13. Menstrual Problems Flashcards
What is the normal Age of:
- Menarche?
- Menopause?
- 13 years old
2. 51 years old
What triggers Menstruation?
Fall in Progesterone 2 weeks after Ovulation (if not Pregnant)
What is the definition of:
- Menorrhagia?
- Dysmenorrhoea?
- Intermenstrual Bleeding?
- Post-Coital Bleeding?
- Oligomenorrhoea?
- Heavy Periods
- Painful Periods
- Bleeding between Periods
- Bleeding after Intercourse
- Infrequent Periods
What is asked in a Menstrual History?
- Subjective
- Clots / Flooding / Pads + Tampon
- Pain +/- Heavy Flow or Premenstrual
What is looked for in a Menstrual Examination?
- General
- Abdominal
- Speculum
- Bimanual
What Investigation are done for Menstrual Complications?
- Full Blood Count - if Menorrhagia
- Endometrial Biopsy
- Chlamydia
- Thyroid / Coagulation
- Pregnancy
- Ultrasound
- Hysteroscopy / Laparoscopy
What are the Likely causes of Menstrual Problems in Early Teens?
- Anovulatory Cycles
- Congenital Abnormality - Rare
- Coagulation Problems - Rare
What are the Likely causes of Menstrual Problems in Teens - 40s?
- Chamydia
- Contraception Related
- Endometriosis / Adenomyosis
- Fibroids
- Andometrial / Cervical Polyps
- Dysfunctional Bleeding
What are the Likely causes of Menstrual Problems in 40’s Menopause?
- Perimenopausal Anovulation
- Endometrial Cancer
- Warfarin
- Thyroid Dysfunction
- Pregnancy - Always consider this
What is the FIGO Classifications of Abnormal Uterine Bleeding?
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
What is Dysfunctional Uterine Bleeding?
Abnormal Bleeding but no Structural / Endocrine / Neoplastic / Infectious causes found (yet)
What is Endometriosis?
Endometrial Type Tissue found Outside the Uterine Cavity - Usually the Ovary / Pouch of Douglas / Pelvic Peritoneum
What are the Symptoms of Endometriosis?
- Asymptomatic
- Premenstrual Pain
- Dysmenorrhoea
- Deep Dyspareunia (Painful Sexual Intercourse)
- Subfertility
- Retrograde Bleed?
- Peritoneal Metaplasia?
What are the Sign of Endometriosis?
- None
- Tender Nodules in the Rectovaginal Septum
- Limited Uterine Mobility
- Adnexal Mass
How is a Diagnosis of Endometriosis made?
- Laparoscopy
- MRI
- Ultrasound Endometrioma
What are the Endometriosis Sites?
- Small Bowel / Appendix / Caecum / Sigmoid Colon / Peritoneum
- Bladder / Ureter / Uterine Serosa / Umbilicus
- Fallopian Tube / Ovary / Rectovaginal Septum / Uterovesical Fold
What is the Medical Treatment of Endometriosis?
- Progesterone (Oral / Injection / Mirena)
- Combined Oral Contraceptive Pill
- GnRH Analogues
What is the Surgical Treatment of Endometriosis?
- Excision of Deposits from Peritoneum / Ovary
- Diathermy / Laser Ablation of Deposits
- Hysterectomy AND Oophorectomy
What is Adenomyosis?
Endometrial Tissue found in the Deep Myometrium
What are the Signs / Symptoms of Adenomyosis?
- Heavy Painful Periods
2. Bulky Tender Uterus
How is Adenomyosis Diagnosed?
- Ultrasound
- Laparoscopy
- Hysteroscopy
- MRI
- Histology Uterine Muscle - Not Endometrial Biopsy
What is the Treatment of Adenomyosis?
- Mirena
- Ablation
- Hysterectomy
Note - Often failed Medical Management/ Ablation and Diagnosed on Pathology after Hysterectomy
What are Fibroids?
Benign, Smooth Muscle Growths (Leiomyoma)
What are the 3 types of Fibroids?
- Sub-Mucous Fibroids - Protrude into Uterine Cavity
- Intramural Fibroids - Within Uterine Wall
- Sub-Serous Fibroids - Project out of the Uterus into the Peritoneal Cavity
What are the Symptoms of Fibroids?
- Asymptomatic
- Pressure Symptoms
- Menorrhagia (If Large)
- Intermenstrual Bleeding - Submucous / Polyp
- May grow fast in Pregnancy - Pain, Malpresent / Obstruct
What are the Treatment of Fibroids?
- Nothing
- Standard Menorrhagia Treatment
- GnRH Analogues
- Ulipristal Oral Treatment
- Transcervical Resection Sub-Mucous Fibroids
- Myomectomy
- Hysterectomy
What are the treatments for Dysfunctional Uterine Bleeding?
- Reassurance - No sinister Pathology
- Fertility Conserving Treatment
- Endometrial Ablation
- Hysterectomy
Note - 3 and 4 if family complete
What is Fertility Conserving Treatment?
- Tranexamic Acid - Reduces Blood Loss
- Mefenamic Acid - Reduces Blood Loss
- Combined Oral Contraceptive Pill - For Bleeding / Pain
- Mirena Progestogen - Reduces Blood Loss
What is Endometrial Ablation?
One off removal of Endometrium to below the Basal Layer, through the Cervix. Can use:
- Diathermy
- Thermal Balloon
What is a Hysterectomy?
Surgical Removal of the Uterus
What are the Routes of Hysterectomy?
- Abdominal
- Vaginal
- Laparoscopically Assiested Vaginal Hysterectomy
What are the Types of Hysterectomy?
- Total Hysterectomy - Uterus and Cervix Removed
2. Subtotal Hysterectomy - Uterus Removed, Cervix Left
What is a Salpingo-Oophorectomy?
Removal of the Fallopian Tubes + Ovaries
Note - Need HRT till 50
