Uterine pathology

Question 1

What are the indications for doing endometrial sampling ?

Answer 1

• Abnormal uterine bleeding (AUB)
• Investigation for infertility
• Spontaneous and therapeutic abortion
• Assessment of response to hormonal therapy
• Endometrial ablation
• Work up prior to hysterectomy for benign indications
• Incidental finding of thickened endometrium on scan
• Endometrial cancer screening in high risk patients

Question 2

List the different types of abnormal uterine bleeding (AUB)

Answer 2

• Menorrhagia
• Metrorrhagia
• Polymenorrhoea
• Polymenorrhagia
• Menometrorrhagia
• Amenorrhoea
• Oligomenorrhoea

Question 3

Define dysfunctional uterine bleeding (DUB)

Answer 3

DUB:AUB with no organic cause

Question 4

Define post-menopausal bleeding (PMB)

Answer 4

AUB > 1 year after cessation of menstruation

Question 5

What are the causes of AUB in adolescence/early repoductive life ?

Answer 5

• DUB usually due to anovulatory cycles
• Pregnancy/miscarriage
• Endometritis
• Bleeding disorders

Question 6

What are the causes of AUB in reporductive life/perimenopause?

Answer 6

• Pregnancy/miscarriage
• DUB: anovulatory cycles, luteal phase defects,
• Endometritis
• Endometrial/endocervical polyp
• Leiomyoma
• Adenomyosis
• Exogenous hormone effects
• Bleeding disorders
• Hyperplasia
• Neoplasia: cervical, endometrial

Question 7

What are the causes of AUB post menopause ?

Answer 7

• Atrophy
• Endometrial polyp
• Exogenous hormones: HRT, tamoxifen
• Endometritis
• Bleeding disorders
• Hyperplasia, Endometrial carcinoma
• Sarcoma

Question 8

How is endometrial thickness assessed and what is the relevent measurements with regards to endometrial cancer ?

Answer 8

TVUS - thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy due to risk of endometrial cancer

Question 9

What is the most common biopsy menthod for obtaining samples from the endometrium and why?

Answer 9

Dilatation and curretage - Most thorough sampling method, but can miss 5% hyperplasias/cancers

Question 10

Define what endometritis is

Answer 10

It is infection or inflammation of the endometrium

Question 11

What are the risk factors for development of endometritis ?

Answer 11

• C-section
• Prolonged rupture of membranes
• Severe meconium staining in liquor
• Long labour with multiple examinations.
• Manual removal of placenta
• Retained products of conception.
• Mother’s age at extremes of reproductive span.
• Poor hygeine
• Maternal anaemia.
• Obesity.
• DM
• Prolonged surgery.
• Internal fetal monitoring
• Pre-existing infection: history of pelvic infection, presence of bacterial vaginosis or Group B streptococcal infection.

Question 12

What are the signs/symptoms of endometritis ?

Answer 12

Symptoms:

• Fever.
• Abdominal pain.
• Offensive-smelling lochia.
• Abnormal vaginal bleeding - postpartum haemorrhage.
• Abnormal vaginal discharge.
• Dyspareunia.
• Dysuria.
• General malaise.

Signs:

• Pyrexial
• Pain and uterine tenderness, which may radiate to the adnexae.
• Tachycardia.

Question 13

What is the treatment of endometritis ?

Answer 13

• 1st line = Co-amoxiclav + metronidazole
• 2nd line = If penicillin allergy co-trimoxazole + metronidazole

Question 14

How do endometrial polyps tend to present ?

Answer 14

• Usually asymptomatic but may present with bleeding or discharge
• Often occur around and after the menopause
• Almost always benign

Question 15

What is adenomyosis ?

Answer 15

It is Endometrial glands and stroma within the myometrium and a cause of AUB resulting in menorrhagia/dysmenorrhoea

Question 16

What is a Leiomyoma and what can it result in ?

Answer 16

• Benign tumour of smooth muscle, may be found in locations other than the uterus
• It can result in AUB - menorrhagia/infertility/mass effect, pain