1. Benign Disease of The Uterus
Khalid Sait (FRCSC)
Professor of Gynecological Oncology
Faculty of Medicine
King Abdulaziz University

3. Anatomy of the uterus
n Endometrium
n Myometrium
Both
are mesodermal in
origin Both
formed secondary to
fusion of mullarian
ducts ( 8-9 weeks
post ovulation)

5. Anatomy of the uterus
Endometrium
n Cycle histological variation
Important in :
1- diagnose luteal phase defect
2- Documentation of ovulation
( change of proliferative endometrium to
secretary endometrium under influence of
progesterone

6. Benign disease of the
endometrium
n Endometrial
Polyp
Localized
overgrowths of
endometrial tissue
covered by epithelium
and containing a variable
amount of glands ,stroma
and blood vessels

7. endometrial polyps.
n a symptomatic
n excessive bleeding during a menstrual period,
n bleeding in between periods,
n spotting after intercourse. Some women report a
few days of brown blood after a normal menstrual
period. If the polyp interferes with the egg and
sperm, it may make it hard to get pregnant.
n slightly higher chance of miscarriage
n could this be cancer?

9. endometrial polyps.
n Sonohysterogram (water ultrasound) The
water opens the uterine cavity, allowing
the doctor to see if any polyps are
hanging around.
n hysterosalpingogram (HSG)
n hysteroscope

11. Benign disease of the
endometrium
n Inflammation
Acute : mostly related with pregnancy and
abortion ( multimicrobial )
Chronic non specific Endometrities:
1- pregnancy
2- PID
3-IUCD
4- Infarcted Polyps
5-Cancer
Chronic specific endometrities:
TB, Mycoplasma,Viral and Fungal

12. Benign disease of the
endometrium
n Endomtrial hyperplasia
Proliferation of a glands of irregular
size and shape with increase in the gland/
stroma ratio compared with proliferative
endometrium

13. Classification Of Endometrial Hyperplasia
WHO ( Kurman &Norris )
n Simple ( Cystic ) Hyperplasia with and
with out atypia
n Complex Hyperplasia with or with out
atypia

16. Benign disease of the
endometrium ( Endometrial hyperplasia……..)
n Unopposed estrogen exposure
n PCO and unovulation
n Estrogen producing tumor
n Estrogen therapy
n Obesity .DM . HTN
n 2% of pt. with out atypia progress to
cancer
n 23 % of pt. with atypia progress to

24. Natural History of Endometrial
Hyperplasia
Type NO Mean age Regress
(%)
Progress
to
carcinoma
no
Mean
( years)
Follow up
( years)
Simple with
out atypia
93 42 74(80) 1 11 1-26.7
10 preg.
Complex
with out
atypia
29 39 23(79) 1 8.3 2-26
3 preg.
Atypical
hyperplasia
48 40 28(58) 11 4.1 1-25
3 preg.
Atypical
simple
13 9 1
Atypical
complex
35 20 10
Kurman et al(170 patients )

25. Young patients
( Endometrial Status)
No Atypia Atypia
simple complex Simple
Mild atypia
Complex
Moderate
Or severe
No
abnormal
bleeding
Abnormal
Bleeding
observe
Intermittent
Progestin
therapy
Intermittent
Or continues Progestin
therapy
Consider
6-month sample
Especially for
Abnormal bleeding
Continuous
High dose
Progestin
therapy
Sample 6 months

26. Uterine preservation is not required
( Old Patients)
Endometrial status
NO CYTOLOGIC
ATYPIA
ATYPIA
Intermittent or
continuous therapy
And sample in 6 months
OR
HYSTERECTOMY
Pt. Is not
surgical candida
Fit for surgery
Intermittent or
continuous therapy
And sample in 6 months
Hysterectomy

27. Medical Treatment
n With out atypia:
1- Provera 10 mg for 10 days for 3 mos
2- OCP
n Atypia pt: mild:
I) 10 mg bid continuously followed by intermittent therapy
14 days per month Or
OCP if contraception is required
n MOD OR SEVER ATYPIA:
10 MG TID continuous for 6 mos
(SAMPLE IN 6 MONTHS)

28. Medical Treatment
n PTS WANT TO CONCEIVE IS GIVEN GnRH agonist for 3 Months.
Followed by Ovulation Induction
n LONG TERM PROGESTERONE : MEGACE 40-160 MG DAILY
n ALTERNATIVE:
DEPOPROVERA 200 MG IM FOLLOWED BY
100 MG EVERY 2 WEEKS TWO TIMES AND THEN
100 MG MONTHLY FOR 6 MONTH

29. Benign disease of the
Uterus
n Congenital anomalies

31. Congenital Uterine Anomaly
n Precise incidence is unknown (range from 1-2 %)
n Clinical presentation:
1 Usually asymptomatic
2 Menstrual disorder
3 Dysmenorrhea
4 Recurrent abortion ( decrease intrauterine volume and
vascularity, increase uterine irritability and cervical
incompetance )
5 Premature labor
6 Abnormal presentation
7 Primary infertility

32. Congenital Uterine Anomaly
n Diagnosis:
History
Pelvic exam
Hysterosalpingography
U/S
MRI
Laproscopy
Hysteroscopy
IVP or U/S (Exclude Renal anomaly )

40. Congenital Uterine Anomaly
n Treatment:
1- Double uterus (didelphic uterus): no need to treat.
2- Bicornate ut. --------- Strassmann
procedure ( if indicated )
3- Ut. Septum --------- (BCP
for dysmenorrhea ), Tompkins metroplasty or
Hysteroscopic resection of septum )
4- Unicornate ut.
-------- Surgery indicated if there is blind horn which
cause symptom----- surgical resection of blind horn.

41. Benign disease of the
Myometrium
n Leiomyoma
n Adenomyosis

42. Q5

44. What Is Fibroids?
Are benign clonal tumours that arise from the
smooth-muscle cells of the human uterus.
Most uterine leiomyomas are asymptomatic.
Uterine leiomyoma locations;
Incidance 25-50%

56. Complication Of Fibroid
n Symptoms
n Infertility
n Degeneration

57. Symptomatic Asymptomatic
Want future
pregnancy
Exclude other.
Med.
Surg. myom.
Ut.a. emb.
Depened on size.
<12 week F.U
>12week
myomectomy
Not want future
pregnancy
Exclude other.
Med.
Surg.myom.,TAH.
Ut.a.emb.
Depened on size.
<12week F.U
>12 week
Myom.,TAH.
MANEGMENT

58. MEDICAL MANEGMENT:
oral-contraception.
nsaids.
antifibrinolytic agents.
danazole.
Gnrh agonist.
progesterone antagonist.

59. SURGICAL MANEGMENT

67. Benign disease of the
endometrium
n DUB
Abnormal uterine bleeding resulting from
derangement in the magnitude or duration
of estrogen and progestron on the
endometrium. It is a clinical term used to
describe bleeding not attributable to an
underlying organic pathological condition

68. Benign disease of the
endometrium ( DUB……)
n Condition has to be excluded
before making the diagnosis of
DUB:
1-Systemic causes
2-Local Cause
3-Pregnancy related