Chapter 13 Abnormal Uterine Bleeding (DMS120)

a more recent treatment for uterine fibroids is called uterine artery embolization. In this procedure

a catheter is introduced into the femoral artery and into the uterine artery. Microspheres injected through the catheter undergo embolization and black Ford Fusion of the distal branches of the uterine artery that Supply the fibroid.

the presence of Trapped blood in the uterine cavity called hematometra in a post-menopausal patient with

a thickened endometrium is worrisome for endometrial carcinoma. endometrial thickness greater than 4 mm is a greater risk for endometrial carcinoma and should undergo biopsy

symptoms of adenomyosis include painful menstruation or

dysmenorrhea. And abnormal uterine bleeding. These symptoms are associated with numerous other common gynecologic conditions.

besides an enlarged uterus immediate postpartum findings may include residual fluid and

echogenic material representing Hemorrhage within the endometrial cavity. studies indicate that an endometrial thickening of less than 10 mm is unlikely to be retained products of conception.

the most common cause of postmenopausal bleeding is

endometrial atrophy. Which appears as an endometrium less than 4 mm in thickness.

tamoxifen is a drug administered to women with breast cancer to block estrogen effects on breast tissue. Although it blocks estrogen in the breast that has the opposite effect in the uterus acting as an

estrogen Agonist. this can stimulate cell growth and proliferation in the endometrial tissue enhancing the risk for abnormalities including carcinoma hyperplasia and polyps.

fibroids are more common an African American women. and range in size from 1 mm to more than 20 cm.

fibroids are known to grow in response to estrogen stimulation and tend to stabilize or regress during menopause.

the focal form of adenomyosis results in a typical appearance and is characterized by

focal masses called adenomyomas. Myometrial striations caused by a adenomyosis can be seen sometimes.

sonographic findings for endometrial polyps

focal or diffuse endometrial thickening with or without small cystic areas. Vascularity within feeding vessel may be seen on color Doppler.

intramural fibroids are relatively easy to visualize when they are

hypoechoic and well encapsulated within the myometrium.

the most effective method for diagnosing adenomyosis is a pathologic specimen of the myometrium obtained at

hysterectomy. This condition is found in 70% of hysterectomy specimens.

submucosal fibroids focally destroyed the endometrium creating an area of

increased or decreased echogenicity within the endometrium. Makes it difficult to differentiate from endometrial polyps. Use of sonohysterography will help.

fibroid surrounded predominantly by myometrium are the most common and are referred to as

intramural fibroids.

tamoxifen exposure causes Cystic changes in the endometrium and in the area of the

junctional Zone representing adenomyosis like changes. There will be endometrial thickening as a common finding.

common myometrial abnormalities resulting in abnormal uterine bleeding include

leiomyomas and adenomyosis.

symptoms for adenomyosis

may be asymptomatic or cause uterine tenderness. Dysmenorrhea. menorrhagia. Or uterine enlargement.

symptoms for endometrial polyps

may be asymptomatic or may cause intermenstrual bleeding or menometrorrhagia.

irregular and heavy Menses is called

menometrorrhagia

heavy menses is called

menorrhagia

adenomyosis can be either diffuse or focal. Diffuse adenomyosis in which the endometrial glands and stroma are diffusely incorporated into the myometrium is

more common in can result and ill-defined myometrial heterogeneity and uterine enlargement.

endometrial adenocarcinoma is the most common gynecologic cancer affecting almost one in every 50 women.

most women are post-menopausal. the most common clinical presentation is postmenopausal bleeding. however only 10% of women with postmenopausal bleeding have endometrial carcinoma.

a patient who undergoes removal of fibroids has a

myomectomy.

endometrial hyperplasia is an abnormal proliferation or growth of the endometrium in response to access or unopposed estrogen.

patients taking estrogen-only hormone replacement medications or women with chronic anovulation are at risk for endometrial hyperplasia

sometimes subserosal fibroids grow off of a stock into the adnexal region has seemingly separate from the uterus. These are referred to as

pedunculated fibroids.

symptoms for retained products of conception

postpartum bleeding or pain sonographic findings include a thickened endometrium / 10 mm with an endometrial Mass

an anovulatory patient does not always produce a corpus luteum cyst. So the endometrium does not

receive adequate progesterone stimulation. The unopposed estrogen causes continual endometrial proliferation potentially leading to abnormal growth.

endometrial polyps contain blood vessels trauma and endometrial glands that can

respond to hormonal stimuli.

fibroids that project into the endometrium are referred to as

submucosal fibroids.

the sonographic findings for endometrial polyps are usually during the secretory phase when a polyp is typically isoechoic to the surrounding endometrium causing

the appearance of either focal or Global endometrial thickening. polyps are well-defined when outlined by saline during a sonohysterography. may be evidence of a vascular feeding vessel on color Doppler.

adenomyosis is a common gynecologic condition in which glands and stroma from the basal layer of the endometrium penetrate into

the myometrium. Causing Distortion of the myometrium from smooth muscle hyperplasia. the glands arise from the basal layer and do not have the typical response to hormonal stimulation that endometrial tissues from the functional layer do.

the arcuate arteries Branch to radial arteries. Extending through the intermediate myometrial layer and into the inner layer.

