Introduction Description: An adenofibroma is an epithelial tumor that consists of glandular elements and large amounts of stromal (fibrous) elements. Adenofibromas are most commonly found as ovarian masses. They may also occur in the cervix or uterine body. Adenofibromas are closely related to cystadenofibromas, which have cystic areas but still contain more than 25% fibrous connective tissue. Prevalence: Uncommon. Predominant Age: Perimenopausal and postmenopausal. Genetics: No…

Introduction Description: Uterine prolapse is the loss of the normal support mechanism, resulting in descent of the uterus down the vaginal canal. In the extreme, this may result in the uterus descending beyond the vulva to a position outside the body (procidentia). Prevalence: Some degree of uterine descent is common in parous women. Predominant Age: Late reproductive age and older. Incidence increases with the loss of…

Introduction Description: A uterine leiomyoma is a benign monoclonal connective tissue tumor found in or around the uterus, which may be disseminated in rare cases. Prevalence: 50%–70% of women older than 50 years (one study has demonstrated a rate of more than 80% in African Americans older than 50 years). Leiomyomata account for approximately 30% of all hysterectomies. Predominant Age: 35–50 years or older. Genetics: Chromosome…

Introduction Description: Uterine abnormalities are characterized by the incomplete formation of the uterus, resulting in one or two separate halves or horns or a single uterus with a central septum. The central septum may divide the uterine cavity either partially or completely. The two resulting halves may be of unequal size or volume. In its most extensive form, duplication of the cervix and vaginal canal also…

Introduction Description: Uterine sarcoma is characterized by a sarcomatous change in the tissues of the Müllerian system, including the endometrial stroma and myometrium. Mixed Müllerian sarcomas may include elements not native to the genital tract such as cartilage or bone (heterologous type). Prevalence: Less than 10% of uterine malignancies, 1/800 smooth muscle tumors, 2.8/100,000 women aged 30–79 years. Predominant Age: 40–70 years; mean age is 60…

Introduction Description: As a symptom only, postmenopausal bleeding—vaginal bleeding that occurs in women who have passed menopause—requires evaluation to rule out processes that may threaten the long-term health of the patient. Prevalence: Common, up to 10% of postmenopausal women. Predominant Age: 50 years or older. Most common near the age of menopause; declines thereafter. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Systemic—estrogen, estrogen/progesterone, thrombocytopenia. Uterine—endometrial…

Introduction Description: Menorrhagia—heavy menstrual flow—is generally divided into primary and secondary. Secondary is caused by (secondary to) some clinically identifiable cause; primary is caused by a disturbance in prostaglandin production. Menorrhagia is generally distinguished from acute vaginal bleeding (most often associated with pregnancy and pregnancy complications). Menorrhagia is classified as heavy menstrual bleeding under the terminology used for dysfunctional (abnormal) uterine bleeding. Prevalence: 10%–15% of women…

Introduction Description: Menstrual cycles that do not follow a rhythmic pattern or have a pattern significantly differing from that expected as “normal” are considered irregular. This represents a special form of dysfunctional (abnormal) uterine bleeding. Prevalence: 10%–15% of all gynecologic visits; annual prevalence rate of approximately 5%. Predominant Age: Reproductive age; highest in adolescents and patients who experience climacteric changes. Genetics: No genetic pattern. Etiology and…

Introduction Description: Bleeding between otherwise normal menstrual cycles. Constitutes a special form of dysfunctional (abnormal) uterine bleeding. Prevalence: 10%–15% of all gynecologic visits involve menstrual disturbances. Predominant Age: Reproductive age; highest in adolescents and patients who are climacteric. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Uterine (pregnancy, endometrial polyps, endometrial hyperplasia, endometrial carcinoma, endometrial hypoplasia [atrophy, hormonal contraception] leiomyomata, intrauterine contraceptive device [IUD]), cervical (polyps,…

