OG29.1,OG31.1,OG32.1-2,OG34.6 | Benign Gynaecology — Glossary

Low-dose oestrogen-progestogen supplementation given alongside GnRH analogue therapy to attenuate hypoestrogenic side effects (hot flushes, bone mineral density loss) when treatment extends beyond 6 months, without significantly reducing therapeutic efficacy.

Surgical excision of a focal adenomyoma (localised adenomyosis nodule) from the myometrium, aiming to preserve the uterus in fertility-desiring women; associated with a risk of myometrial dehiscence in subsequent pregnancy and higher recurrence rates than hysterectomy.

The presence of endometrial glands and stroma within the myometrium (>2.5 mm from the basal endometrium), causing uterine enlargement, menorrhagia, and dysmenorrhoea.

Drugs (e.g. alendronate, risedronate) that inhibit osteoclast-mediated bone resorption; first-line pharmacological treatment for osteoporosis; reduce fracture risk by 30–50% at the spine and hip.

Cancer antigen 125, a serum glycoprotein elevated in endometriosis (modestly), ovarian cancer, fibroids, PID, and normal states; useful for monitoring treatment response in endometriosis but not diagnostic (neither sensitive nor specific enough for primary diagnosis).

Dense condensations of endopelvic fascia running from the lateral cervix and upper vagina to the lateral pelvic sidewall; the primary supports of the uterus (DeLancey Level I).

Synonym for red degeneration of a fibroid; the cut surface appears brick-red due to haemorrhagic infarction; commonest degeneration in pregnancy.

See endometrioma; the dark-brown inspissated old blood within an ovarian endometrioma gives it this colloquial name.

Meyer's alternative theory of endometriosis: multipotential peritoneal mesothelial cells undergo metaplasia into endometrial-like tissue; explains rare cases in males and pre-menarchal girls where retrograde menstruation is impossible.

Hormone replacement therapy containing both oestrogen and a progestogen; required for women with an intact uterus to prevent endometrial hyperplasia from unopposed oestrogen.

Prolapse of the anterior vaginal wall and underlying bladder base, causing a bulge on the anterior vaginal wall; associated with urinary symptoms.

Endometriotic lesions that penetrate >5 mm below the peritoneal surface; associated with the most severe pain symptoms, bowel and bladder involvement, and complex surgical management.

Dual-energy X-ray absorptiometry — the gold standard investigation for bone mineral density; T-score ≤ −2.5 = osteoporosis; T-score −1.0 to −2.5 = osteopenia.

A fourth-generation progestin (2 mg/day oral) approved specifically for endometriosis; demonstrates efficacy comparable to GnRH analogues for pain relief with a more favourable side-effect profile (fewer hypoestrogenic symptoms, acceptable bleeding pattern); increasingly preferred as second-line to COC.

Painful defaecation, typically cyclical (worse during menstruation) in endometriosis; suggests rectosigmoid or uterosacral ligament involvement.

Pain during sexual intercourse; deep dyspareunia (pain deep in the pelvis with deep penetration) is characteristic of endometriosis involving the Pouch of Douglas or uterosacral ligaments.

Thinning and fragility of the postmenopausal endometrium due to oestrogen deficiency; the most frequent (though not most important) cause of PMB (~30–40%); produces scanty, intermittent bleeding from superficial haemorrhage.

Malignancy arising from the endometrial glandular epithelium; the most common gynaecological malignancy in developed countries; presents with PMB in ~90% of cases; 10–15% of PMB is due to endometrial carcinoma.

Abnormal proliferation of endometrial glands driven by unopposed oestrogen; classified as simple/complex with or without atypia; complex atypical hyperplasia has 25–30% risk of concurrent or subsequent carcinoma.

A benign focal overgrowth of endometrial glands and stroma on a fibrovascular stalk; a common cause of PMB and abnormal uterine bleeding; treated by hysteroscopic polypectomy; all polyps must be sent for histology.

An ovarian cyst formed by endometriotic implants on the ovarian cortex that accumulates old haemorrhagic fluid; colloquially called a 'chocolate cyst' due to the dark-brown, inspissated contents.

A condition in which functional endometrial glands and stroma are found outside the uterine cavity, typically in the pelvis; characterised by cyclic hormone-dependent behaviour producing pain, adhesions, and infertility.

Herniation of the peritoneum (with or without small bowel) through the rectovaginal pouch into the posterior vaginal wall; true peritoneal hernia.

An international classification system (Munro, 2011) numbering uterine fibroids 0–8 based on their location relative to the endometrial cavity and uterine serosa, used to guide surgical planning.

Surgical staging system: Stage IA (myometrial invasion <50%), IB (≥50%), II (cervical stroma), IIIA (serosa/adnexa), IIIB (vagina/parametria), IIIC1 (pelvic nodes), IIIC2 (para-aortic nodes), IVA (bladder/bowel mucosa), IVB (distant metastases).

A collective term for the urogenital changes of oestrogen deficiency: vaginal atrophy, dryness, dyspareunia, and urinary symptoms (frequency, urgency, recurrent UTIs); progressive without treatment.

