Mandi Twist's lecture
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| endometriosis | presence and growth of stroma and glands of endometrial uterus in an aberrant location, endometrium where it's not supposed to be
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| adenomyosis | presence and growth of stroma and glands of the endometrium in the myometrium, endometriosis of the myometrium
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| uterine fibroids | leiomyomas, myomas, benign tumor of muscle cell origin found in any tissue that contains smooth muscle
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| endometrial polyps | localized overgrowths of endometrial stroma and glands that project beyond the endometrium
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| most common incidence of chronic pelvic pain | endometriosis
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| estrogen-dependent disease (decreased estrogen leads to decreased risk) | endometriosis
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| ways to decrease endometriosis risk | decrease body fat, (smoking)
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| locations of endometriosis | dependent areas of the pelvis: vulva, vagina, ovaries, peritoneum, cervix, Fallopian tubes, rectosigmoid, etc.
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| symptoms of endometriosis | cyclic pelvic pain, secondary dysmenorrhea, pelvic heaviness, swelling, bloating, dyspareunia, AUB, cyclic abdominal pain, intermittent constipation or diarrhea, urinary frequency or dysuria, hematuria
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| signs of endometriosis | classic sign is fixed uterus w/tenderness and scarring posteriorly, nodularity, ovarian enlargement, visualizations of lesions on speculum exam
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| diagnosis of endometriosis | direct visualization of lesions with histologic confirmation (laparoscopy) is gold standard, US may be used to r/o ddx
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| appearance of endometriosis lesions | varying colors (red, brown, yellow, pink, etc.) and scarring, red = more active phase, brown and larger = older lesions, scarring = oldest lesions
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| endometriosis treatment options | medical (induction of amenorrhea): GnRH agonists, OCPs, pregestin; surgical (only option if medical tx fails): conservative (excision, cautery, etc.), definitive (hysterectomy with bilateral salpingo-oophorectomy)
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| GnRH agonists | suppress gonadotropin secretion, decreases estrogen production by pituitary, leads to amenorrhea, no effect on SHBGs; menopause-like symptoms, amenorrhea in 6-8 weeks, decreased bone density, most patients experience resolution of or decrease in symptoms
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| adenomyosis | basalis layer of endometrium invades myometrium, seen most often in parous women, spongy appearance; diffuse involvement of anterior/posterior walls of uterus (most common) or focal involvement of a small encapsulated area
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| s/s of adenomyosis | menorrhagia (heavy bleeding), dysmenorrhea, dyspareunia, or asymptomatic; usually in women 35-60 (often not on OCP), may have iron-deficiency anemia due to blood loss
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| diagnosis of adenomyosis | diffuse enlargement of uterus (2-3 x normal), globular and tender uterus right before/during menses, tenderness and consistency of uterus changes from exam to exam; pelvic US or MRI
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| treatment of adenomyosis | no satisfactory medical treatment, occassional relief from OCPs and GnRH agonists and PG synthetase inhibitors; hysterectomy is definitive surgical treatment
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| leiomyoma | fibroids, most common benign pelvic tumor, benign tumor of muscle cell origin; mutation of normal myometrium influenced by estrogen, progesterone, and other growth factors
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| intramural fibroid/leiomyoma | located in body of uterus
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| submucosal fibroid | located just below the endometrium
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| subserosal fibroid | located just beneath the serosa
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| broad ligament fibroid | located within the broad ligament
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| parasitic fibroid | receives blood supply from nearby organ (usually from ovary)
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| s/s of leiomyomas/fibroids | most common is menorrhagia (or other AUB), pain (dysmenorrhea, pelvic pain), pressure (bloating), asymptomatic
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| rapid-growing fibroid | possiblity of leiomyosarcoma
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| diagnosis of fibroid | physical exam (bimanual), US (most helpful), ~MRI (expensive, cannot distinguish between benign or otherwise), x-ray (calcified fibroids)
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| treatment of fibroids | observation of small and asymptomatic fibroids (pelvic exam q 6 months and sonogram q year); surgery for larger and symptomatic (myomectomy), laparotomy (larger fibroids), laparoscopy (smaller fibroids, decreased post-op pain), hysteroscopic, hysterectomy
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| endometrial polyps | localized overgrowths of endometrial glands and stroma that project beyond the endometrium, sessile (broad base), pedunculated (narrow base)
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| s/s of endometrial polyps | asymptomatic, wide range of AUB, polyp may protrude through os
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| diagnosis of endometrial polyps | work-up of AUB, US (r/o fibroids), saline sonohysterogram, hysteroscopy (incidental finding)
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| treatment of endometrial polyps | D&C, send for pathology
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| septate uterus | partition divides uterus either partially or completely (rare), diagnosis is made by US or MRI
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| unicornate uterus | single Fallopian tube, ovary is often on opposite side, often is asymptomatic and diagnosed upon pregnancy
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| bicornate uterus | "heart-shaped" uterus, recurrent miscarriage is common, diagnosis often made during pregnancy
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| uterine didelphys | double uterus, two cervices, may be two vaginas, presenting symptom is often bleeding despite tampon placement
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| mullerian agenesis | uterus is often not present, varying malformations of the vagina, presenting symptom is primary amenorrhea
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| arcuate uterus | concave fundus, often considered normal variant, diagnosis by US
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| DES uterus | T-shaped uterus; daughters of women who took DES while pregnant; s/s include miscarriage, infertility, ectopic pregnancy, clear cell adenocarcinoma of vagina and cervix
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