Introduction Description: Hematometra is a collection of blood in the body (cavity) of the uterus, resulting from the obstruction of the normal outflow tract. This obstruction may result from congenital abnormalities, acquired cervical stenosis, iatrogenesis (dilation and curettage, endometrial ablation), or obstruction by neoplasia. Prevalence: Uncommon. Predominant Age: Early reproductive and postmenopausal age most common. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Obstruction or atresia…

Introduction Description: Endometritis is an acute or chronic inflammation, usually of infectious origin, of the lining of the uterus. This is a general term that is used for this condition in either nonpregnant or not recently pregnant patients; chorioamnionitis or endomyometritis are the terms commonly used for pregnant or recently pregnant patients. Acute endometritis is often characterized as an intermediate state in infections ascending from the…

Introduction Description: Endometrial polyps are fleshy tumors that arise as local overgrowths of the endometrial glands and stroma and project beyond the surface of the endometrium. They are most common in the fundus of the uterus but may occur anywhere in the endometrial cavity. They are generally small (a few millimeters) but may enlarge to fill the entire cavity. Prevalence: Up to 10% of women (from…

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Introduction Description: Endometrial cancer is characterized by malignant changes of the endometrial tissues. These are generally of the adenocarcinoma (endometrioid, also called type 1 tumors, 80%), adenosquamous, clear cell, or papillary serous cell types. Prevalence: 2%–3% lifetime risk. The most frequent malignancy of the female reproductive tract in developed countries, approximately 65,950 cases per year in the United States; 12,550 deaths each year (2022 estimate), eighth…

Introduction Description: Dysfunctional (abnormal) uterine bleeding is irregular or is intermenstrual bleeding with no clinically identifiable underlying cause. The bleeding may be abnormal in schedule, duration, or quantity. Prevalence: 10%–35% of all gynecologic visits involve menstrual disturbances. Predominant Age: Reproductive age; highest in adolescents and patients experiencing climacteric changes. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: The causes of abnormal uterine bleeding have been summarized…

Introduction Description: Asherman syndrome is characterized by the scarring or occlusion of the uterine cavity after curettage, especially when performed after septic abortion or in the immediate postpartum period. Although the same changes occur following therapeutic endometrial ablation, the term is generally not applied in that setting. Prevalence: Uncommon (1.5% of women undergoing hysterosalpingography, up to 20% with a history of uterine curettage). Predominant Age: Reproductive…

Introduction Description: Adenomyosis is characterized by islands of endometrial glands and stroma found in the uterine wall (myometrium) and causing hypertrophy of the surrounding myometrium. Prevalence: 10%–35% of women; may be present in 60% of aged women 40–50 years. Predominant Age: 35–50 years. Genetics: Familial predisposition (polygenic or multifactorial inheritance pattern). Etiology And Pathogenesis Causes: Adenomyosis is derived from aberrant glands of the basalis layer of…

Introduction Description: Nabothian cysts are retention cysts of the cervix that are made up of endocervical columnar cells and that result from the closure of a gland opening, tunnel, or cleft by the process of squamous metaplasia. Prevalence: Normal feature of the adult cervix. Predominant Age: Reproductive age. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: A cervical gland opening, tunnel, or cleft that is covered…

Introduction Description: Cervicitis is the inflammation (acute or chronic) of the endocervical glands or the ectocervix. Less commonly it can affect the squamous epithelium of the ectocervix. Prevalence: 10%–40% of women. Predominant Age: Reproductive age; highest rate in adolescents to early 20s. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Endocervical— Chlamydia trachomatis (up to 60% of cases in some studies), Neisseria gonorrhoeae. Almost 50% of…

Introduction Description: Cervical stenosis is the narrowing of the cervical canal, either congenital or acquired, which may result in complete or partial obstruction. Stenosis occurs most often in the region of the internal cervical os. Prevalence: Uncommon. Predominant Age: 30–70 years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Operative damage (cone biopsy [up to 8% of patients], electrocautery, cryocautery [<1% of patients]), radiation, infection, neoplasia,…