Noviani Rianda Tari

Etiology Classification by
FIGO
STRUKTURAL NON-STRUKTURAL

Munro MG, et al. Int J Gynaecol Obstet 2011;113:3-13

 CERVICAL POLYP

EXCESSIVE GROWTH OF
ENDOCERVIX
PEDUNCULATED
USSUALY ASYMPTOMATIC
CONTACT BLEEDING, VAGINAL
DISCHARGE
Th/ : EXTIRPATION
 UTERINE POLYP

EXCESSIVE GROWTH OF
ENDOMETRIUM
PEDUNCULATED
USSUALY ASYMPTOMATIC
Th/ CURRETAGE
Adenomyosis = internal endometriosis

: endometrial glands within the myometrium

Reproductive age : < 40 years

Symptom sign
Often asymptomatic
Menorrhagia
Dysmenorrhea, before - during menses
Diffusely enlarged uterus,
usually < 14 cm length, mobile.
Management

Depend on patient age - desire for

fertility
Conservative treatment :
Young woman, preserve fertility
premenopause
- NSAID
- Contraseptive agent
Hysterectomy
Uterine Leiomyoma
= Myoma = Fibroid

Most common benign uterine tumour

20% of all women of reproductive age
Cause : unknown single neoplastic cell
Subserosal: pedunculated, intraligament,
parasitic
Intramural
Submucosal prolapse pedunculated
Pedunculated subserosal
Myoma

subserosal

intramural

Pdunculated
submucosal

submucosal
intra ligamenter
Cevical Myoma

Pedunculated
Submucosal
Symptom sign

Asymptomatic discovered incidentally

Irregular enlarged uterus
Menorrhagia
Chronic pelvic pain - dysmenorrhea,
dyspareunia, pelvic pressure
(Acute: torsion, infark red degeneration)
Urinary symptoms :
frequency
partial ureteral obstruction
completely ureteral obstruction
Infertility < 3% of infertile woman
 Management

Principally : Hysterectomy
Exception :
Myomectomy :
Reproductive function preservation
Sub serous without tubal involvement
Laparotomy / Hysteroscopy
GnRH :
Small, fertility
Pre myomectomy
Small, premenopause
Medical contraindication to surgery
Endometrial Hyperplasia

Spectrum of morphologic and biologic alteration of

endometrial gland and stroma (physiologic - Ca insitu)

Type of Hyperplasia Progresssion to

Cancer ( % )

Simplex ( Cystic (-) atypia 1

Complex ( Adenomatous (-) Atypia 3
Atypical :
Simplex ( cystic (+) atypia 8
Complex ( adenomatous (+) atypia 29
 Influenced by :
age
underlying ovarian disease
Endocrinopathy
obesity
exogenous hormones exposure

Sign : metrorrhagia
Management

Young age progestin

Old women D & C PA :
atypia (-) progeteron th/ +
curretage 3-6 month

atypia (+) HT
Progesteron +
curretage
DISFUNGTIONAL UTERUS BLEEDING

Definition
Is an abnormal bleeding from uterus that
came only by hormonal disturbance
without organic abnormalities.

Happen in teenagers, reproductive period

and premenopause period.
Clasification :
1. DUB in anovulation cycles
Corpus luteum do not developed, level of
estrogen is high, progesteron
level is low.

2. DUB in ovulation cycles

- midcycles bleeding
- Bleeding cause by disturbance in
endometrial release
- Spotting premenstruation and
postmenstruation.

3. DUB in persistent follicles

- often found in reproductive line
- Endometrial hyperplasia : -Simplex
- Cystic
How to reach diagnosis
1. Anamnesis, gynecological examination
2. Anovulation diagnosis

Basal temperature : monophasic

Progestin level : low
Gonadotropin level : LH low
Menstrual cycles : irregular.

Treatment
Hormonal therapy combination estrogen and
progesteron