A drug (e.g. leuprolide, goserelin) that down-regulates pituitary GnRH receptors, reducing oestrogen to menopausal levels; used pre-operatively to shrink fibroids by 35–60% over 3 months.

A synthetic analogue of gonadotrophin-releasing hormone (e.g., leuprolide, buserelin) that, when given continuously rather than in pulses, down-regulates pituitary receptors and suppresses LH/FSH secretion, causing a reversible hypo-oestrogenic state used in endometriosis and adenomyosis management.

A sudden sensation of intense warmth over the face, neck, and chest lasting 1–5 minutes, caused by oestrogen withdrawal disrupting hypothalamic thermoregulation via KNDy neurones.

The most common type of fibroid degeneration in which smooth-muscle cells are replaced by avascular hyaline material; usually asymptomatic.

Direct visualisation of the uterine cavity via a hysteroscope, with targeted biopsy of suspicious areas; gold standard investigation for PMB when Pipelle is insufficient or a focal lesion is suspected on TVS.

A glycoprotein secreted by granulosa cells of developing ovarian follicles that suppresses FSH; its decline is the earliest hormonal marker of the perimenopause, occurring before oestrogen falls.

The inner myometrial layer (subendometrial myometrium) visible on MRI as a low-signal zone between the endometrium and outer myometrium; a junctional zone thickness >12 mm is the most specific MRI criterion for adenomyosis.

Kisspeptin–neurokinin B–dynorphin neurones in the hypothalamic arcuate nucleus that modulate GnRH pulsatility; activated by oestrogen withdrawal; the primary mediators of hot flushes; targeted by neurokinin 3 receptor antagonists (fezolinetant).

A surgical procedure that partially obliterates the vaginal lumen by suturing the anterior and posterior vaginal walls together, creating two lateral tunnels for drainage; reserved for very elderly sexually inactive women with procidentia who are poor surgical risks.

A benign tumour arising from smooth-muscle cells of the myometrium; the correct histological term for a uterine fibroid.

The principal muscle of the pelvic diaphragm, comprising pubococcygeus, iliococcygeus, and puborectalis; its contraction closes the genital hiatus and supports the pelvic floor.

Levonorgestrel-releasing intrauterine system (e.g., Mirena); releases 20 µg/day of levonorgestrel locally into the uterine cavity, causing endometrial atrophy and reducing menstrual blood loss by up to 90%; first-line treatment for adenomyosis-related menorrhagia and a useful adjunct in endometriosis-related pain.

A progesterone-releasing device (Mirena) placed within the uterine cavity; effective for menorrhagia in fibroids that do not distort the cavity (FIGO types 3 and above).

Hereditary non-polyposis colorectal cancer (HNPCC) syndrome caused by mutations in mismatch repair genes (MLH1, MSH2, MSH6, PMS2); carries 40–60% lifetime risk of endometrial carcinoma — the most common extra-colonic Lynch cancer.

A uterus-preserving surgical procedure for prolapse that combines amputation of the elongated cervix, shortening of the cardinal ligaments, anterior colporrhaphy, and posterior colpoperineorrhaphy.

Iatrogenic hypo-oestrogenic state induced by GnRH analogues (or bilateral oophorectomy) that suppresses endometriosis and adenomyosis activity; associated with vasomotor symptoms and bone loss unless add-back therapy is provided.

Permanent cessation of menstruation resulting from loss of ovarian follicular activity, diagnosed retrospectively after 12 consecutive months of amenorrhoea with no other cause.

Excessive menstrual bleeding, defined as blood loss >80 mL per cycle or clinically significant enough to interfere with quality of life; the most common presenting symptom of submucous fibroid.

A synthetic form of natural progesterone (Utrogestan) used in combined HRT; carries a more favourable breast cancer risk profile than synthetic progestogens such as medroxyprogesterone acetate.

Surgical removal of uterine fibroids while preserving the uterus; the procedure of choice for women who desire fertility.

Stress urinary incontinence that is masked preoperatively by the prolapse (which kinks the urethra); detected only on urodynamics after prolapse reduction; must be treated simultaneously at the time of prolapse repair.

HRT containing oestrogen without a progestogen; safe only in women who have had a hysterectomy, as there is no endometrium to protect.

A skeletal condition characterised by reduced bone mineral density (DEXA T-score ≤ −2.5) and microarchitectural deterioration, leading to increased fracture risk; accelerated by postmenopausal oestrogen deficiency.

A fibroid attached to the uterus by a narrow stalk; can be intracavitary (FIGO type 0) or subserosal (FIGO type 7); subserosal pedunculated fibroids can undergo torsion.

Systematic voluntary contractions of the levator ani (Kegel exercises) — at least 10 contractions, 3 sets daily for ≥12 weeks; reduces prolapse symptoms in mild-moderate cases.

Downward displacement of pelvic organs (uterus, bladder, rectum, bowel) into or beyond the vaginal canal due to failure of pelvic floor supports.

