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3rd Year - Reproductive Diseases > 13. Menstrual Problems > Flashcards

13. Menstrual Problems Flashcards

1
Q

What is the normal Age of:

  1. Menarche?
  2. Menopause?
A
  1. 13 years old

2. 51 years old

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2
Q

What triggers Menstruation?

A

Fall in Progesterone 2 weeks after Ovulation (if not Pregnant)

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3
Q

What is the definition of:

  1. Menorrhagia?
  2. Dysmenorrhoea?
  3. Intermenstrual Bleeding?
  4. Post-Coital Bleeding?
  5. Oligomenorrhoea?
A
  1. Heavy Periods
  2. Painful Periods
  3. Bleeding between Periods
  4. Bleeding after Intercourse
  5. Infrequent Periods
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4
Q

What is asked in a Menstrual History?

A
  1. Subjective
  2. Clots / Flooding / Pads + Tampon
  3. Pain +/- Heavy Flow or Premenstrual
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5
Q

What is looked for in a Menstrual Examination?

A
  1. General
  2. Abdominal
  3. Speculum
  4. Bimanual
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6
Q

What Investigation are done for Menstrual Complications?

A
  1. Full Blood Count - if Menorrhagia
  2. Endometrial Biopsy
  3. Chlamydia
  4. Thyroid / Coagulation
  5. Pregnancy
  6. Ultrasound
  7. Hysteroscopy / Laparoscopy
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7
Q

What are the Likely causes of Menstrual Problems in Early Teens?

A
  1. Anovulatory Cycles
  2. Congenital Abnormality - Rare
  3. Coagulation Problems - Rare
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8
Q

What are the Likely causes of Menstrual Problems in Teens - 40s?

A
  1. Chamydia
  2. Contraception Related
  3. Endometriosis / Adenomyosis
  4. Fibroids
  5. Andometrial / Cervical Polyps
  6. Dysfunctional Bleeding
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9
Q

What are the Likely causes of Menstrual Problems in 40’s Menopause?

A
  1. Perimenopausal Anovulation
  2. Endometrial Cancer
  3. Warfarin
  4. Thyroid Dysfunction
  5. Pregnancy - Always consider this
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10
Q

What is the FIGO Classifications of Abnormal Uterine Bleeding?

A 
PALM COEIN
P - Polyp
A - Adenomyosis
L - Leiomyoma
M - Malignancy / Hyperplasia
C - Coagulation (e.g. Von Willebrands Disease)
O - Ovarian (e.g. PCO / Perimenopausal Anov. Cycles)
E - Endocrine (e.g. Thyroid)
I - Iatrogenic (e.g. Warfarin)
N - Not Classified Yet
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11
Q

What is Dysfunctional Uterine Bleeding?

A

Abnormal Bleeding but no Structural / Endocrine / Neoplastic / Infectious causes found (yet)

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12
Q

What is Endometriosis?

A

Endometrial Type Tissue found Outside the Uterine Cavity - Usually the Ovary / Pouch of Douglas / Pelvic Peritoneum

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13
Q

What are the Symptoms of Endometriosis?

A
  1. Asymptomatic
  2. Premenstrual Pain
  3. Dysmenorrhoea
  4. Deep Dyspareunia (Painful Sexual Intercourse)
  5. Subfertility
  6. Retrograde Bleed?
  7. Peritoneal Metaplasia?
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14
Q

What are the Sign of Endometriosis?

A
  1. None
  2. Tender Nodules in the Rectovaginal Septum
  3. Limited Uterine Mobility
  4. Adnexal Mass
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15
Q

How is a Diagnosis of Endometriosis made?

A
  1. Laparoscopy
  2. MRI
  3. Ultrasound Endometrioma
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16
Q

What are the Endometriosis Sites?

A
  1. Small Bowel / Appendix / Caecum / Sigmoid Colon / Peritoneum
  2. Bladder / Ureter / Uterine Serosa / Umbilicus
  3. Fallopian Tube / Ovary / Rectovaginal Septum / Uterovesical Fold
17
Q

What is the Medical Treatment of Endometriosis?

A
  1. Progesterone (Oral / Injection / Mirena)
  2. Combined Oral Contraceptive Pill
  3. GnRH Analogues
18
Q

What is the Surgical Treatment of Endometriosis?

A
  1. Excision of Deposits from Peritoneum / Ovary
  2. Diathermy / Laser Ablation of Deposits
  3. Hysterectomy AND Oophorectomy
19
Q

What is Adenomyosis?

A

Endometrial Tissue found in the Deep Myometrium

20
Q

What are the Signs / Symptoms of Adenomyosis?

A
  1. Heavy Painful Periods

2. Bulky Tender Uterus

21
Q

How is Adenomyosis Diagnosed?

A
  1. Ultrasound
  2. Laparoscopy
  3. Hysteroscopy
  4. MRI
  5. Histology Uterine Muscle - Not Endometrial Biopsy
22
Q

What is the Treatment of Adenomyosis?

A
  1. Mirena
  2. Ablation
  3. Hysterectomy
    Note - Often failed Medical Management/ Ablation and Diagnosed on Pathology after Hysterectomy
23
Q

What are Fibroids?

A

Benign, Smooth Muscle Growths (Leiomyoma)

24
Q

What are the 3 types of Fibroids?

A
  1. Sub-Mucous Fibroids - Protrude into Uterine Cavity
  2. Intramural Fibroids - Within Uterine Wall
  3. Sub-Serous Fibroids - Project out of the Uterus into the Peritoneal Cavity
25
Q

What are the Symptoms of Fibroids?

A
  1. Asymptomatic
  2. Pressure Symptoms
  3. Menorrhagia (If Large)
  4. Intermenstrual Bleeding - Submucous / Polyp
  5. May grow fast in Pregnancy - Pain, Malpresent / Obstruct
26
Q

What are the Treatment of Fibroids?

A
  1. Nothing
  2. Standard Menorrhagia Treatment
  3. GnRH Analogues
  4. Ulipristal Oral Treatment
  5. Transcervical Resection Sub-Mucous Fibroids
  6. Myomectomy
  7. Hysterectomy
27
Q

What are the treatments for Dysfunctional Uterine Bleeding?

A
  1. Reassurance - No sinister Pathology
  2. Fertility Conserving Treatment
  3. Endometrial Ablation
  4. Hysterectomy
    Note - 3 and 4 if family complete
28
Q

What is Fertility Conserving Treatment?

A
  1. Tranexamic Acid - Reduces Blood Loss
  2. Mefenamic Acid - Reduces Blood Loss
  3. Combined Oral Contraceptive Pill - For Bleeding / Pain
  4. Mirena Progestogen - Reduces Blood Loss
29
Q

What is Endometrial Ablation?

A

One off removal of Endometrium to below the Basal Layer, through the Cervix. Can use:

  1. Diathermy
  2. Thermal Balloon
30
Q

What is a Hysterectomy?

A

Surgical Removal of the Uterus

31
Q

What are the Routes of Hysterectomy?

A
  1. Abdominal
  2. Vaginal
  3. Laparoscopically Assiested Vaginal Hysterectomy
32
Q

What are the Types of Hysterectomy?

A
  1. Total Hysterectomy - Uterus and Cervix Removed

2. Subtotal Hysterectomy - Uterus Removed, Cervix Left

33
Q

What is a Salpingo-Oophorectomy?

A

Removal of the Fallopian Tubes + Ovaries

Note - Need HRT till 50

3rd Year - Reproductive Diseases (41 decks)

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