Uterine Abnormalities

Question 1

What are structural causes of AUB?

Answer 1

Endometrial Polyps
Adenomyosis
Leiomyoma

Question 2

What is an endometrial Polyp?

Answer 2

Hyperplastic overgrowth of endometrial glands and stroma that projects from endometrial surface: and originates from endometrial tissue

Question 3

How can Endometrial polyps be diagnosed?

Answer 3

visualize on Transvaginal US or operative Hysteroscopy

Polypectomy is performed to diagnosis histologically

Question 4

What is Adenomyosis?

Answer 4

invasion of endometrial glands into the myometrium: commonly in women 35-50

Question 5

What are risk factors for Adenomyosis?

Answer 5

Endometriosis and uterine fibroids

Question 6

What are common symptoms of Adenomyosis?

Answer 6

Dysmenorrhea and Menorrhagia

Question 7

What is the most accurate test for Adenomyosis?

Answer 7

MRI

Question 8

What is seen on physical exam with Adenomyosis?

Answer 8

Uterus is large, globular and boggy

Question 9

How do you treat Adenomyosis?

Answer 9

Hysterectomy
-only definitive treatment/only way to definitively diagnose

Question 10

What is Leiomyoma?

Answer 10

Uterine fibroids: benign monoclonal tumors that stem from smooth muscle cells of the myometrium: they can occur under the serosa, wihtin the myometrial wall or within the endometrial cavity

Question 11

What patient population is Leiomyoma common in?

Answer 11

Obese and African American Women

Question 12

What are common Symptoms of Leiomyoma?

Answer 12

Heavy, irregular bleeding with pelvic pain and pressure: tumors are hormone sensitive: Grow in pregnancy and shrink with menopause

Question 13

What is revealed on Bimanual exam in Leiomyoma?

Answer 13

Enlarged, mobile and irregular nontender uterus

Question 14

How does diagnostic testing for Leiomyoma begin?

Answer 14

Transvaginal US: if the submucosa cannot be visualized use saling infusion sonography of hysteroscopy

Question 15

What are the treatment options for Leiomyoma?

Answer 15

Hormonal Contraceptives: Levonorgestrel IUD
Myomectomy
Hysterectomy once childbearing is complete

Question 16

What is Endometriosis?

Answer 16

Implantation of endometrial tissue outside of the endometrial cavity

Question 17

Where are the most common sited for Endometrial tissue to implant in Endometriosis?

Answer 17

Ovary and Pelvic Peritoneum

Question 18

What population does Endometriosis occur in?

Answer 18

F of reproductive age and more common if a 1st degree relative has endometriosis

Question 19

How does Endometriosis present?

Answer 19

Cyclical pelvic pain: starts 1-2 weeks before menstruation: peaks 1-2 days before and ends with menstruation

Heavy Menstrual bleeding

Physical exam: nodular uterus and adnexal mass

Question 20

How is Endometriosis Diagnosed?

Answer 20

Direct visualization via Laparoscopy: looks like a rusty or dark brown lesion: cluster of lesions on the ovary called an endometrioma looks like a “Chocolate cyst”

Question 21

How is endometriosis treated?

Answer 21

NSAIDs
hormonal contraceptives
GnRH agonists
Aromatase Inhibitors

Question 22

What can be added to decrease FSH and LSH for moderate to severe symptoms in endometriosis?

Answer 22

Danazol or Leuprolide

Question 23

How does Danazol work?

Answer 23

Androgen derivative

Question 24

What are the side effects of Danazol?

Answer 24

Acne, oily skin, weight gain and hirsutism

Question 25

What is the mechanism of Leuprolide acetate?

Answer 25

GnRH agonist: when given continuously is suppresses estrogen

Question 26

What are the side effects of Leuprolide acetate?

Answer 26

Hot flashes and decreased bone density

Question 27

How do you manage severe symptoms or infertility of Endometriosis?

Answer 27

Surgery to remove all endometrial implants and adhesions to restore pelvic anatomy If patients have completed child-bearing consider Total Abdominal hysterectomy or bilateral salpingo-oophorectomy

Question 28

What do the majority of Endometria Hyperplasia and Carcinoma occur secondary to?

Answer 28

Chronic exposure of the endometrium to unopposed estrogen

Question 29

How do Endometrial Hyperplasia and Carcinoma present?

Answer 29

AUB or postmenopausal bleeding

Question 30

What are the 2 categories of Endometrial Hyperplasia?

Answer 30

Hyperplasia without atypia (Benign) Atypical Hyperplasia (Endometrial intraepithelial Neoplasm EIN)

Question 31

What is Endometrial Hyperplasia without atypia?

Answer 31

Benign: Proliferative endometrium with dilated and contorted glands

Question 32

What is Endometrial Atypical Hyperplasia?

Answer 32

Endometrial Intraepithelial Neoplasm (EIN): epithelial crowding: increased gland to stroma ratio and cells appearing distinct from normal endometrial cells

Question 33

What are rick factors for Endometrial hyperplasia and carcinoma?

Answer 33

Obese, postmenopausal PCOS Tamoxifen therapy Early Menarche Late menopause Lynch Syndrome

Question 34

How do you treat endometrial hyperplasia/Carcinoma?

Answer 34

Surveillance, progestin therapy or hysterectomy

Question 35

What is the treatment of choice for Endometrial EIN?

Answer 35

Hysterectomy due to high risk of progression to endometrial carcinoma