The transitional period leading up to and including the first year after the final menstrual period, characterised by irregular cycles, fluctuating hormones, and the onset of menopausal symptoms.

A flexible suction curette used for office-based endometrial biopsy without anaesthesia; sensitivity ~90% for endometrial carcinoma; first-line biopsy method for PMB investigation.

Pelvic Organ Prolapse Quantification — international standardised staging system using the hymenal ring as zero reference point; measures descent in centimetres; stages 0 to IV.

Any vaginal bleeding occurring 12 or more consecutive months after the final menstrual period; an alarm symptom requiring urgent investigation to exclude endometrial carcinoma.

Menopause occurring before the age of 40 years; may be spontaneous (autoimmune, genetic) or iatrogenic (surgery, chemotherapy, radiation); requires HRT until at least age 50.

Complete third-degree uterine prolapse in which the entire uterus lies outside the vagina (equivalent to POP-Q Stage IV); the bladder and rectum are often drawn down with it.

A state in which endometriotic tissue fails to respond normally to progesterone signalling, leading to reduced decidualisation, persistent oestrogen-stimulated growth, and impaired endometrial receptivity; a key mechanism of endometriosis pathogenesis and hormone-therapy failure.

The compressed layer of surrounding myometrium around a fibroid, which forms the surgical dissection plane during myomectomy.

The revised American Society for Reproductive Medicine staging system for endometriosis (I–IV, scored 1 to >40 points), based on the extent and depth of peritoneal implants, ovarian endometriomas, and adhesions; it correlates better with fertility prognosis than with pain severity.

Prolapse of the posterior vaginal wall and underlying rectum; associated with difficulty defaecating and incomplete evacuation.

Haemorrhagic infarction of a fibroid most commonly occurring during pregnancy; presents with acute localised uterine pain, fever, and leucocytosis; managed conservatively.

A flexible ring device inserted into the vagina to support the pelvic organs mechanically; the first-line option for women who decline or are unfit for surgery; requires 3–6 monthly changes.

Laparoscopic uterus-preserving prolapse repair using synthetic mesh to suspend the posterior cervix from the sacral promontory; preferred in younger sexually active women.

Instillation of saline into the uterine cavity during ultrasound to delineate submucous fibroids and endometrial polyps; distinguishes FIGO types 0, 1, and 2 by showing degree of intramural extension.

The retrograde menstruation theory of endometriosis: viable endometrial cells reflux through the fallopian tubes during menstruation and implant on peritoneal surfaces, where immune dysregulation allows them to survive and proliferate.

Malignant transformation of a fibroid into leiomyosarcoma; rare (<0.5% of fibroids), suspected when rapid enlargement occurs especially in a postmenopausal woman.

A fibroid that distorts the endometrial cavity (FIGO types 0–2), associated with the greatest menorrhagia and infertility effects.

Total abdominal hysterectomy with bilateral salpingo-oophorectomy; the primary surgical treatment for endometrial carcinoma; allows staging (myometrial invasion depth, cervical involvement) and lymph node assessment.

A selective oestrogen receptor modulator used in breast cancer treatment; acts as an oestrogen ANTAGONIST in breast tissue but as a WEAK AGONIST in the endometrium, predisposing to endometrial polyps, hyperplasia, and carcinoma; women on tamoxifen with PMB must be investigated urgently.

The concept that HRT initiated within 10 years of menopause or before age 60 has cardiovascular benefit, while HRT started late (>10 years after menopause) in women with established atherosclerosis may be harmful.

Transvaginal ultrasound measurement of the endometrium; >4–5 mm in a postmenopausal woman not on HRT mandates endometrial sampling to exclude carcinoma; ≤4 mm gives ~1% malignancy risk.

Endometrioid adenocarcinoma (~80% of cases); oestrogen-driven; arises via endometrial hyperplasia; risk factors include obesity, nulliparity, diabetes, and unopposed oestrogen; generally low-grade with good prognosis.

Non-endometrioid carcinomas (~20% of cases): serous, clear cell, or carcinosarcoma; oestrogen-independent; arise on atrophic endometrium; high-grade with poor prognosis; associated with p53 mutation.

Oestrogen administered or produced without progestogen opposition; a major risk factor for endometrial hyperplasia and Type I endometrial carcinoma; occurs with oestrogen-only HRT in women with an intact uterus, obesity (peripheral aromatisation), and anovulatory PCOS.

Investigations of bladder and urethral function (cystometry, uroflowmetry) performed before prolapse repair to identify occult stress incontinence and detrusor overactivity that may be unmasked post-operatively.

A minimally invasive radiological procedure in which the uterine arteries are occluded with embolic particles, causing fibroid ischaemia and shrinkage; suitable for women who wish to avoid surgery but are not planning pregnancy.

Women's Health Initiative — a large US randomised controlled trial published in 2002 enrolling postmenopausal women aged 50–79; the combined CEE+MPA arm was stopped early due to increased breast cancer and VTE risk; results have limited applicability to younger women using modern HRT formulations.