Gynecologic Pathology- Maddie

What is normal menstrual bleeding? Age, quantity, duration, frequency

Age: 12-52

Quantity: 10-80 mls / 28 days

Duration: 2-8 days

Frequency: 26-35 days

What is abnormal menstrual bleeding?

Outside of the normal age, quantity, etc

Causes or abnormal bleeding

-Pregnancy

-Gyn disorders like cycle or lesion problems

-STIs

-Bleeding disorders

-Gyn malignancies

Vulva and vaginal causes or abnormal bleeding

-Trauma including candidiasis

-Atrophy (low localized estrogen)

-Pathologic lesions

-Cancer

-STIs

2 pathologic processes that can affect both vulva and mouth

Lichen planus

Lichen sclerosis

Vulvar lichen planus symptoms

Erosive

Wickam's striae

Painful!

Oral lichen sclerosis how common?

Not as common as vulvar

What is lichen sclerosis?

Chronic progressive sclerosing disease

Unknown causes

Pretty common

Cervical causes or abnormal bleeding

-Friable cervix

-Cervical polyps (common)

-Cancer

-STIs

Women with Metabolic Syndrome are at much higher risk of...

Who are at risk of this?

how do they present

cardiovascular diseases (CVD) and kidney disease

-pt. with PCOS

-may present with oral candidiasis

What causes friable cervix?

Mainly intercourse

Why are endometrial causes of abnormal bleeding more complicated

Endometrium is hormone dependent so lots of things can go wrong

Endometrial causes of abnormal bleeding

-Endometrial polyps

-Atrophic endometrium

-Endometrial hyperplasia

-Endometritis

-Pregnancy states

-Cancer

What are endometrial polyps

Overgrowths of endometrial tissue of varying sizes

How common are endometrial polyps

Very common

Usually not malignant

How to detect endometrial polyps

Ultrasound done for abnormal uterine bleeding

Atrophic endometrium cause

Thin endometrium from too little estrogen or too estrogen relative to progesterone

Often from Progestin IUD

What is atrophic endometrium bleeding like?

Usually spotty and minimal

Why can hormonal IUD cause abnormal uterine bleeding?

Atrophic endometrium

It's too thin and fragile

Endometrial hyperplasia cause

Too much estrogen relative to progesterone

Why is endometrial hyperplasia dangerous?

High chance of the hyperplasia developing into cancer

Treatment for endometrial-hyperplasia-related cancer

Hysterectomy

Endometrial hyperplasia bleeding symptoms

Usually persistent and can be heavy

Myometrial causes of abnormal bleeding

Fibroids

Adenomyosis

Cancer

What are fibroids?

Benign tumors of myometrial cells of varying size

How common are fibroids?

20-80% of women have them

Fibroids are also called ____?

Leiomyoma

Fibroids symptoms

Bleeding

Pain and pressure

Can disrupt other organ functions

Sometimes no symptoms though!

What is adenomyosis?

Endometrial tissue found within the myometrium

Cause of adenomyosis?

Unknown

Adenomyosis symptoms

Heavy bleeding and pain

Adenomyosis tx and cure

Progestin IUD as tx

Hysterectomy or menopause is cure

Dental symptoms of menopause

dry mouth

if a pt. has a uterus and is given estrogen what else does she need

progesterone

Ovarian causes of abnormal bleeding

-Anovulation and oligo-ovulation

-Endometriosis

-Endocrine disorders

-Cancer

What is PCOS?

Dyssynchrony or ovarian and endometrial cycles

PCOS bleeding pattern

Less frequent and longer periods

PCOS symptoms

Polycystic ovaries on US

Metabolic disorder (obesity, HT, insulin resistance)

-High testosterone

If you ovulate only 4 times per year, what happens?

Overstimulating the endometrium, so it gets thick and is more likely to get uterine cancer

How to treat PCOS?

Progestin IUD or birth control pills

Metformin to treat DM which makes them ovulated

What is endometriosis?

Endometrial tissue is found in places outside of the uterus

Endometriosis symptoms

Pain with some having irregular bleeding

Where can endometrial tissue grow in endometriosis

Anywhere but especially in ovaries

Endometriosis is asssociated with ________?

Infertility

What is an ovarian cyst?

Large cyst usually caused by overgrown follicle

Ovarian cyst symptoms

Pain and bleeding with rupture

Ruptured ovarian cyst treatment

IV opiods and hospital management

How do most ovarian cysts resolve?

On their own

What is ovarian torsion?

Rotation of the ovarian on its axis

What causes ovarian torsion?

Large cyst or heavy mass

Consequences of ovarian torsion

Blood supply to ovary can be cut off, usually requiring surgery

What are dermoids/tertomas?

Germ cell tumor!!! Can have hair, fat, teeth, can have any human body part