial cavity following irreversible damage of the single layer of thick basal epithelium (which Does not regenerate)

Question 25

What is a complication of Asherman syndrome?

Answer 25

Subfertility

Question 26

What are causes of Asherman Syndrome?

Answer 26

Surgery Overzealous curettage in TOP Pregnancy w uterine infection (endometritis)

Question 27

How do you manage Asherman syndrome?

Answer 27

Adhesiolysis (surgical breakdown of intrauterine adhesions)

Question 28

What are fibroids?

Answer 28

Leiomyoma | Benign tumour of uterine smooth muscle

Question 29

What are RF for fibroids?

Answer 29

Nulliparous Obese Afro carribean ethnicity

Question 30

What are the four locations of fibroids

Answer 30

SICS Subserosal Cervical Intramural Submucosal

Question 31

What are symptoms of fibroids?

Answer 31

``` HMB, IMB Subfertility, recurrent pregnancy loss, Pressure and pain Bladder and bowel dysfunction Abdominal distension ```

Question 32

How do fibroids reacts to oestrogen=?

Answer 32

They are OESTROGEN DEPENDENT - enlarge during pregnancy - shrink after menopause

Question 33

How do fibroids cause sub fertility?

Answer 33

mechanical distortion of endometrial tissue, preventing implantation / occlusion of FT

Question 34

What are investigations for fibroids?

Answer 34

FBC (anaemia) USS (TVUSS, TAUSS) Saline infusion sonography RMI Hysteroscopy

Question 35

What is the medical mx of fibroids?

Answer 35

For HMB: - LNG-IUS - Tranexamic acids - COCP - Injection f GnRH agonist (induces temporary menopause) - Ulipristal acetate

Question 36

What is Ulipristal Acetate

Answer 36

Selective Progesterone Receptor Modulator

Question 37

What is surgical mx for fibroids?

Answer 37

Myomectomy (surgical resection of fibroids, preserves fertility) Transcervical fibroid resection Hysterectomy Uterine artery embolisation

Question 38

What must you give prior to myomectomy / hysterectomy?

Answer 38

GnRH agonist pre-treatment for 3 months | This reduces bulk and vascularity of fibroids

Question 39

What is radiological tx for fibroids=

Answer 39

Uterine artery embolisation

Question 40

What is adenomyosis?

Answer 40

Endometrial glands and storm are found deep within the myometrium

Question 41

How does adenomyoisis present?

Answer 41

Secondary dysmenorrhoea Uterine enlargement HMB

Question 42

What is the gold standard investigation for adenomyosis?

Answer 42

MRI

Question 43

How do you manage adenomyosis?

Answer 43

Progesterone containing LARC | Hysterectomy - permanent tx

Question 44

Are fibroids associated to leiomyosarcoma?

Answer 44

very few women with fibroids then develop leiomyosarcoma Likely to be only because they are similar (confusing for dx) or coincidental as fibroids are very common Little evidence for causation

Question 45

What is the main RF for fibroids?

Answer 45

OESTROGEN

Question 46

What are possible triggers for fibroid growth?

Answer 46

PREGNANCY | also high BMI

Question 47

Why is high BMI a trigger for fibroid growth?

Answer 47

Adipose tissue converts testosterone to oestrogen

Question 48

What are the four types of fibroid you can get?

Answer 48

Submucosal Cervical intramural Subseerosal

Question 49

Where do submucosal fibroids sit?

Answer 49

Below the mucosa | They bulge out into the endometrial cavity

Question 50

Where do cervical fibroids sit?

Answer 50

At the cervix

Question 51

Where do intramural fibroids sit?

Answer 51

Within the myometral wall

Question 52

Where do subsrosal fibroids sit?

Answer 52

Just below serous layer, on outer edge of uterus

Question 53

What is another term for dysmenorrhoea?

Answer 53

UTERINE ANGINA | Essentially because contractions during periods cause reduced blood supply, leading to pain

Question 54

WHAT DO symptoms for fibroids depend on?

Answer 54

ON the LOCATION of the fibroid

Question 55

What are common symptoms with fibroids and why do they occur?

Answer 55

- HMB (increased surface area means increased bleeding) - Dysmenorrhoea (increased uterine angina) - Anaemia (from excess bleeding) - Subfertility (if submucosal, makes it hard for implantation) - Pain and pressure sx (if very large(

Question 56

How do fibroids affect pregnancy?

Answer 56

Early miscarriage Late miscarriage Premature birth Because fibroids stretch the myometrium, triggering early labour

Question 57

What is red degeneration of fibroids?

Answer 57

Fibroid grows excessively during pregnancy It outgrows the blood supply DIes

Question 58

What factors should you consider when managing fibroids?

Answer 58

Effect on quality of life Fertility Cultural wishes