Subseptate uterus

Where the inside has a dip and the fundus is normal

Arcuate uterus

When the fundus has a little dip

Bicornate uterus

When the uterus has a deep dip in the fundus and in the endometrial tissue delow

Uterus didelphys

When there's two unicornate uteruses, two cervix and the vagina is separated with a septa

Uterine leiomyomas. Describe them in general.

• benign tumors derived from smooth musc cells of the myometrium
• most common uterine tumor
• rare before menarche
• degeneration can cause pain
• malignancies are rare
• can be sub-mucosal, sub-serosal, intramural, may be on cervix, bowel also

How do uterine leimyomas present clinically?

• mostly asymptomatic
• excessive uterine bleeding
• mass effect (pain, congestion, urinary frequancy)
• menorrhagia (esp with intramural and submucosal)
• if it distorts the uterus: infertility, spontaneous abortion, premature rupture of membranes, dystocia (cannot give birth), post-partum bleeding

Describe a DDx for uterine leiomyomas?

• endometrial hyperplasia
• malignancy
• tubular or ovarian cyst
• tubular or ovarian neoplasm (most common)
• pelvic kidney
• diverticular or inflamm bowel mass
• colon cancer
• pregnancy
• adenomyosis

How would you treat a uterine leiomyoma?

• tx only if symptomatic
• medical-hormonal: progestin only therapy, combination hormonal contraceptive methods, GnRH agonist
• surgical: myomectomy, hysterectomy, embolization of uterine arteries, ablation of submucosal fibroids via hysteroscopy

Define an endometrial polyp

localized overgrowth of endometrial glands and stroma

Describe the presentation, diagnosis and treatment of endometrial polyps

• can cause unpredictable bleeding and menorrhagia
• source of post-menopausal bleeding
• benign (incidence of carcinoma very rare)
• Diagnosis: U/S or curretage during hysteroscopy
• Tx: removal with dressing forceps during D&C or just removed from the outside if it protrudes from the endocervix

Define cervical polyps

• commonest benign growth of the cervix
• local proliferation of cells
• polypoid fold of endocervical tissue
• benign lesion

How would a cervical polyp present clinically and how would you diagnose and treat it?

• may present with post-coital bleeding, leucorrhoea or may be incidental finding
• Diagnosis confirmed on biopsy
• tx: narrow based can be removed by twisting in the office, cautery in an operative setting, all specimens sent for pathology (early adenocarcinomas may present this way)

Nabothian cyst

• very common ("normal" variant)
• result of squamous metaplasia due to chronic inflammation
• layer of superficial squamoud cells covers an invagination of columnar cells under the cervix

Endometrial hyperplasia, everything but tx

• an epithelial condition of the uterine corpus and cervix
• sometimes seen when there is unopposed estrogen action
• dx from endometrial biopsy
• clinical picture: inter-menstrual bleeding, dysfunctional uterine bleeding & menorrhagia

How would you treat endometrial hyperplasia?

• simple with no atypia: medroxyprogesterone acetate then repeat endometrial biopsy, or treat underlying cause
• complex without atypia: needs formal evaluation of endometrium with fractional D&C
• complex with atypia: hysterectomy or careful follow-up after 3 mo of progesterone

Asherman's syndrome

• loss or large component of functional endometrial lining
• usually iatrogenic (D&C in high risk setting)
• endometrial ablation a deliberate intent to cause amenorrhoea or ameliorate menorrhagia