Upper Gynaecological Problems Flashcards
(31 cards)
Give 4 risk factors for endometrial polyps
Obesity Hypertension Hx of cervical polyps Tamoxifen HRT 40-50yrs
What are endometrial polyps?
Small, benign tumours in the uterine cavity originating from the endometrial lining
Give 3 clinical features of endometrial polyps
Irregular menstrual bleeding
Post-menopausal bleeding
Menorrhagia
Post-coital bleeding
How are endometrial polyps diagnosed?
Hysteroscopy
TV ultrasound
How are endometrial polyps treated?
Surgical removal by curettage or diathermy
How common are fibroids?
1 in 3 women
Give 3 risk factors for fibroids?
Obesity 15-50yrs old (reproductive age) FHx Afro-Caribbean Nulliparous
What is the pathophysiology of fibroids?
Benign tumours of the myometrium (leiomyomata). Made up of smooth muscle and fibrous connective tissue.
Why are they not seen in post-menopausal women?
After the menopause they calcify and regress
Microscopically, what appearance to fibroids have?
‘Whorled appearance’
Give 5 possible clinical features of fibroids
Depends on size and location of fibroid: Menorrhagia Abdominal pain Painful sex Increased urinary frequency Decreased fertility Bloating
How are fibroids diagnosed?
TV Ultrasound
Hysteroscopy
Can also have MRI
When are fibroids not treated?
> 45 years old
No symptoms
Not growing
Subserous (protrudes externally) or intramural (in wall with no protrusion)
How can fibroids be treated medically?
Tranexamic acid NSAIDs COCP Oral progesterone GnRH analogues Ulipristal acetate
How can fibroids be managed surgically?
Laparoscopic removal –> myomectomy
Hysterectomy
Hysteroscopic removal
Give 2 procedures which can reduce the symptoms of fibroids
Uterine artery embolisation –> blocks fibroid blood vessels
Endometrial ablation –> removes lining of uterus (reduces fertility)
What is adenomyosis?
Presence of endometrium in the myometrium so uterus becomes enlarged.
Give 3 risk factors for adenomyosis
~40 yrs
Parous
Early menarche
Hx of uterine surgery
Give the 3 main symptoms of adenomyosis
Dysmenorrhea
Menorrhagia
Dyspareunia
How is adenomyosis diagnosed?
Can see thickened junctional zone on MRI
How is adenomyosis treated?
Hysterectomy
Give 4 risk factors for endometriosis
Post menarche
Pre menopause
Nulliparous
FHx
What is the pathophysiology of endometriosis?
Endometrial cells are found outside the uterus. Each month the endometrial cells sheds a period. The tissue outside the uterus has nowhere to bleed into and so causes pressure build up leading to symptoms.
No one knows why endometriosis occurs. Thought to be due to retrograde flow of period blood back into the fallopian tubes (Sampson’s theory) combined with a weaker immune system so the cells cannot fight off the implanting endometrial cells.
Genetics is also thought to have a role in the development.
Alternative theory is that multipotential cells undergo metaplasia to become endometrium (Meyer’s theory)
What period symptoms will an endometriosis patient experience?
Heavy, prolonged, painful periods
Irregular
Loss of old blood before period
Intermenstrual spotting
