For women presenting with abnormal uterine bleeding with or without findings of a pelvic mass by clinical examination, differential diagnosis should include leiomyoma uteri, adenomyosis, ovarian tumors and endometrial polyps. Characterizing the pattern of uterine bleeding in association with the size and contour of the uterus, palpation of an adnexal mass and the presence of pelvic pressure, urinary and/or bowel dysfunction are important considerations when considering these other pathologies.
Pelvic pain is not a common presentation but may signify degeneration, torsion, cervical dilatation caused by a prolapsing submucous leiomyoma or the presence of concomitant adenomyosis or endometriosis. In rare instances, an insiduous onset of …show more content…
Among women in the reproductive age, the differentiation of the two is necessary , as it applies to management options and prognostication of treatment.
To differentiate between the clinical impression of leiomyoma and adenomyosis, transvaginal ultrasonography and magnetic resonance imaging may be necessary albeit dictated in favor of ultrasonography when considering availability and cost.iii On ultrasonography, a myoma is seen as a well-defined hypo- to hyperechogenic lesion surrounded by or attached to the myometrium with circumferential blood flow at the outer border. In comparison, asymmetric thickening of the myometrium, myometrial cysts, hyperechogenic islands, fan-shaped shadowing, subendometrial echogenic lines and buds (linear striation), and an irregular endometrial–myometrial junction are suggestive of adenomyosis.
Ultrasonography is the first-line test for leiomyoma. With a skilled sonologist, this easy to perform, inexpensive and readily accessible diagnostic modality can characterize, localize, measure and provide differentiating information from other diagnosis. It may allow identification of atypical leiomyoma morphology that may lead to an increased suspicion of non-benign uterine masses. Color doppler flow findings include
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Therefore, the scope of information provided is limited to essential information directly related the purpose providing women facts about endometriosis. The facts are brief enough to what the health consumer can reasonably learn in the time allowed. The headings are clearly stated which makes the information provided on this pamphlet easy to follow and promotes learning and interaction among women. This information can aid women to understand about their diagnosis and empower them to make an informed decision. 1,2,2
22. An office consultation is performed for a postmenopausal woman who is complaining of spotting in the past 6 months with right lower quadrant tenderness. A comprehensive history and physical are
In endometriosis, this endometrial tissue begins to grow in places outside the uterus. Typical sites include the fallopian tubes, intestines, vagina, and on scars that my form after abdominal surgery. The misplaced endometrial tissue thickens, engorges with blood and bleeds during the menstrual cycle, just like the normal tissue in the uterus. However, there is no place for the abnormally placed endometrial tissue outside the uterus to shed blood. This results in the formation of cysts, scars, and adhesions. This process can also block or affect the fallopian tubes so that conception and pregnancy are less likely to happen. It can also result in complete infertility. Other symptoms of endometriosis are often associated with heavy or painful periods. Risk factors for the development of endometriosis include having a mother or sister with the disorder, never having children, starting the menstrual period at an early age, and frequent or long periods. According to Dr. Camron Nezhat, Laparoscopic Surgeon at Stanford University, 5.5% of women in the U.S are infected with Endometriosis and 30% to 40% are infertile as a result of it.
Endometriosis is an abnormal growth of endometrial cells it is most commonly found in the organs of the pelvis. Endometrial tissue is shed during each month during menstruation. Rarely endometriosis can occur outside of the pelvis. The surrounding tissue can become irritated and eventually be scrapping scar tissue and adhesions. Bands of fibrous tissue can cause tissues and organs stick to each other. Though the exact cause has never been identified, endometriosis is more common in women who experience infertility than in fertile women. There might be a couple of explanations such to why endometriosis occurs such as retrograde menstruation. Retrograde menstruation is blood that contains endometrial cells that flow back through the fallopian tubes and also into the pelvic cavity
Fibroids are becoming more and more common in women in the United States. It is estimated that 171 million women in the U.S. were affected by this condition in 2013(6). About 20% to 80% of women develop fibroids by age 50 (6). As many as three out of four women may have uterine fibroids in her lifetime (4). Fibroids, also known as uterine leiomyoma, are benign tumors that can be found in women of childbearing age due to its dependence on estrogen and progesterone (7). They are made of muscle cells and other tissues that can grow around or in the uterus or womb. With fibroids, a single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue (2). Some fibroids even go through growth spurts where they grow and shrink on their by itself. There are women with fibroids who have no symptoms at all. If they do, it may consist of heavy or painful periods, frequent
