Uterine disorders: Pathology review

29-year-old Carmen presents to the physician’s office complaining of severe lower abdominal pain during her menstrual periods as well as pain during intercourse.

She has been trying unsuccessfully to get pregnant for the first time for the past 2 years.

Pelvic examination shows a normal sized uterus.

Later that day, 44-year-old Susanna comes to her physician reporting heavy menstrual periods that last about 10 days.

This has been occurring for the past 6 months and is accompanied with a feeling of “fullness” in the lower abdomen as well as fatigue.

On further history, she has never been pregnant.

Physical examination shows an enlarged uterus with multiple round masses.

Laboratory studies reveal iron deficiency anemia.

Based on the initial presentation, Carmen and Susanna both have some form of uterine disorder.

Let’s first review physiology real quick.

The uterus consists of 3 layers, an outer layer called the perimetrium or the serosa, a middle smooth muscle layer called the myometrium, and the innermost layer, the endometrium.

The endometrium has two layers, an inner functional layer made up mainly of glands and supporting connective tissue, called stroma, and an outer thin basal layer which regenerates the overlying functional layer after each menstrual cycle.

Okay, now, the first uterine disorder is endometritis or inflammation of the endometrium.

This is usually caused by normal bacterial flora of the lower genital tract, meaning the cervix, vagina or external genital organs, that travel upwards into the endometrium.

A high yield risk factor to remember is the retention of products of conception, like parts of the placental or fetal tissues, following delivery or abortion.

Another risk factor is the presence of a foreign body, like an intrauterine contraceptive device.