Uterus

Question 1

Endometriosis - What is it?

Answer 1

Chronic inflammatory conditions
Oestrogen dpt
➤ Proliferation of functional endometrial tissue developing outside the uterine cavity (pelvic peritoneum + ovaries)

Question 2

Endometriosis - S&S

Answer 2

Asymptomatic
Chronic pelvic P
LBP
Dysmenorrhoea
Dyspareunia
Infertility
Menorrhagia
Urinary symptoms
Cyclical GI

Question 3

Endometriosis - Risk factors

Answer 3

Unknown
? Smoking
? Nulliparity
? Family Hx
? Age
? Pelvic infection
? White ethnicity

Question 4

Endometriosis - Ix

Answer 4

Case Hx
Increase CA125
Abdo / pelvic exam
Pelvic US
MRI
Laparoscopy

Question 5

Endometriosis - Staging

Answer 5

➤ Based on location, depth of infiltrates, severity of adhesions

1: minimal
2: mild
3: moderate
4: severe

Question 6

Endometriosis - Tx

Answer 6

Analgesia - NSAIDs, neuromodulators
Hormone - OCP, progestogen, GnHR agonist & antagonist
Surgery - ablation, excision

Question 7

Endometriosis - Cx

Answer 7

Endometrioma
Infertility
Ovarian CA
Ovarian cysts / adhesions

Question 8

Fibroids / Leiomyomas - Age?

Answer 8

Childbeating years

Question 9

Fibroids / Leiomyomas - Types

Answer 9

Intramural
Submucosal
Subserosal
Pedonculated submucosal

Question 10

Fibroids / Leiomyomas - S&S

Answer 10

Anaemia
Infertility
Menorrhagia
Dysmenorrhoea
LBP
Pressure
Bowel & bladder pbs
Asymptomatic

Question 11

Fibroids / Leiomyomas - Risk factors

Answer 11

age
ethnicity
family Hx
early puberty

Question 12

Fibroids / Leiomyomas - What decreases risk?

Answer 12

Progestogen only

Question 13

Fibroids / Leiomyomas - Influenced by?

Answer 13

Female H

Question 14

Fibroids / Leiomyomas - Ix

Answer 14

case Hx
pelvic exam
US
MRI
hysteroscopy
bloods (FBC, Hb)

Question 15

Fibroids / Leiomyomas - Tx

Answer 15

Decrease oestrogen ➤ be careful with fertility and osteoporosis
➤ Depends on age - Menopause ➤ shrinks
Decrease menorrhagia: levonorgestrel IU, tranexamic acid, OCP, anti-inflammatories, progesterone only
Decrease fibroids: gonadotropin releasing H analogues, ulipristal acetate (synthetic selective progesterone receptor modulator), surgery (hysterectomy, myomectomy)

Question 16

Fibroids / Leiomyomas - Cx

Answer 16

menorrhagia
malignancy
infertility
pregnancy
degenerative fibroids

Question 17

Abnormality of the uterus - Examples

Answer 17

absent
unicornate
double uterus
bicornate 
septated uterus
DES (T shape)

Question 18

Abnormality of the uterus - Ix

Answer 18

case Hx
pelvic exam
US
MRI
laparoscopy 
hysteroscopy

Question 19

Endometrial hyperplasia - S&S

Answer 19

abnormal bleeding - intermenstrual, postcoital, postmenopausal

Question 20

Endometrial hyperplasia - Risk factors

Answer 20

increase BMI
unopposed oestrogen (tamoxifen)
an ovulation (PCOS)
some tumours

Question 21

Endometrial hyperplasia - What does it progress to if left untreated?

Answer 21

CA

Question 22

Endometrial hyperplasia - Ix

Answer 22

case Hx
pelvic exam
US
CT
MRI
hysteroscopy
endometrial biopsy

Question 23

Endometrial hyperplasia - Tx

Answer 23

• Spontaneous regression if no atypia ➤ 75% cases. Regression increase with progestogen.
• Not wanting to maintain fertility ➤ total abdominal hysterectomy B salpingo-oophorectomy (TAHBSO)
• Atypia + want fertility ➤ monitor, ?H

Question 24

Endometrial CA - S&S

Answer 24

postmenopausal bleeding
dyspareunia
intermenstrual bleeding
abnormal watery discharge 
pelvic P

Question 25

Endometrial CA - Risk factors

Answer 25

age unopposed oestrogen ➤ M (tamoxifen), obesity, PCOS, DM, irregular ovulation, malignancy length of years menstruating nulliparity endometrial hyperplasia hereditary non-polyposis colorectal CA (HNPCC)

Question 26

Endometrial CA - Stages

Answer 26

I: in uterus II: uterus + cervix III: spread beyond uterus but not reached rectus, bladder but involvement of pelvic LN IV: spread past pelvis ➤ bladder, rectum, distant parts of the body

Question 27

Endometrial CA - Tx

Answer 27

surgery - total abdominal hysterectomy radiation M - synthetic progestin chemo

Question 28

Uterine prolapse - Why?

Answer 28

Pelvic floor muscles & ligaments stretch & weaken ➤ inadequate support ➤ uterus protrude

Question 29

Uterine prolapse - When?

Answer 29

Any age | Post-menopausal ++

Question 30

Uterine prolapse - Causes

Answer 30

``` damage of supporting tissue ➤ pregnancy, childbirth gravity decrease oestrogen straining chronic cough ```

Question 31

Uterine prolapse - S&S

Answer 31

``` sensation of heaviness in pelvis tissue protruding from vagina urinary pbs ➤ retention, incontinence LBP bowel pbs ```

Question 32

Uterine prolapse - Risk factors

Answer 32

``` > 1 vaginal delivery large baby increase age - decrease oestrogen heavy lifting chronic coughing straining genetic conditions - obesity, COPD, constipation, Marfan's, hyper mobility, EDS ```

Question 33

Uterine prolapse - Tx

Answer 33

vaginal pessary surgery - repair, hysterectomy exercises no smoking

Question 34

Uterine prolapse - Prevention

Answer 34

decrease weight high fibre diet pelvic floor ex