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Benign Uterine

Mandi Twist's lecture

endometriosis presence and growth of stroma and glands of endometrial uterus in an aberrant location, endometrium where it's not supposed to be
adenomyosis presence and growth of stroma and glands of the endometrium in the myometrium, endometriosis of the myometrium
uterine fibroids leiomyomas, myomas, benign tumor of muscle cell origin found in any tissue that contains smooth muscle
endometrial polyps localized overgrowths of endometrial stroma and glands that project beyond the endometrium
most common incidence of chronic pelvic pain endometriosis
estrogen-dependent disease (decreased estrogen leads to decreased risk) endometriosis
ways to decrease endometriosis risk decrease body fat, (smoking)
locations of endometriosis dependent areas of the pelvis: vulva, vagina, ovaries, peritoneum, cervix, Fallopian tubes, rectosigmoid, etc.
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
signs of endometriosis classic sign is fixed uterus w/tenderness and scarring posteriorly, nodularity, ovarian enlargement, visualizations of lesions on speculum exam
diagnosis of endometriosis direct visualization of lesions with histologic confirmation (laparoscopy) is gold standard, US may be used to r/o ddx
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
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)
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
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
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
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
treatment of adenomyosis no satisfactory medical treatment, occassional relief from OCPs and GnRH agonists and PG synthetase inhibitors; hysterectomy is definitive surgical treatment
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
intramural fibroid/leiomyoma located in body of uterus
submucosal fibroid located just below the endometrium
subserosal fibroid located just beneath the serosa
broad ligament fibroid located within the broad ligament
parasitic fibroid receives blood supply from nearby organ (usually from ovary)
s/s of leiomyomas/fibroids most common is menorrhagia (or other AUB), pain (dysmenorrhea, pelvic pain), pressure (bloating), asymptomatic
rapid-growing fibroid possiblity of leiomyosarcoma
diagnosis of fibroid physical exam (bimanual), US (most helpful), ~MRI (expensive, cannot distinguish between benign or otherwise), x-ray (calcified fibroids)
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
endometrial polyps localized overgrowths of endometrial glands and stroma that project beyond the endometrium, sessile (broad base), pedunculated (narrow base)
s/s of endometrial polyps asymptomatic, wide range of AUB, polyp may protrude through os
diagnosis of endometrial polyps work-up of AUB, US (r/o fibroids), saline sonohysterogram, hysteroscopy (incidental finding)
treatment of endometrial polyps D&C, send for pathology
septate uterus partition divides uterus either partially or completely (rare), diagnosis is made by US or MRI
unicornate uterus single Fallopian tube, ovary is often on opposite side, often is asymptomatic and diagnosed upon pregnancy
bicornate uterus "heart-shaped" uterus, recurrent miscarriage is common, diagnosis often made during pregnancy
uterine didelphys double uterus, two cervices, may be two vaginas, presenting symptom is often bleeding despite tampon placement
mullerian agenesis uterus is often not present, varying malformations of the vagina, presenting symptom is primary amenorrhea
arcuate uterus concave fundus, often considered normal variant, diagnosis by US
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
Created by: Carrie D.