W11 L1 Mon uterine disorder Flashcards
(37 cards)
What is menstrual cycle
The regular renewal of the lining of the uterus (the endometrium) to prepare for potential embryo implantation.
Step in the menstrual cycle
- Menses – Thickened endometrium is eliminated
- Proliferative – Endometrium re-grows
- Secretory – Post-ovulation, the endometrium decidualises and prepares for implantation
Period pain is considered normal if
- Pain is present on the first 1 or 2 days of menses
- Pain is relieved by heat packs or mild medications
- Pain does not prevent you from doing day-to-day activities
Period pain is considered abnormal if
- Pain is severe enough to disrupt normal activities
- Pain persists beyond the menses period
- Pain is chronic and last more than 6 months
Primary Dysmenorrhea
- High prevalence (43-93%)
- Severe pain experienced (30%)
- Lasts 1-3 days
- Unknown cause – speculated hyperproduction of prostaglandins (induce uterine contractions)
- Treated with Non-steroidal anti-inflammatory drugs NSAID (aspirin, ibuprofen), COX inhibitors (naproxen)
Secondary Dysmenorrhea
- Pain due to an underlying pathology
- Common causes are endometriosis and adenomyosis
- Treatment is OCP (progestin) and/or surgery (removal of underlying cause)
Abnormal Uterine Bleeding (AUB)
occurs when menstrual bleeding falls outside normal parameters 25-80ml(for a period >6 months)
§ Causes: PALM-COEIN to investigate structural changes to uterus + non-structural issues
Ø PALM: Polyps, Adenomyosis, Leiomyoma (fibroids), Malignancy + hyperplasia
Ø COEIN: Coagulopathy (clotting disorders), Ovarian dysfunction, Endometrial dysfunction, Iatrogenic (nonmenstrual bleeding/spotting due to hormonal therapies), Not otherwise classified
Heavy Menstrual Bleeding (HMB)
§ HMB: excessive menstrual blood loss which interferes with physical, emotional, social + quality of life
Ø Normal 5-80mL blood loss (35mL average)
Ø >80mL causes anaemia + severe fatigue (27-54% of menstruating women)
pathology of HMB
uterine fibroids (30%) + polyps (10%) but most histologically normal
impact of HMB in QoL
bloodstains, pain, anxiety/depression, moodiness, interference w/ life
Treatment for HMB
- hormonal (OCP or progestagens to stop cycle)
- prostaglandin inhibitors (block prostaglandin production),
- anti-fibrinolytic agents (blocks fibrinolysis = removal of small clots),
- manage iron deficiency,
-surgery (ablation – removal of uterine lining but regrows under E; hysterectomy – remove uterus)
What is Uterine fibroids and the incident rate
“benign tumours of smooth muscle cells of the myometrium”
* Most common being tumour (77% of reproductive-aged women)
* Incidence and severity is higher in women of African descent
* Main indication for hysterectomy
Possible symptom for fibroids
- None
- Heavy menstrual bleeding
- Chronic pain, dysmenorrhoea and pressure symptoms
- Fertility and pregnancy problems
Characteristic of fibroids
- Firm, round, well separated from surrounding myometrium, non-invasive
- Occur as single or multiple tumours
- Vary in size and growth rates
- Vary in location:
– Submucosal
– Intramural
– Sub-serosal
– Pedunculated
Clonal origion of fibroids
derived from a single smooth muscle cell
* Although clonal, multiple cell types exist within the fibroid (SMC, fibroblasts, endothelial cells, immune cells)
* Fibroid cell sub-populations may be clonally expanded from a multipotent progenitor cell that undergoes differentiation.
* Fibroids are vascularized often with an avascular core (which stimulates more vascularization).
Treatment of Uterine Fibroids
§ Treatment:
-GnRH analogues (hypoestrogenism to shrink tumour before surgery; short term use only),
-hormone modulators (selecive oestrogen receptor modulators SERM + progesterone (SPRMs) to slow growth),
-progestins (reduce HMB by stopping cycle)
§ Surgical treatment:
-hysterectomy (remove uterus), myomectomy (remove uterine fibroid),
- uterine artery embolisation (block blood supply feeding fibroid),
-magnetic resonance-guided focused-ultrasound MRgFUS (untrasound energy heats + destroy fibroid)
Adenomyosis
presence of endometrial tissue wtihin myometrium
Ø Demarcation line b/w endometrium + myometrium destroyed
Ø 5-70%: mean frequency at hysterectomy 20-30%, coexists with other pathologies
Cause and symptom of adenomyosis
§ Causes: invasive endometrial tissue; unknown mechanism (may be overproduction of protein breakdown enzymes)
§ Symptoms: asymptomatic or pelvic pain, abnormal uterine bleeding, infertility
diagnosis of adenomyosis
-hysterectomy + histopathology,
-imaging (ultrasound, MRI)
Treatment of adenomyosis
-GnRH analogues (hypoestrogenism + antiproliferative effects)
- progestins (endometrial atrophy + hypoestrogenism),
- OCP (endometrial atrophy),
-NSAIDs (block prostaglandins, reduce pain)
what is endometriosis
Presence of estrogen-dependent endometrial- like lesions containing glands and stroma outside of the uterus
incidence of endometriosis
- 11.4% of reproductive-aged women
- 50-60% of women with pelvic pain
- 30-50% of women with infertility
Cost of endometriosis
High personal (quality of life) and healthcare costs (7 billion AUD annually)
-burden of disease
-direct healthcare cost
-productivity loss
-taxation
lesion of endometriosis
contains glands + stroma (similar to normal endometrium);
-hormonally responsive + bleed/wound repair like endometrium,
- scarring/adhesion formation