the radial arteries Branch to spiral arteries. Which enter the endometrium and Supply the functional layer.

subserosal fibroids are in contact with

the serosa layer and distort the uterus Contour.

during Menses lack of hormonal stimulation causes atrophy of

the spiral arteries. And the functional layer of the endometrium sloughs and bleeds.

endometrial polyps are benign focal overgrowth of endometrial glands and stroma. They're size variable.

they are soft. Fleshy. Tan or Red. Growths attached to the endometrium by a narrow pedunculated stalk. Or less commonly a broad base of attachment.

sonographic findings for endometrial carcinoma

thick endometrium over 4 mm in postmenopausal women. Uniformly echogenic or heterogeneous. Cystic changes. Fluid with or without Echoes may be present in uterine cavity.

risk factors for endometrial carcinoma

unopposed estrogen stimulation. Obesity. nulliparityy. Diabetes. Hypertension. tamoxifen therapy for breast cancer. Chronic anovulation. And the presence of atypical endometrial hyperplasia.

mri-guided focused ultrasound therapy is another recent treatment for fibroids. This treatment involves

using focused converging ultrasound beans to generate Heat at a focal point causing necrosis of tissue. used for accurate targeting of the focal point and for monitoring tissue temperatures

symptoms for leiomyomas

uterine enlargement. Pelvic pain. Pelvic pressure. And abnormal uterine bleeding.

leiomyomas are also called myomas or fibroids. And they are benign smooth muscle tumors that develop within the myometrium. But they may intrude into any of the uterine layers.

uterine fibroids are the most common pelvic tumor and are the leading cause of hysterectomy.

sonographic findings for leiomyomas

uterine or endometrial Contour irregularity. Heterogeneous. Generalized uterine enlargement. Focal hypoechoic or hyperechoic mass is without or with cystic spaces and calcifications.

retained products of conception is likely if an echogenic Mass with vascularity is present. An echogenic Mass

without vascularity may represent either retained products of conception or blood clots.

only a biopsy can be used to differentiate between endometrial hyperplasia and

carcinoma. sonographic findings associated with endometrial carcinoma include abnormally thickened endometrium. Heterogeneous echotexture. hematometra or the presence of Trapped blood in the uterine cavity. And an enlarged uterus

fibroids are myometrial in origin and they can be surrounded by myometrium. Intrude into the endometrium or

come in contact with the serosa layer.

sonographic findings for adenomyosis

diffuse uterine enlargement. Ill-defined myometrial heterogeneity. Myometrial striations. loss of distinct junctional Zone. Myometrial cysts. and minimal Distortion of the endometrial or serosal Contour.

sonographic findings for endometrial hyperplasia

diffusely thickened echogenic endometrium. With or without small cystic spaces but more commonly without them.

generally submucosal fibroids tend to appear hypoechoic to the secretory endometrium have a broad base of attachment. And

display sonographic evidence of attenuation.

generally only submucosa or a large intramural fibroids cause abnormal uterine bleeding. Pedunculated fibroids are remote from the endometrium and myometrium and typically

do not cause menorrhagia or heavy menses.

symptoms for tamoxifen

drug administered to women with breast cancer. Sonographic findings are similar to carcinoma. Hyperplasia. And polyps. cystic changes within polyps and in subendometrial area are common.

abnormal uterine bleeding that is not caused by a structural problem is usually endocrine in nature and is called

dysfunctional uterine bleeding rdub.

endometrial hyperplasia is divided as without cellular atypia. Or with cellular a tibia which is called atypical hyperplasia.

25% of patients with atypical hyperplasia progresses to carcinoma.

for menstrual age women normal double layer endometrial thickness should measure

4 to 14 mm with maximum thickness occurring during the secretory phase. endometrial pathology is very unlikely in a post-menopausal woman if endometrial thickness is less than 5 mm

postmenopausal women taking hormone replacement therapy can experience a slightly thickened endometrium during the estrogen cycle. Up to

8 mm. And should undergo repeat scanning during the progesterone cycle.

cancer is limited to the endometrium or inner uterus without metastasis have cure rates in the

90% range. Generally endometrial carcinoma limited to the uterus may be treatable with hysterectomy.

symptoms for endometrial hyperplasia

abnormal uterine bleeding most commonly in perimenopausal and postmenopausal women.

symptoms for endometrial carcinoma

abnormal uterine bleeding or postmenopausal bleeding.

46. Woman. Last menstrual. Several months ago. 3 weeks prior heavy menstrual. That lasted 7 Days. Normal size 9 tender uterus. Normal endometrium. Globular appearance of uterus. Diffusely heterogeneous myometrium. Diagnosis?

an episode of menorrhagia. Normal endometrium. globular uterine appearance. And heterogeneous myometrium. Striations evident in the images are typical of adenomyosis however uterine shape can contribute to fibroids.

the uterine artery enters the uterus around the level of the isthmus. Giving rise to the

arcuate arteries which lie in between the outer and intermediate layers of the myometrium.

retained products of conception means that after delivery of an infant or after an abortion some of the gestational contents May remain within the uterine cavity and cause

bleeding and infection. They typically consist of placental tissue which can persist for months and result in abnormal uterine bleeding.