Uterine Disorders Flashcards
(23 cards)
Dysmenorrhea definition
Painful periods
Crampy abdominal pain that starts at the onset of the period
Dysmenorrhea classification
Primary = menstrual pain with no underlying pelvic pathology
Secondary = menstrual pain with associated pelvic pathology
Causes of abnormal uterine bleeding
PALM COEIN
Structural
Polyps
Adenomyosis
Leiomyoma
Malignancy + hyperplasia
Non-structural
Coagulopathies
Ovarian dysfunction
Endometrial
Iatrogenic
Not yet classified
What is a leiomyomata?
Fibroid
Anatomical location of fibroids
Myometrium of uterus
Fibroids classification
Intramural = confined to myometrium of uterus
Submucosal = develops immediately underneath the endometrium of the uterus and protrudes into the uterine cavity
Subserosal = protrudes into and distorts serosal surface of uterus +/- pedunculation
Fibroids pathogensesis
Currently unknown
Thought to be due to oestrogen stimulation
Fibroids risk factors
Obesity
Early menarche
Increasing age
Family history
Ethnicity (Black)
Fibroids clinical features
Abdominal symptoms
Heavy menstrual bleeding
Subfertility
Acute pelvic pain
Fibroids management
Medical: transexamic acid, mefanamic acid, COCP, GnRH analogues, Selective progesterone receptor modulators
Surgical: Hysteroscopy, myomectomy, uterine artery embolisation, hysterectomy
Fibroids complications
Iron def anaemia
Compression of pelvic organs (UTI, incontinence, hydronephrosis, UR)
subfertility / infertility
Degeneration
Torsion
Uterine fibroids are a benign tumour of which tissue?
Smooth muscle
What is the most common type of uterine fibroid?
Intramural
Fibroids surgical management for women who still want to have children
Myomectomy
Endometriosis pathophysiology
Unknown
? Retrograde menstruation
Cyclical pain due to oestrogen stimulation from menstrual cycle
Repeated inflammation and scarring > adhesions
Endometriosis risk factors
Early menarche
Fx
Short menstrual cycles
Long duration of menstrual bleeding
Heavy menstrual bleeding
Defects in uterus / Fallopian tubes
Endometriosis clinical features
Cyclical pelvic pain (at time of menstruation)
Dysmenorrhea
Dysparenunia
Dysuria
Dyschezja
Subfertility
Haemothorax (distant sites)
What is adenomyosis?
presence of endometrial tissue within myometrium of uterus
benign invasion
possible variant of endometriosis
Adenomyosis clinical features
Menorrhagia
Dysmenorrhoea
+/- fibroids
adenomyosis pathophysiology
endometrial stroma communication with myometrium following uterine damage
Most common site of adenomyosis
posterior wall of uterus
Risk factors of adenomyosis
high parity
uterine surgery (endometrial ablation / curettage)
previous caesarian section
Fx
endometriosis investigations
laparoscopy (gold standard)
- chocolate cysts, adhesions, peritoneal deposits
TVUS
pelvic MRI (to assess extent of endometrial involving bladder, bowel, ureters)
