This document discusses benign diseases of the uterus, including the anatomy and histological variation of the endometrium and myometrium. Specific conditions covered include endometrial polyps, various types of endometrial hyperplasia (simple, complex, with or without atypia), endometritis, congenital uterine anomalies, leiomyomas (fibroids), adenomyosis, and dysfunctional uterine bleeding (DUB). Diagnostic methods and treatment approaches are described for each condition. Medical therapies include hormonal treatments, while surgical options include hysteroscopic resection, myomectomy, and hysterectomy depending on the diagnosis and patient's desire for future fertility.

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