Uterine Disorders

Question 1

What is adenomyosis?

Answer 1

Functional endometrial tissue in the myometrium of the uterus
(variant of endometriosis)

Question 2

What are the main symptoms of adenomyosis?

Answer 2

Menorrhagia
Dysmenorrhoea
Dyspareunia
Irregular bleedings

Question 3

Outline the pathophysiology of adenomyosis?

Answer 3

Endometrial stroma is allowed to make contact and communicate with the underlying myometrium after uterine damage

Question 4

Which scenarios may allow communication of the endo and myometrium?

Answer 4

Pregnancy and childbirth
C-sec
Uterine surgery
Surgical management of miscarriage or TOP

Question 5

Where is the invasion of the myometrium commonly found in adenomyosis?

Answer 5

Posterior wall of uterus

Question 6

What is the term given to endometrial glands which form visible nodules?

Answer 6

Adenomyoma

Question 7

What are the main risk factors for adenomyosis?

Answer 7

High parity
Uterine surgery
Prev C-sec
FHx

Question 8

What is felt on examination in adenomyosis?

Answer 8

Symmetrically enlarged tender uterus

Question 9

How is adenomyosis investigated?

Answer 9

Histological hysterectomy
TV USS
MRI

Question 10

How is adenomyosis cured?

Answer 10

Only cure is hysterectomy

Question 11

How is adenomyosis managed?

Answer 11

NSAIDs
COCP
IUS/IUD
GnRH agonist
Aromatase inhibitors

Question 12

Which surgical treatment can be offered in adenomyosis in women who wish to keep fertility?

Answer 12

Uterine artery embolisation

Question 13

When is the peak incidence of endometrial cancer?

Answer 13

65-75

Question 14

What is the most common form of endometrial cancer?

Answer 14

Adenocarcinoma

Question 15

What is the main cause of adenocarcinoma?

Answer 15

Stimulation of endometrium by unopposed oestrogen

Question 16

What are the risk factors for endometrial cancer?

Answer 16

Early menarche/late menopause
Nulliparity
Age
PCOS
HRT
Obesity
Lynch syndrome

Question 17

What are the clinical features of endometrial cancer?

Answer 17

Post-menopausal bleeding
Discharge
(Irregular bleeding is premenopausal)
Weight loss
Abdo pain

Question 18

Which examinations are performed on suspicion of endometrial cancers?

Answer 18

Abdo
Speculum
Bimanual

Question 19

How is endometrial cancer investigated?

Answer 19

TV USS

Biopsy

Question 20

What is a stage I endometrial carcinoma?

Answer 20

Confined to uterine body

Question 21

What is a stage II endometrial carcinoma?

Answer 21

Extends to cervix but not beyond uterus

Question 22

What is a stage III endometrial carcinoma?

Answer 22

Extends beyond uterus but still in pelvis

Question 23

What is a stage IV endometrial carcinoma?

Answer 23

Involves bladder or bowel

Mets

Question 24

How is endometrial hyperplasia treated?

Answer 24

Progestogens

IUS

Question 25

How is atypical endometrial hyperplasia treated?

Answer 25

Total abdominal hysterectomy | Bilateral salpingo-oophrectomy

Question 26

How are stage I and II endometrial cancers treated?

Answer 26

Total abdominal hysterectomy Bilateral salpingo-oophrectomy Stage II also take tissue around cervix away

Question 27

How is stage III endometrial carcinoma treated?

Answer 27

De-bulking surgery | Chemo/radio

Question 28

How is stage IV endometrial cancer treated?

Answer 28

De-bulking surgery | Palliative

Question 29

What is endometriosis?

Answer 29

Chronic condition in which endometrial tissue is located outwith the endometrium

Question 30

Who is most commonly affected by endometriosis?

Answer 30

women 25-50

Question 31

Which hormone is endometrial tissue sensitive to?

Answer 31

Oestrogen

Question 32

What are the main risk factors for endometriosis?

Answer 32

``` Early menarche FHs Short men cycles Long duration of bleeding HMB Structural defect ```

Question 33

How does endometriosis commonly present?

Answer 33

``` Cyclical pelvic pain Dysmenorrhoea Dyspareuia Dysuria Dyschezia ```

Question 34

How is endometriosis investigated?

Answer 34

Laparoscopy gold standard | Pelvic USS

Question 35

What are the typical laparoscopic findings on laparoscopy of endometriosis?

Answer 35

Chocolate cysts Adhesions Peritoneal deposits

Question 36

How is endometriosis managed?

Answer 36

Analgesics COCP Norethisterone Surgical removal or laser ablation

Question 37

How do COCP, IUD, IUS and norethisterone work in the management of endometriosis?

Answer 37

Supressing ovulation for 6-12 months can cause atrophy of the endometriosis lesions

Question 38

What are uterine fibroids?

Answer 38

Benign smooth muscle tumours

Question 39

What are uterine fibroids also known as?

Answer 39

Leiomyomas

Question 40

What is the most common type of fibroid?

Answer 40

Intramural

Question 41

Where is an intramural fibroid?

Answer 41

Confined to myometrium

Question 42

Where is a submucosal fibroid?

Answer 42

Develops immediately underneath the endometrium and projects into cavity

Question 43

Where is a subserosal fibroid?

Answer 43

Protudes into and distorts the surface of the uterus

Question 44

Which hormone stimulates the growth of fibroids?

Answer 44

Oestrogen

Question 45

What are common risk factors for fibroids?

Answer 45

``` Obesity Early menarche Increasing age FHs African-American ```

Question 46

How do fibroids present?

Answer 46

``` Usually asymptomatic May have pressure symptoms Bloating HMB Acute pelvic pain - rare ```

Question 47

How are fibroids investigated?

Answer 47

Pelvis USS | MRI

Question 48

How are fibroids managed medically?

Answer 48

Tranexamic or mefenamic acid COCP GnRH analogue Ulipristal

Question 49

How are fibroids managed surgically?

Answer 49

Myomectomy Uterine artery embolisation Hysterectomy TCRF

Question 50

What is Ulipristal?

Answer 50

Selective progesterone receptor modulator

Question 51

Why can GnRH analogues only be used for 6 months in fibroid management?

Answer 51

Risk of osteoporosis (due to temporary menopausal state)

Question 52

What is the role of Zolidex in fibroid management?

Answer 52

(GnRH) | Induces temporary menopausal state to reduce fibroid size before surgery

Question 53

Which surgical option is the choice for submucosal fibroids?

Answer 53

Transcervical resection of the fibroid (TCRF)