Uterine disorders: Pathology review

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Uterine disorders: Pathology review




Uterine disorders: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 23-year-old nulliparous woman comes to the office because of chronic episodic pelvic pain. The pain begins 2-3 days before menses and continues throughout the menses, after which it subsides. Menarche was at age 14. She has a regular menstrual cycle of 25 days with 5-6 days of moderate bleeding. Medical history is significant for recurrent migraine headaches with aura. She is not sexually active. Physical examination shows a fixed anteverted uterus and nodularity in the posterior cul-de-sac. The patient is provided with a medication that acts to inhibit the growth of endometrial tissue. Which of the following medications was most likely provided? 


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.


Uterine disorders are conditions that affect the uterus, the female reproductive organ that is responsible for gestating a fertilized egg. Common uterine disorders endometritis, asherman syndrome, endometrial hyperplasia, endometrial polyps, endometriosis, and leiomyomas.

Endometritis refers to the acute or chronic inflammation of the endometrium due to invasion by bacteria normally found in the lower genital tract. Asherman syndrome involves intrauterine adhesions following procedures like dilation and curettage and can result in amenorrhea, infertility, or recurrent pregnancy loss. Endometrial hyperplasia is the excessive growth of the endometrial glands, most commonly caused by long-standing increased exposure to estrogen without the counteracting effect of progesterone.

There is also endometrial cancer, which is a type of cancer that begins in the lining of the uterus, called the endometrium. There can also be endometrial polyps, which are benign growths of the endometrial glands and stroma that protrude into the uterine cavity. Next, there is endometriosis in which there is the presence of endometrial tissue outside the endometrial cavity, usually on the ovaries, causing pelvic pain and bleeding that gets worse during menstruation. Finally, there are leiomyomas or uterine fibroids, which are extremely common benign smooth muscle tumors that usually develop in premenopausal women, in response to estrogen. Leiomyomas can present with abnormal uterine bleeding, pain, iron deficiency anemia, or fertility issues.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Schwartz's Principles of Surgery" F.C. Brunicardi (2018)
  4. "Williams Gynecology, Third Edition" McGraw-Hill Education / Medical (2016)
  5. "Echogenic Endometrial Fluid Collection in Postmenopausal Women Is a Significant Risk Factor for Disease" Journal of Ultrasound in Medicine (2005)
  6. "Invasive implantation and intimate placental associations in a placentotrophic african lizard, Trachylepis ivensi (scincidae)" Journal of Morphology (2011)
  7. "Review: Chronic endometritis and its effect on reproduction" Journal of Obstetrics and Gynaecology Research (2019)

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