What mullerian disorder of the uterus is most commonly seen with pregnancy loss?
Uterine Septum
What uterine anatomical change is frequently associated with mid-trimester loss of pregnancy of pre-term birth?
Bicornuate or Unicornuate Uterus
How do vaginal septums occur?
Incomplete canalization of the mullerian tubercle
When to vaginal septums typically present?
Typically around puberty due to pelvic mass or amenorrhea
What imaging study is useful in diagnosing uterine and tubal disorders?
Hysterosalpingogram
__________ Syndrome results commonly from intrauterine synechiae (adhesions) usually due to recurrent curettage
Asherman’s Syndrome
T/F: Patients requiring recurrent curettage due to miscarriage or elective pregnancy termination are more at risk for Asherman’s Syndrome
True
_____ _________ is inflammation of the endometrial lining that typically occurs from an ascending infection (Gc/Chl) from the lower genital tract
Benign Endometritis
T/F: In non-pregnant population, endometritis is most commonly associated with Pelvic Inflammatory Disease
True
Are endometrial polyps typically benign or malignant?
Benign
How are benign endometrial polyps diagnosed?
Treated:
Dx: Sonohysterogram
Tx: Hysteroscopic Resection
_____ ______ is described as the presence of ectopic endometrial glands and stroma in the myometrium which typically presents in parous women between the ages of 35-50 y.o.
Benign Adenomyosis
How may a uterus feel/appear on physical examination in a patient with Adenomyosis?
Diffusely enlarged, globular, tender uterus
How is adenomyosis diagnosed?
Clinical Suspicion
US or MRI
How is adenomyosis managed?
- r/o co-esistent pathology
- NSAIDs +/- Hormones
- Hysterectomy
What is the most common solid pelvic tumor in women?
Leiomyoma Uteri
What is a Leiomyoma Uteri?
Benign tumors of smooth muscle origin
T/F: The majority of Leiomyoma Uteri are symptomatic
False
The majority are asymptomatic
Although Leiomyoma Uteri is asymptomatic…..
What would the most common symptom be at presentation?
Bleeding Abnormalities
What imaging modality is commonly used to work up Leiomyoma Uteri?
US
MRI is occassionally used
How is asymptomatic Leiomyoma Uteri managed?
No treatment required
What is the goal of management for symptomatic Leiomyoma Uteri?
Control Hormonal Regulation and minimize unopposed estrogen
Will OCPs shrink uterine fibroids?
No
What medication class have shown to reduc uterine bulk from Leiomyoma Uteri?
GnRH Agonists
What is the only viable management option for Leiomyoma Uteri in women who wish to preserve fertility?
Myomectomy
What is the most DEFINITIVE management for Leiomyoma Uteri?
Hysterectomy
A 49 y/o female patient presents for routine gyne exam. She reports that for the last 6 months her menses have been getting longer and heavier. She also says she has been experiencing urinary frequency and constipation. Her abdominal exam is unremarkable. On pelvic exam, you feel a slightly enlarged irregular uterus and a left adnexal mass that moves with the uterine fundus. No other clinical findings. What is the most likely diagnosis?
Leiomyoma Uteri
What is the most common etiology of endometrial hyperplasia?
Unopposed Estrogen
What is the biggest risk factor for endometrial hyperplasia?
Obesity
What breast CA medication places a patient at higher risk for developing endometrial hyperplasia?
Tamoxifen
How could endometrial hyperplasia diagnosed?
- PAP Smear with glandular cells
- Endometrial Biopsy
- US
- Hysteroscopy with D&C
How is endometrial hyperplasia without atypia managed?
Cyclical Progestrin Therapy
Case #8: A 52 y/o obese patient with persistent menorrhagia undergoes an endometrial bx and is diagnosed with atypical adenomatous hyperplasia. What is the next best step in management?
A) Hysteroscopy/D & C to confirm no adenocarcinoma followed by total abdominal hysterectomy
B) Observation with repeat biopsy in 3 months
C) D & C to confirm no adenocarcinoma followed by daily Progesterone therapy
D) Oral Progesterone for 14 days a month and repeat biopsy in 6 months
A) Hysteroscopy/D & C to confirm no adenocarcinoma followed by total abdominal hysterectomy