Life Cycle > Endometrium > Flashcards

Endometrium Flashcards

(44 cards)

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1
Q

What factors are increased during the luteal phase of the menstrual cycle?

A

[in the endometrium]

  • inflammatory cells
  • gland hypertrophy
  • increased mucus secretion
  • spiral artery growth
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2
Q

What are the 4 layers of the endometrium?

A
  • compactum: proliferative layer
  • spongiosum: secretory layer
  • basalis: layer will remain intact after menstruation
  • junctional zone: anchor which sits between basalis layer and the myometrium. Contains properties of both endometrium and muscle. some roles proposed in pregnancy and menstrual problems.
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3
Q

What is mechanism underlying menstruation?

A
  • Caused by withdrawal of E2 and P
  • mediated by PGs (which vasoconstriction) and platelet aggregating factor (PAF)

this causes:

  • spiral artery vasoconstriction
  • spiral artery relaxation
  • PGs cause vasoconstriction of end-arteries in the endometrium - there is no alternative blood supply to these areas so this causes ischaemia
  • ischaemia and tissue damage
  • shedding of functional endometrium
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4
Q

What is the functional endometrium?

A

these are the layers that are lost during menstruation

=> compactium and spongiosum layers

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5
Q

What are the 2 general types of prostaglandins?

A

VASOCONSTRICTORY
promote platelets clotting (pro-coagulable)
PG-F2a and PG-Tx

VASODILATORY
reduces platelet binding to the endothelium
(pro-bleeding)
PG-E and PG-I

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6
Q

What are the general functions of prostaglandins?

A
  • inflammatory mediators
  • vasodilation
  • vasoconstriction
  • sensitise pain receptors (all classes of PGs)
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7
Q

What inflammatory mediators are released during menstruation?

A
  • PGs
  • IL-8, IL-13, IL-16
  • TNF
  • PAF
  • Matrix metalloproteinases (MMPs)
  • coagulation/fibrinolysis
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8
Q

What must occur for “normal menstruation?”

A

correct balance and regulation of inflammation, coagulation and fibrinolysis in the endometrium

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9
Q

What clinical problems can occur in association with menstruation?

A

[anything different to usual baseline pattern]

  • menorrhagia: excessive bleeding
  • polymenorrhoea; bleeding too often
  • Inter-Menstrual bleeding (IMB)
  • post-coital bleeding (PCB)
  • Chaotic bleeding: constant and not regulated at all
  • functional abnormality: endometrium is normal but something is not working functionally
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10
Q

What are pathological causes of abnormal vaginal bleeding?

A
  • fibroids (submucosal)
  • adenomyosis
  • endometrial pathology
  • cervical pathology
  • pregnancy
  • cervical ectropion
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11
Q

What kinds of endometrial pathology can cause abnormal vaginal bleeding?

A

benign adenomas or polyps
hyperplasias
carcinoma

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12
Q

What kind of cervical pathology can cause abnormal vaginal bleeding?

A

polyps
carcinoma
infective: chlamydia

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13
Q

What are cervical ectropion caused by?

A

oestrogen expo

can result in abnormal vaginal bleeding

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14
Q

What is adenomyosis?

A

pockets of endometrium in the myometrium.

often caused painful, heavy periods

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15
Q

What are submucous fibroids?

A

fibroids: benign myometrium mass
submucous: fibroid poking into uterine cavity (can affect bleeding)

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16
Q

What is DUB?

A

dysregulated uterine bleeding
(= AUB)

Dx of exclusion (no identified organic cause of bleeding issues)

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17
Q

What is the significance of submucous fibroids?

A

associated with 3x increased risk of abnormal peri-menopausal bleeding

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18
Q

What is the significance of polyps?

Study These Flashcards
A

more frequent in women with menstrual disorders or abnormal bleeding on HRT

19
Q

What needs to be considered when dealing with abnormal bleeding?

Study These Flashcards
A
  • exclude pregnancy
  • exclude cervical pathology
  • exclude focal intracavity pathology (polyps, submucous fibroids)
  • consider endometrial pathology for >40yo

[use the least invasive method to achieve this]

20
Q

What are the important points in the history to consider in abnormal vaginal bleeding?

Study These Flashcards
A
  • last menstrual period
  • regular or irregular periods
  • inter-period bleeding
  • heavy clots? flooding?
  • post-coital bleeding?
  • pain
  • medication
  • smoking history
  • smear
  • past operations
  • contraception: is family complete?

