ENDOMETRIAL POLYP and ADENOMYOSIS GAKO.pptx

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1. ENDOMETRIAL POLYP DR NGABONZIZA E

2. introduction Endometrial polyps are a localized overgrowth of glands and connective tissue around a vascular core, or a small blood vessel. Single or multiple polyps may occur ranging from a few millimeters to many centimetres in size. They may lie flat against the surrounding endometrium or be very long and protuberant.

3. Risk factors Endometrial polyps are common. Many cause no symptoms. Their prevalence is between 8 and 35% depending on the type of patient studied Risk factors for the development of polyps include age over 40, high blood pressure, obesity and use of tamoxifen Malignancy may occur in up to 13% of endometrial polyps

4. Symptoms of endometrial polyp Intermenstrual bleeding Vaginal discharge Heavy periods Fertility problems Problems associated with polyp-to-cancer progression Large polyps may protrude through the cervix causing bleeding after intercourse

5. Diagnosis of endometrial polyp Saline-infused sonography hysteroscopy and curettage under general anaesthesia Hysterosalpingography

6. Medical management levonorgestrel releasing intrauterine device (Mirena)

7. Surgical management Dilatation and curettage Hysteroscopic resection(polypectomy) Hysterectomy for post menopausal women or at risk of cancer

8. ADENOMYOSIS a gynecologic condition characterized by the presence of endometrial glands and stroma within the myometrium can significantly reduce quality of life Adenomyosis occurs in 8.8% to 61.5% of women undergoing hysterectomy The prevalence is estimated to range from 20% to 34%

9. SYMPTOMS Heavy menstrual bleeding and dysmenorrhea are common symptoms Other symptoms include: dyspareunia, chronic pelvic pain, infertility, and obstetrical complications, such as preterm birth, small for gestational age size in neonates.

10. pathogenesis The pathogenesis of adenomyosis is unproven, but evidence supports a role for invagination of the endometrial basalis into the myometrium. Alternatively, metaplasia of displaced embryonic Mullerian remnants or differentiation of adult endometrial progenitor cells may be the underlying cause.

11. diagnosis Physical exam: reveals a diffusely enlarged “boggy” or soft uterus, which may be mildly tender. The histologic diagnosis of adenomyosis is based on the presence of irregularly shaped islands of endometrial glands and stroma in the myometrium, leading some to term adenomyosis

12. diagnosis Ultrasound and MRI • Enlarged uterus • Asymmetric myometrial thickness • Heterogeneous myometrial echotexture • Poorly defined endomyometrial junction • Endomyometrial junctional zone measures >12 mm on MRI • Other gynecologic etiologies excluded ( eg , uterine fibroids)

13. treatment First-line treatment Nonsteroidal anti-inflammatory drugs for pain only symptoms ( eg , 400-600 mg ibuprofen every 6 h) Levonorgestrel-releasing intrauterine system (LNG-IUS) Oral progestins ( eg , 5 mg norethindrone daily) Combined oral contraceptive pills (COCs)

14. treatment Second-line treatment Gonadotropin-releasing hormone (GnRH) agonist GnRH antagonist Uterine artery embolization if fertility not desired Hysterectomy if fertility not desired