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Reproduction > Uterine Disorders (NOT DONE) > Flashcards

Uterine Disorders (NOT DONE) Flashcards

1
Q

What is Endometrial hyperplasia?

A

May be defined as abnormal proliferation of the endometrium in excess of the normal proliferation which occurs during the menstrual cycle. (A precursor for Endometrial Cancer in the minority)

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2
Q

What are the Types of Endometrial Hyperplasia?

A
  • Simple
  • Complex
  • Simple Atypical
  • Complex Atypical
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3
Q

What are some of the signs of Endometrial hyperplasia?

A

Abnormal Vaginal Bleeding e.g. intermenstrual/ Post menopausal.

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4
Q

What is the management of Endometrial hyperplasia?

A

Simple: High dose progestetogens then re-sampling in 3/4 months. Some types may resolve spontaneously.

Atypical: Hysterectomy usually advised.

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5
Q

What is the mainstay of treatment of an Endometrial Adenocarcinoma in early disease?

A

Total hysterectomy and bilateral salpingo-oophorectomy.
Standard surgical Approach as its curative in the early stages of disease.

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6
Q

What are Fibroids (leiomyomas)?

A

Benign smooth muscle tumours originating from the myometrium of the uterus.

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7
Q

What are some risk factors for Fibroids?

A

Unknown - Thought to be influenced by genetic, hormonal and environmental factors.

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8
Q

What hormones are important in the growth of fibroids?

A

Oestrogen and progesterone
- They usually stimulate development of the uterine lining during each menstrual cycle and appear to promote growth of fibroids.

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9
Q

Do fibroids contain oestrogen and progesterone receptors?

A

Yes, they contain more than normal uterine muscle cells.

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10
Q

What are the different types of Fibroids?

A
  • Subserosal, below the outer later of the uterus.
  • Intramural, within the myometrium - the muscle of the uterus.
  • Submucosal, Just below the lining of the uterus (endometrium)
  • Pedunculated, on a stalk.
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11
Q

In which ethnic group are fibroids most common?

A

Black women over other ethnic groups.

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12
Q

How do Fibroids usually present?

A

Often Asymptomatic however, can also present with:
- Heavy menstrual bleeding (most common symptom)
- Prolonged menstruation
- Abdo pain worse during menstruation.
- Bloating or feeling full
- urinary or bowel symptoms due to pelvic pressure or fullness.
- Deep dyspareunia (pain during sex)

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13
Q

What physical examination is done in suspected fibroids?

A

Abdominal and Bimanual Palpation.
- May reveal palpable masses or an enlarged firm, non-tender uterus.

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14
Q

What is the initial investigation for submucosal fibroids presenting with menorrhagia?

A

Hysteroscopy.

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15
Q

What is the investigation of choice for larger fibroids?

A

Pelvic ultrasound.

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16
Q

When May MRI scanning be considered in the management of fibroids?

A

Before surgical options, where more information is needed on size, shape and blood supply.

17
Q

How are fibroids less than 3cm managed?

A

The same as heavy menstrual bleeding:
- Mirena coil (1st line)
- Symptomatic Management (NSAIDs and Tranexamic acid)
- COCP
- Cyclical oral progestogens.

18
Q

How are Fibroids >3cm Managed Medically?

A

Referral to Gynaecology for Ix and Tx.

Medical management options include:
- Symptomatic Management w NSAIDs and Tranexamic Acid.
- Mirena coil (depends on size + shape_
- COCP
- Cyclical oral progestogens.

19
Q

How are fibroids >3cm managed surgically?

A

Surgical options for larger fibroids:
- Uterine artery embolisation
- Myomectomy
- Hysterectomy.

20
Q

How are fibroids <3cm Managed Surgically?

A

Surgical options for smaller fibroids:
- Endometrial ablation
- Resection of submucosal fibroids during hysteroscopy
- Hysterectomy.

21
Q

What drugs can be given to try reduce the size of fibroids before surgery?

A

GnRH antagonists (goserelin, Leuprorelin)

22
Q

What does Red Degeneration of Fibroids refer to?

A

Ischaemia, infarction and Necrosis of the fibroid due to disrupted blood supply.
- Likely to occur in fibroids >5cm during 2nd and 3rd trimester of pregnancy.

Presents with severe abdo pain, low-grade fever, tachycardia and often vomiting.
Mx - supportive w rest and fluids + analgesia.

23
Q

What is Adenomyosis?

A

Refers to Endometrial tissue inside the myometrium.

24
Q

When is Adenomyosis more common?

A
  • In later reproductive years
  • In patients who have had several pregnancies. (Multiparous)
  • Occurs in around 10% of women overall.
  • May occur alone or with endometriosis or fibroids.
25
Q

Why do Adenomyosis symptoms tend to resolve after Menopause?

A

Because the condition is hormone dependant.
- Similar to endometriosis and fibroids.

26
Q

How does Adenomyosis Typically present?

A
  • Painful periods (dysmenorrhoea)
  • Heavy Periods (menorrhagia)
  • Pain during intercourse (dyspareunia)
27
Q

What would the uterus feel like in adenomyosis?

A

Enlarged and tender uterus.
- softer than a uterus containing fibroids.

28
Q

How is Adenomyosis diagnosed?

A

TVUS is the first line investigation.

MRI and Transabdominal are alternative investigations where TVUS is not suitable.

29
Q

What is the Gold standard diagnosis of Adenomyosis?

A

Histological examination of the uterus after a hysterectomy.
- Not usually suitable for obvious reasons.

30
Q

What is the Management of Adenomyosis?

A

Depends on the symptoms, age and plans for pregnancy.
NICE recommend the same Tx as for Heavy Menstrual bleeding.

31
Q

How is Adenomyosis treated when the patient does not want contraception?

A

Treatment can be used during menstruation for symptomatic relief:
- Tranexamic acid when no pain assoc. (Antifibrinolytic - reduces bleeding)
- Mefenamic acid when there is assoc pain (NSAID - reduces both bleeding and pain)

32
Q

What is the management of Adenomyosis when the patient does want contraception or it is accepted?

A
  1. Mirena coil (first line)
  2. COCP
  3. Cyclical oral progestogens.
33
Q

What complications is Adenomyosis associated with in pregnancy?

A
  • Infertility
  • Miscarriage
  • Preterm birth
  • SGA
  • Preterm Premature rupture of membranes
  • Malpresentation
  • Need for C-section
  • PPH

Reproduction (17 decks)

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