Uterine and Fallopian Tube Disease

Abnormal uterine bleeding is the medical term for abnormalities in the frequency, volume, duration, and regularity of the menstrual cycle. Abnormal uterine bleeding is classified using the acronym PALM-COEIN, with PALM representing the structural causes and COEIN indicating the non-structural causes. Etiologies include polyp (P), adenomyosis (A), leiomyoma (L), malignancy/hyperplasia (M), coagulopathy (C), ovulatory dysfunction (O); endometrial pathology including endometritis and atrophy (E), iatrogenic causes (I), and etiologies not otherwise classified (N). Diagnosis usually requires careful history-taking and examination, basic laboratory work, transvaginal ultrasound, and endometrial biopsy based on age and risk factors. Management depends on the underlying etiology, but often includes oral contraceptive pills, levonorgestrel-containing intrauterine devices, and surgery.

Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Implants outside of the abdominopelvic cavity are also possible, though uncommon. Endometriosis typically presents in a reproductive-aged female with pelvic pain that worsens around menstruation. Endometrial implants tend to be inflammatory, leading to cyclic, chronic pain; adhesions; and an increased risk of infertility. The diagnosis is usually made clinically, though definitive diagnosis requires laparoscopy. Lab work is rarely useful. Management involves suppression of endometrial growth with progestins, typically with oral contraceptive pills. In severe cases, surgery is helpful to confirm the diagnosis and treat any implants.

Fallopian tube tumors are rare with an incidence of 3.6 per one million. Fallopian tube carcinoma is of epithelial origin and share similar pathogenesis mechanisms with epithelial ovarian cancer. Early obstruction of the fallopian tube results in rapid onset of symptoms such as abdominal pain and distension and patients with fallopian tube carcinoma usually present at an early stage. Treatment of choice for early stage fallopian tube carcinoma is surgical removal of the tumor and any involved pelvic structures.

Anovulatory cycles are a symptom and not a disease. Polycystic ovary syndrome, pituitary microadenoma, impaired GnRH release, and hypothyroidism are common etiologies for anovulation and should be excluded. Patients can present with amenorrhea which needs etiology-specific treatment or with acute dysfunctional uterine bleeding which might need emergency treatment. Emergency treatment can be either medical with estrogen or surgical with dilation and curettage. Oral contraceptive pills can be used in an attempt to make the menstrual cycle more regular before trying more specific treatments.

Salpingitis is the inflammation of the fallopian tubes usually due to gonorrheal or chlamydial infections, but other gram-negative and anaerobic bacterial pathogens have been also implicated. Patients can present with lower abdominal pain, fever and an elevated erythrocyte sedimentation rate. Ultrasonography and diagnostic laparoscopy can help confirm the diagnosis of salpingitis and exclude other differential diagnoses or associated complications such as hydrosalpinx, adhesions, and tubo-ovarian abscesses. Antimicrobial management is the mainstay of treatment and surgical management should be reserved to patients with non-responsive tubo-ovarian abscesses or ruptured abscesses.

Endometrial hyperplasia is abnormal growth of the endometrium in the uterus. It is caused by excess estrogen unopposed by progesterone. Pathology shows an increased gland-to-stroma ratio and can show atypia. Atypia is linked to endometrial cancer, the most common gynecological malignancy in the developed world. Treatment includes progesterone therapy and if there is atypic  hysterectomy is recommended. Lynch syndrome has a high lifetime risk of developing endometrial cancer.

Get prepared for your anatomy exams: Here, you will find the most important information on the structure and function of the woman’s internal and external sexual organs.

A uterine rupture represents an important complication during pregnancy, as well as during delivery. A uterine rupture can become a life-threatening emergency which requires an immediate Caesarean section. The patient complains about severe, devastating pain. The uterus feels rigid when palpated, and signs of hypovolemic shock are visible. This article presents you with a compact overview of this complication.