Uterine Pathology Flashcards
(45 cards)
what are the phases of the ovarian cycle?
folliclar phase = oestrogen driven formation of follicle, ends with ovulation
ovulation = follicle ruptures and releases oocyte
luteal phase = formation of corpus luteum, ends with wither pregnancy or luteolysis
phases of uterine cycle?
menstrual phase (day one-three when period starts) proliferative phase (endometrium proliferates for around 14 days) secretory phase (14 days exactly)
how long is uterine cycle?
28 days
what drives proliferation?
oestrogen
what triggers the switch between proliferative and secretory phase?
progesterone
what triggers menstrual phase?
withdrawal of hormones
causes necrosis
when is and what happens in the fertilised phase?
secretory phase onwards
triggered by progesterone and HCG
causes hypersecretion and decidualisation
what happens in post menopausal phase?
nothing
inactive, atrophic endometrium
non-cycling
histological signs of proliferative phase?
mitotic figures in round glands of endometrium
where are the cells which secrete progesterone to drive the secretory phase?
corpus luteum (degenerates if fertilisation doesnt take place)
signs of secretory phase on histology?
glands are less round
pale secretions can be seen around the outside of the glands
indicates that ovulation just occurred in past couple of days
indications for endometrial sampling/biopsy?
abnormal uterine bleeding
infertility investigation
spontaneous therapeutic abortion
assessment of response to hormonal therapy (e.g in endometrial cancer)
endometrial ablation
work up to prior to hysterectomy for benign indications
incidental finding of thickened endometrium on scan
endometrial cancer screening in high risk patients (obese)
what do the following terms mean?
- menorrhagia
- amenorrhoea
- oligomenorrhoea
menorrhagia = prolonged and increased menstrual bleeding amenorrhoea = absence of emnstruation >6 months oligomenorrhoea = menses at intervals of >35 days
what is post menopausal bleeding?
abnormal uterine bleeding 1 year after cessation of menstruation
what can cause AUB in adolescence/early reproductive life?
DUB usually due to anovulatory cycles
pregnancy/miscarriage
endometriosis
bleeding disorders
what can cause AUB in reproductive life/perimenopause?
pregnancy/miscarriage
DUB usually due to anovulatory cycles, luteal phase defects
endometritis
endometrial/endocervical poly
leiomyoma (smooth muscle tumour - may be called fibroid in endometrium)
adenomyosis (glands in smooth muscular wall of uterus)
exogenous hormone effects
bleeding disorders
hyperplasia
neoplasia (cervical, endometrial)
what can cause AUB post menopause?
atrophy (usually only happens once) endometrial poly exogenous hormones (HRT, tamoxifen) - tamoxifen often taken in breast cancer endometritis bleeding disorders hyperpalsia endometrial carcinoma sarcoma
what thickness of endometrium is too thick and warrants a biopsy?
16mm in premenopausal
4mm in post menopausal
how can the endometrium be assessed?
hysteroscopy
how can the endometrium be sampled?
andometrial pipelle
- quick, easy
- done as outpatient
- not painful
- very safe but limited sample ability as doesnt reach whole uterus so can miss a cancer etc
dilation and curretage
- more thorough (can also miss few cancers)
required history in uterine problem?
Age date of LMP and length of pregnancy pattern of bleeding hormones (drugs) recent pregnancy
do you need to know number of pregnancies or other drugs that arent hormonal?
no
when should an endometrial sample be taken in uterine cycle?
not really informative in menstrual phase as infrastructure is falling apart
can tell theres not a cancer but thats about it
what is DUB?
dysfunctional uterine bleeding
irregular uterine bleeding that reflects a disruption in the normal cyclic pattern od ovulatory hormonal stimulation to the endometrial lining (no organic cause for bleeding)