N.B. progesterone contraception can cause irregular bleeding

21
Q

What points in examination are important to consider for abnormal vaginal bleeding?

Study These Flashcards
A
  • BMI
  • Abdo: distension, scars, pain, masses
  • Bimanual: uterine size, adnexal masses, pain
  • cervix: polyps, suspect lesions
22
Q

Why is BMI an important consideration for abnormal uterine/vaginal bleeding?

Study These Flashcards
A

if overweight then will be hyper-oestrogenic

peripheral fat depots make oestrogen

23
Q

What investigations should be done for abnormal vaginal/uterine bleeding?

Study These Flashcards
A
  • pregnancy test (if appropriate)
  • Haemaglobin (if heavy bleeding)
  • swabs: endocervical (for chlamydia)
  • transvaginal USS
  • endometrial sampling (biopsy)
  • hysteroscopy (in-patient or OPD)
24
Q

What kind of anaemia is most common with heavy uterine bleeding?

Study These Flashcards
A

iron-deficiency anaemia

25
What is transvaginal sonography (TVS)?
- can assess relationships of fibroids to the cavity - high detection rate for polyps - assess function: anovulatory cycles - assess tubal and ovarian pathology - well-accepted by patients - cheap with few complications
26
What are the limitations of transvaginal sonography (TVS)?
good for focal pathology not good for predicting endometrial pathology: biopsy still needed for many cases periovulatory or post-menstrual endometrium: difficult to gauge endometrial thickness
27
What is the use of hydrosonography?
used in conjunction with TVS allows separation of 2 layers to see in between
28
What is the normal endometrial thickness (ET) in pre-menopausal women?
6mm post-menstrual 12mm (max.) anytime in cycle [arbitrary values]
29
When is a hysteroscopy indicated?
- if TVS is abnormal - no response to medical therapy - multiple risk factors for endometrial pathology
30
What are the risk factors for submucous fibroids?
- obesity - nulliparity - early menarche/late menopause - hypertension - DM - anovulation e.g. PCOS - FHx breast/endometrual/colonic Ca (CA-125 Ag)
31
What is the classical presentation for endometrial Ca or PCOS?
obesity HT, DM peri-menarche [Metabolic X syndrome]
32
What is the main cause of endometrial hyperplasia?
unopposed oestrogen (E2) with no progesterone e.g. anovulatory can Rx with progesterone to balance
33
What are the 3 types of endometrial hyperplasia?
- simple (benign) - atypical (aka dysplastic, not benign and on its way to malignant) - carcinoma
34
What are the Rx for polyps?
SURGERY transcervical removal of polyps (TCRP) vs polypectomy TCRP is a more definitive removal, less chance of polyp returning)
35
What are the Rx for fibroids?
MEDICAL Mirena coil IUS SURGERY transcervical removal of fibroids (TCRF) Myomectomy (requires abdo approach) Hysterectomy (total/subtotal abdo, vaginal)
36
What is a contraindication for Mirena IUS?
abnormal uterine cavity | e.g. multiple uterine fibroids
37
What are the consideration for Rx for DUB?
does she want or need Rx? does she need contraception/pregnancy? how much is it affecting QoL? is she physically compromised?
38
What are the Rx options for DUB?
- nothing - Medical: hormonal vs. non-hormonal - Surgery
39
What are the non-hormonal Rx options for DUB?
ANTI-FIBRINOLYTIC 40-50% reduction in blood loss e.g. TXA MEFENAMIC ACID 30% reduction in blood loss
40
What are the hormonal Rx options for DUB?
COCP 20-30% reduction in blood loss MIRENA IUS 90% reduction [progestagens are not beneficial for blood loss, used to control cycle length in anovulatory DUB]
41
How does mefenamic acid work to control DUB?
menorrhagia: more dilatory PGs present Mefenamic acid shifts the PGs to reduce the vasodilatory PGs => specific effect on bleeding loss and pain Mx in uterus
42
What are the surgical options for Rx DUB?
- endometrial resection/ablation - hysterectomy (vaginal/abdominal, more commonly laproscopic) - oophorectomy
43
What is the most common surgical Rx for DUB?
radio frequency ablation (produced heat) of endometrium -permanent frying of endometrial tissue
44
What is Ponstan?
trade name for Mefenamic acid
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