Marisa R. Adelman, M.D. as Assistant Professor, with a specisl interest in Minimally invasive gynecology. Dr. Adelman received a B.A. from Johns Hopkins University, and her M.D. from the University of Virginia. She completed her Obstetrics
Uterine leiomyoma also known as uterine fibroids are non-cancerous tumors in women during childbearing age. The tumors come from smooth muscle cells of the myometrium within the uterus that changes in size and cellular properties during the reproductive years of a woman. The change in size and cellular property with hypertrophy of the smooth muscle cells normally happen during pregnancy and also occur with uterine fibroids. The development of the tumors is dependent upon estrogen and progesterone and interaction with growth factors, cytokines and extracellular matrix components (Taylor, Holthouser,
Exploratory laparoscopy can be performed if there is concern for ectopic pregnancy. Patients in pain and/or those who are hemodynamically unstable should proceed to laparoscopy. Laparoscopy allows assessment of the pelvic structures, the size and exact location of the ectopic pregnancy, the presence of hemoperitoneum (see the image below), and the presence of other conditions such as ovarian cysts and endometriosis, which, when present with an intrauterine pregnancy, can mimic an ectopic pregnancy. Furthermore, laparoscopy provides the option to treat once the diagnosis is established. Laparoscopy remains the criterion standard for diagnosis; however, its routine use on all patients suspected of ectopic pregnancy may lead to unnecessary risks, morbidity, and costs. Moreover, laparoscopy can miss up to 4% of early ectopic pregnancies; as more ectopic pregnancies are diagnosed earlier in gestation, the rate of false-negative results with laparoscopy would be expected to
In addition to pain during menstruation, the pain of endometriosis can occur at other times of the month. There can be pain with ovulation, pain associated with adhesions, pain caused by inflammation in the pelvic cavity, pain during bowel movements and urination, during general bodily movement like exercise, pain from standing or walking, and pain with intercourse. But the most desperate pain is usually with menstruation and many women dread having their periods. Pain can also start a week before menses, during and even a week after menses, or it can be constant. There is no known cure for endometriosis.
Radiologic abnormalities on an ultrasound would show polycystic ovaries. Polycystic ovaries are the formation of clusters of pearl-sized cysts containing immature eggs in the ovaries. In healthy women, a follicle grows and at the time of ovulation, an egg is released into the Fallopian tube. In women with polycystic ovary syndrome, the development of the follicle is arrested and the egg does not burst forth. Therefore, the egg dies and the follicle becomes a cyst that remains in the ovary (Banning 635-636).
Endometriosis affects 10% of reproductive-age women (Yale School of Medicine). It affects nearly 176 million women, ranging from 15-49, all over the world (World Endometriosis, 2011). “Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant) (Mayo Clinic, 2013)” It most commonly involves your ovaries and the lining of the pelvis, but in extreme cases can spread to other parts of the body. The displaced tissue continues to act like it normally would in the uterus, thickening and breaking down with each menstrual cycle. Since the displaced tissue has nowhere to go, it becomes trapped with no way to get out (Mayo Clinic, 2013).
There are two main types of cancer of the uterus, uterine sarcomas and endometrial carcinomas. Endometrium cancer begins when the tissues of the inner lining of the uterus (endometrium) begin to grow out of control.1 There are many subtypes of endometrial cancer based on the histology of the cells. Endometrial cancer is furthermore, graded based on how much the cancer forms and glands that have the similar morphology of healthy and normal endometrium glands.2 Endometrial Cancer primarily affects woman of postmenopausal age and some of the risk factors include, things that affect hormone levels, like taking estrogen after menopause, birth control pills, or tamoxifen; the number of menstrual cycles (over a lifetime), pregnancy, obesity, certain ovarian tumors, and polycystic ovarian syndrome, use of an intrauterine device, age, diet and exercise, diabetes, family history (having close relatives with endometrial or colorectal cancer, having been diagnosed with breast or ovarian cancer in the past, having been diagnosed with endometrial hyperplasia in the past and treatment with radiation therapy to the pelvis to treat another cancer. 3
Symptoms that show a possible endometriosis are pelvic pain of significant intensity, painful periods and also painful urination during periods, pain during sexual activity and others.
Uterine Fibroids are non-cancerous growths that develops in the myometrium layer of the uterus. A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue (EA, 2013). There are different types of growth patterns to uterine fibroids. Sometimes they are small and in some cases they are extremely large. Woman between the ages of 30-and 40 years old are more at risk of developing uterine fibroids. They develop mostly in the child bearing years of a woman’s life. African American women have a greater risk of developing uterine fibroids at a younger age than any other race. Uterine fibroids are also called leiomyomas or myomas. Uterine Fibroids can develop on the inside or outside of the uterus.