uterus

Endometritis

  • Definition: Infectious inflammation localized to the endometrium.

  • PID risk: can extend to uterine tubes (salpingitis), ovaries, or pelvic peritoneum; termed pelvic inflammatory disease (PID).

  • Types: acute and chronic. Postpartum endometritis is a subtype of acute endometritis.

  • Features: endometrium appears red and granular; chronic endometritis may be seen on hysteroscopy in women with repeated implantation failure.

Acute Endometritis

  • Present for <30\text{ days} (acute).

  • Common etiologies: sexually transmitted infections (Chlamydia trachomatis, Neisseria gonorrhoeae) or bacterial vaginosis (BV); may be postpartum with retained products of conception/placenta or after instrumentation.

  • Microbiology: usually bacterial; histology shows prominent intraluminal neutrophils with glandular epithelium destruction.

  • Signs and symptoms: fever; abnormal bleeding; purulent discharge; pelvic pain.

Chronic Endometritis

  • Duration: >30 days30\text{ days}.

  • Microbiology: polymicrobial (Streptococcus, Escherichia coli, Staphylococcus, Mycoplasma, Gardnerella vaginalis, Candida); plasma cells present on histology.

  • Associated factors: IUDs; history of multiple pregnancies; prior abortions; recurrent implantation failure after IVF.

  • Symptoms: often asymptomatic; abnormal uterine bleeding; dyspareunia; pelvic pain; can be associated with moderate to severe intrauterine adhesions.

Endometriosis

  • Definition: Ectopic endometrial tissue deposits outside the uterine cavity.

  • Prevalence: >11\% of women in Australia.

  • Common sites: ovary; pelvic peritoneum; other sites including bowel and bladder.

  • Pathophysiology: estrogen-responsive lesions that undergo cyclic changes, enlarge, bleed, cause inflammation, scarring, fibrosis, and peritoneal irritation; can cause infertility; may form cystic lesions ("chocolate cysts").

  • Detection: ultrasonography and MRI.

  • Implants: multiple lesions can present as superficial or deep endometriosis; typical appearance includes red-brown or bluish lesions; can cause adhesions and pelvic pain.

Endometriosis Signs and Symptoms

  • Extrauterine/endometriotic tissue growth on ovary, peritoneum, uterine tube, serosa, bladder, and intestine.

  • Dysmenorrhea (painful menses).

  • Pelvic and back pain; lower abdominal pain.

  • Dyspareunia (pain with intercourse).

  • Pain on defecation.

  • Heavy or abnormal uterine bleeding is less specific but can contribute to anemia and fatigue.

Endometrial Hyperplasia

  • Definition: Thickening of the endometrium due to increased proliferation.

  • Pathology: hyperplastic endometrium.

  • Etiology: associated with excess/unopposed estrogen.

  • Risks: increased risk of endometrial adenocarcinoma.

  • Treatment: may respond to progesterone therapy (progesterone suppression).

Endometrial Cancer

  • Most common gynecologic malignancy.

  • Usually develops from endometrial hyperplasia.

  • Demographics: can be seen in premenopausal and postmenopausal women; tumor usually starts in the fundus and can spread to myometrium, cervix, and other reproductive organs.

  • Histology: most endometrial cancers are slow-growing adenocarcinomas.

Endometrial Carcinoma: Type I vs Type II

  • Type I (most common): estrogen-dependent; low-grade histology; often associated with atypical endometrial hyperplasia; generally good prognosis.

  • Type II: occurs in older postmenopausal women; estrogen-independent; not associated with endometrial hyperplasia; poorer prognosis.

Endometrial Cancer Risk Factors (high estrogen)

  • Obesity

  • Nulliparity

  • Infertility

  • Late onset of menopause

  • Unopposed estrogen therapy

  • Diabetes mellitus

  • Hypertension

  • Polycystic ovary syndrome (PCOS)

  • Family history of ovarian or breast disease

  • Hormonal imbalances or diseases

Endometrial Cancer Signs and Symptoms

  • Abnormal vaginal bleeding (including postmenopausal bleeding)

  • Bleeding between menstrual periods

  • Pelvic pain

  • Uterine enlargement or palpable mass

  • Abnormal vaginal discharge

Leiomyomas (Uterine Fibroids)

  • Definition: Benign tumors of smooth muscle cells and fibroblasts in the myometrium.

  • Epidemiology: Most common benign tumor of female genital tract; affects approximately 30−50%30-50\% of women of reproductive age; incidence increases with age; often multiple.

  • Pathogenesis: Genetic components (chromosomal rearrangements, gene mutations); hormonal components (estrogens promote growth; possibly stimulated by oral contraceptives); tend to shrink after menopause.

  • Classification (location): Intramural; submucosal; subserosal; fundal/subserosal; pedunculated variants.

  • Symptoms: about 25%25\% are symptomatic; symptoms depend on size/location and include chronic pelvic/abdominal pain, menorrhagia leading to anemia, constipation, urinary symptoms, infertility, and adverse pregnancy outcomes.

  • Risk factors: age 30−40 years30-40\text{ years}; family history; hormonal factors; obesity; PCOS; environmental toxins.

Cervical Cancer

  • Etiology: HPV—most cervical cancers are linked to oncogenic HPV strains.

  • HPV role: detectable in precancerous and cancerous lesions; also implicated in other anogenital cancers.

  • Risk factors: exposure to HPV; persistent HPV infection; early age at first intercourse; multiple sexual partners; partner with multiple partners.

  • Preinvasive disease: usually asymptomatic; detected by cervical screening.

  • Invasive carcinoma signs: abnormal vaginal bleeding; persistent vaginal discharge; pain and bleeding after intercourse.

  • Spread: direct extension to vaginal wall and parametrium, toward bladder and rectum; metastasis to pelvic lymph nodes more common than distant nodes.

Summary Points

  • You should be able to describe pathophysiology of common uterine conditions: Endometrium (endometritis, endometriosis, hyperplasia, neoplasia) and Myometrium (fibroids).

  • You should be able to describe pathogenesis, clinical features, and complications of these conditions.