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Benign Disease of Uterus

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Classified in termsof the tissue origin

Uterine cervix

Endometrium

Myometrium

Cervical ectropion

Cervical stenosis

Endometrium polyp

Asherman syndrome

Uterine fibroid

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Anatomy of cervix

This anatomicaljunction fluctuates

with hormonalinfluence

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Origin: Uterine cervix

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- An infection screen to exclude chlamydia & other STI should be

performed prior to tx

*Nabothian cyst: The columnar glands within the transformation zone become sealedover, forming small, mucus filled cysts (visible on ectocervix)

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Cervical Stenosis

Usually an iatrogenic phenomena caused bya surgical event (cone biopsy, loopdiathermy)

T(x): Surgical dilatation of the cervix withhysteroscopic guidance

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Cervical Stenosis

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Origin: Endometrium

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Endometrial Polyps

What?

Discreteoutgrowth

ofendometrium, attachedby a pedicle

-pedunculated/

sessile

-single/multiple-vary in size

Vaginalbleeding

Mucus

discharge

S & S Diagnosis

Ultrasound:Areas of

increasedendometrial

thickening

Sonohysterography: Confirmsthe diagnosis

Postmenopausal

age

Mandatory to remove EP, whichcan be due to hyperplasia or

malignancy

>40 y/o &premenopausal

Removal: Usually resolves thesymptoms

Most common abnormality:endometrial hyperplasia

EP should be considered for removal

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Asherman SyndromeCauses:

Overzealous curettage of theuterine cavity during D&C/following 2 PPH

TB, schistosomiasis

T(x): Difficult to treat; prevention is

the mainstay of therapy

Option: Hysteroscopic techniqueto manually break down or lysed

intrauterine adhesion

An irreversible damage of the single layerthick basal endometrium

Doesnt allow normal regeneration of

the endometrium

Endometrial cavity undergoes fibrosis &adhesion formation

Ashermansyndrome

Reduced / absent

menstrual bleeding

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Origin: Myometrium

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Uterine Fibroids

DefinitionA benign tumour of uterine smooth muscle

Termed as leiomyoma

Pathology Firm, whorled tumour

Typical whorled appearancemay be altered from

following degenerations:

Red degeneration

Hyaline degeneration

Cystic degeneration

Unknown, but an estrogen dependant tumourEtiology & RF

Nulliparity, obesity, (+) family h(x), African racial origin

Incidence 20% in reproductive age

Based on the location

Submucous fibroid

Intramural fibroid

Subserosal fibroid

Pedunculated

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Location of Fibroids

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Clinical subgroups

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Signs &symptoms

History

Usually asymptomatic

Menstrual disturbance &pressure symptoms

Pain: unsual

Menorrhagia

Indicates submucousorigin

Distorting the endometrialcavity by increasing theendometrial surface area

Subfertility

Mechanical distortion

/ occlusion of FT

Endometrial cavity grosslydistorted by submucous

fibroid; prevent implantationof a fertilized ovum

Abdominalexamination

Presence of firm

mass arisingfrom the pelvic

In late pregnancy:abnormal lie (fibroidlocated in the cervix /

lower uterine segment)

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Fibroid Degeneration

Red Degeneration

An acute disruption of theblood supply to the fibroidduring active growth,classically during mid-second

trimester of pregnancy May present with the sudden

onset of pain with localizedtenderness to an area ofuterus, mild pyrexia,leuckocytosis

Sign and symptoms resolve

over a few days Surgical intervention rarely

required

Hyalin Degeneration

Occurs when the fibroidgradually outgrows its bloodsupply, may progress tocentral necrosis, leaving

cystic space at central

termed cystic degeneration

Calcification of a fibroid maybe detected incidentally on anabdominal x-ray in a post-menopause woman

Rarely, malignant or

sarcomatous degenerationcan occur

The suspicion is greatest inthe post-menopausal periodwhen there is a rapidlyincreasing size of fibroid

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Diagnosis & Investigation

From generalexamination : reveal

varying degree of anemia

Palpation : palpablemass, firm, well-defined

margin,

Bimanual examination :uterus enlarged

Ultrasound will confirmthe diagnosis

Diagnostic laparoscopyhelpful to differentiate apedunculated subserous

fibroid from a solidovarian tumor

Hysterosalphingographyor hysteroscopy will help

to detect submucousfibroid

Hysteroscopy and endometrial biopsy isindicated in cases of irregular or

intermenstrual bleeding to exclude thepresence of coexisting endometrial pathology

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Conservativemanagement

Asymptomatic

fibroidsIt is useful to establishthe growth rate of the

fibroids by repeatclinical examination orultrasound after a 6-12

month interval.

Medical t(x)

Gonadotrophin

releasing hormone(GnRH) agonists. Usually limited touse in preparation

for surgery

Surgical t(x)

Determined by thepresenting complaint & pts

aspirations for menstrualfunction & fertility

Hysteroscopic removal:Menorrhagia associated with

a submucous fibroidMyomectomy w uterine

conservation @hysterectomy: Bulky fibroiduterus causes pressure

symptoms

Treatment

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