1- Menstrual disorders (conditions) Flashcards
menarche
first period
menopause
end of periods
amenorrhea
abscence of periods
primary amenorrhea
never had a period
secondary ammenorrhea
the cessation of menstruation for 3–6 months in women with previously normal and regular menses
Dysmenorrhoea
painful menstruation
menorrhagia
heavy/ prolonged bleeding
oligomenorrhoea
infrequent periods
oligomenorrhoea
infrequent periods
intermenstrual bleeding
(between periods)
o Post coital (after sex)
o Breakthrough (irregular bleeding on hormonal contraception)
Amenorrhea vs abnormal uterine bleeding
abnormal uterine bleeding
- Menorrhagia
- Dysmenorrhea
- Intermenstrual
- Post coital
- Break through
causes of AUB
PALM COEIN (FIGO)
Structural
- Polyp
- Adenomyosis
- Leiomyoma (fibroid)
- Malignancy/ hyperplasia
Non-structural
- Coagulopathy
- Ovulatory dysfunction (includes thyroid)
- Endometrial
- Iatrogenic
- Not yet classified (DUB)
menorrhagia background
heavy or prolonged bleeding
- interfers with womans physical, emotional and social QoL
parameters of menorrhagia
- > 8 days
- > 80mL/cycle
- more frequent than 24 days
- intermenstrual bleeding or postcoital spotting
causes of me norrhagia
- Idiopathic
- Fibroids (non cancerous growths)
- Endometriosis
- Blood clotting (von willebrand disease) disorders/ warfarin
- Contraceptive pill
- Hypothyroidism
- PID
- Endometriosis
presentation of menorrhagia
o May pass clots and/or experience flooding (having to change pads frequently) or having to wear pads and tampons simultaneously.
investigations for menorrhagia
- pelvic examination with speculum and bimanual (unless young and not sexually active)
to assess for fibroids, ascites and cancers
- FBC- iron def anaemia
- pelvic and transvaginal US
- coagulation screen
- thryoid function tests
- swabs if evidence of infection
management of menorrhagia
First line:
- Mirena (often not first line in practice due to what women wants)
Second line:
- Tranexamic acid
- NSAIDS such as mefenamic acid
- COCP/POP
Third line: endometrial ablation and hysterectomy
*remember that coppper coil can cause menorrhagia
important questions to ask in a history for gynaecological problemms
- Age at menarche
- Cycle length, days menstruating and variation
- Intermenstrual bleeding and post coital bleeding
- Contraceptive history
- Sexual history
- Possibility of pregnancy
- Plans for future pregnancies
- Cervical screening history
- Migraines with or without aura (for the pill)
- Past medical history and past drug history
- Smoking and alcohol history
- Family history
dysmenorrhoea background
o Low anterior pelvic pain which occurs in association with periods
o Primary- period pains since start of period
o Secondary- occurring later, with previously normal periods
causes of dysmenorrhoea
- Excess or imbalance of prostaglandins in menstrual fluid, which causes vasoconstriction in the uterine vessels, causing uttering contractions which produce pain
-Prostaglandins may explain: diarrhoea, nausea, headache etc
- Endometriosis
- PID
- Fibroids
- Copper IUD -> may hurt for a few months after fitting
- Childbirth reduces dysmenorrhoea
investigations for dysmenorrhea
o Good history
o Speculum exam of cervix
o High vaginal swap
o Pelvic/ transvaginal US
presentation of dysmenorrhea
o 1-2 days before or with onset of menses
o Improves 12-72 h
o Crampy and intermittently intense, or continuous dull ache
o Lower abdomen and suprapubic area
mangement of dysmenorrhea
- Lifestyle- stop smoking, exercise
- NSAIDs
- Hormonal treatment
COCP
Dep-povera
Coil - Surgery
Laparoscopic uterine nerve ablation
hysterectomy in rare cases
endometriosis physiology
where there is ectopic endometrial tissue outside the uterus.
- lump of endometrial tissue outside the uterus = endometrioma e.g. chocolate cysts in the ovaries
cause of endometriosis
a number of theories
- retrograde menstruation
- due to misplacement of embryonic cells
- spread of endometiral cells through lymphatics like cancers
- metaplasia of cells