Diseases of uterus · 8/31/2011 5 Abnormal uterine bleeding • Dysfunctional uterine bleeding (DUB) • Leiomyoma (myoma uteri) • Adenomyosis Dysfunctional uterine bleeding •

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Diseases of uterus

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Menstrual cycle

Endometrium

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Endometrium

Clinical manifestations • abnormal uterine bleeding (AUB) • lower abdominal pain / pelvic pain • dysmenorrhea • infertility

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Abnormal uterine bleeding • Normal bleeding : menstruation

• Menstrual blood (normal cycle)

• 28 +/-7 days (21-35 days) interval

• 3-4 days (2-7) duration

• 35 ml (20-80) volume

LMP = the first day of last menstruation

Menarche 12 (8-16)

Menopause 40-55

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Abnormal uterine bleeding • Dysfunctional uterine bleeding

(DUB)

• Leiomyoma (myoma uteri)

• Adenomyosis

Dysfunctional uterine bleeding • no organic cause • hormonal imbalance • Ovulatory • Anovulatory

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Ovulatory • Inadequate proliferative phase • Inadequate secretory phase • Irregular shedding

Anovulatory • prolonged estrogen stimulation • proliferative endometrium in

secretory phase • endometrial hyperplasia

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Endometritis • abortion • postpartum • instrumentation • IUD Pyometra : pus accumulation in uterine cavity

Endometritis

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Endometritis

Pelvic inflammatory disease (PID) Salpingitis Oophoritis Salpingo-oophoritis Tubo-ovarian abscess

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Endometriosis endometrial tissue in abnormal locations Theories • Regurgitation • Metaplastic • Lymphatic / vascular dissemination

Endometriosis

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Endometriosis

Adenomyosis • enclosed endometrial tissue in

myometrium • myometrial endometriosis

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Adenomyosis

Endometrial hyperplasia • perimenopausal period • hyperestrogenism • Stein-Leventhal syndrome • Granulosa cell tumor of ovary

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Endometrial hyperplasia • Simple hyperplasia : 0.5% - CA • Adenomatous hyperplasia • Atypical hyperplasia : 23% - CA • progestogen therapy • hysterectomy

Endometrial hyperplasia

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Endometrial hyperplasia

Endometrial tumors • Endometrial polyp : focal hyperplasia • Endometrial carcinoma • Stromal tumor

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Endometrial polyp

Endometrial carcinoma • perimenopause • hyperestrogenism • endometrial hyperplasia • High risk :

obesity, hypertension, DM, nulliparity

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Endometrial carcinoma • Endometrioid adenocarcinoma • Secretory carcinoma • Squamous cell carcinoma • Adenosquamous carcinoma • Mucinous carcinoma • Serous carcinoma

Endometrial carcinoma

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Endometrial carcinoma

Leiomyomas • most common benign tumor in

females : myoma uteri • locations : intramural, submucosal,

subserosal • Cellular leiomyoma • Atypical leiomyoma

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Leiomyoma

Leiomyoma

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Leiomyosarcoma

Investigations • pelvic examination • curettage : D/C, fractional curettage • ultrasonography