18 - Menstrual Disorders (endometriosis, adenomyosis, endometrial polyps, HMB, amenorrhoea, PCOS, DUB) Flashcards
what is the length of a menstrual cycle?
the time from the first day of a woman’s period to the day before her next period
what is the normal loss of blood during a cycle?
less than 80 ml over 7 days (16 tsp)
what is the avergae loss of blood during a cycle?
30-40 ml (6-8tsp)
how long is the average cycle?
28 days (average 24-35 days)
what is the average menarche?
average -12 years
10-16 years
when is the average onset of menopause?
50-55years
describe days 1-5 of a 28 day cycle in terms of uterus lining?
uterus lining breaks down due to no implantation and menstruation occurs
describe days 6-10 of a 28 day cycle in terms of uterus lining?
uterus lining begins to thicken again
describe days 11-18 of a 28 day cycle in terms of uterus lining?
ovulation occurs - usually @ day 14
describe days 19-28 of a 28 day cycle in terms of uterus lining?
uterine line continues to thicken to prepare for implantation
define frequent periods?
taking place every <24 days
define infrequent periods?
taking place every >38 days
define regular periods?
<20 days variation in 12 m
define irregular periods?
> 20 days variation in 12 m
define prolonged periods?
> 8 days
define shortened periods?
< 2 days
define normal duration periods?
2-7 days
define a heavy period?
> 80 ml
define a normal flow/ volume period?
5-80 ml
describe a light period?
<5 ml
describe 5 uterine and ovarian pathologies for heavy menstrual bleeding?
Uterine fibroids
Endometrial polyps
Endometriosis and adenomyosis
Pelvic inflammatory disease and pelvic infection
PCOS
describe 3 systemic diseases and how they cause heavy menstrual bleeding?
coagulation disorders
hypothyroidism
renal disease
describe 3 iatrogenic causes for heavy menstrual bleeding?
Anticoagulant treatment
Herbal supplements
Intrauterine contraceptive device(CU IUD)
define fibroids?
Non cancerous growths made of muscle and fibrous tissue. also called myoma or lieomyoma
name 4 possible symptoms of fibroids?
pressure symptoms
HMB
backache
asymptomatic
diagnosis of fibroids?
US scan
management of fibroids?
symptom-based
describe treatment of small fibroids?
COCP
POP
Mirena
describe treatment of large fibroids?
fibroid embolisation
myomectomy
describe treatment of submucosal fibroids?
Hysteroscopic fibroid resection
describe treatment for failed medical treatment and fertility preservation is not required?
hysterectomy
define endometriosis?
endometrial tissue present outside the lining of uterus - during menstruation this ectopic tissue behaves the same as endometrium and bleeds
who does endometriosis affect?
women of reproductive age
how does endometriosis present?
7 symptoms
pelvic pain
HMB
menstrual cramps which get worse
pain during/ after sex
painful bowel movements/ peeing
abmormal bleeding/ spotting between periods
diarrhoea/ nausea/ bloating
multi-systemic presentation
what can endometriosis cause?
infertility
fatigue and systemic symptoms
4 differential diagnoses for endometriosis?
PCOS
fatigue
thyroid issues
IBS
how many stages of endometriosis?
4
describe stage 1 of endometriosis?
MINIMAL -
mall patches, surface lesions or inflammation around the organs in pelvic cavity
describe stage 2 of endometriosis?
MILD -
more widespread and starting to infiltrate pelvic organs
describe stage 3 of endometriosis?
MODERATE -
peritoneum (pelvic side walls) - also scarring and adhesions
describe stage 4 of endometriosis?
SEVERE -
infiltrative and affecting many pelvic organs
diagnosis of endometriosis?
US scan and diagnostic laparoscopy
3 management options for endometriosis?
medical
surgical
analgesic
give 2 examples of medical management of endometriosis?
COCP (combined oral contraceptive pill)
POP
give 2 examples of surgical management of endometriosis?
Ablation
Hysterectomy
define adenomyosis?
condition where endometrium becomes embedded in myometrium
2 symptoms of adenomyosis?
HMB
significant dysmenorrhea
painful periods
treatment for adenomyosis?
may respond to hormones partially
definitive treatment - hysterectomy
define endometrial polyps?
Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
diagnosis of endometrial polyps?
US or Hysteroscopy
management of endometrial polyps?
polypectomy
give 2 examples of medical treatments for HMB?
Tranexamic acid
Mefenamic acid
(both reduce blood loss)
give an example of hormonal treatment for HMB?
COCP
oral progesterones
3 ways in which a hysterectomy can be undertaken?
abdominally
vaginally
laparoscopically
name 3 risks associated with hysterectomy?
infection
DVT
altered bladder function
what does a hysterectomy guarantee?
amenorrhoea
what procedure removes the fallopian tubes and the ovaries?
Salpingo-oophorectomy
name one advantage and one disadvantage of oophorectomy?
adv - reduced risk of ovarian cancer
dis - immediate menopause - HRT until age 50
define oligo/ amenorrhoea?
Infrequent, absent or abnormally light menstruation
4 lifestyle causes of oligo/ amenorrhoea?
stress
eating disorders
obesity
intense exercise
3 hormonal causes of oligo/ amenorrhoea?
POP
mirena
depot injection
4 medical causes of oligo/ amenorrhoea?
Primary ovarian insufficiency
Polycystic ovarian syndrome
Hyperprolactinemia
Grave’s Disease
define PCOS?
Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria met
name the criteria which must be met for PCOS to be diagnosed?
Clinical hyperandrogenism
oligomenorrhoea
hirsuitism
acne
infertility
obesity
conservative management of PCOS?
symptom-based treatment
aim to achieve normal BMI
hormonal treatment of PCOS?
COCP/ POP/ mirena IUS or norethisterone -
used to achieve At least 3 withdrawl bleeds required per year to prevent hyperplasia
define DUB - dysfunctional uterine bleeding?
common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases
cause of DUB?
ovarian hormonal dysfunction
what are the common causes to rule out for DUB and other mentrual disorders?
P - polyp
A - adenomyosis
L - leiomyoma/ fibroid
M - malignancy
C - coagulopathy O - ovulation dysfunction E - endometrium/hyperplasia I - iatrogenic N - not yet classified
what is a good treatment for bridging pre-menopausal women with DUB?
GnRh analogues - these are anti-oestrogen and they create a pseudo-menopause
conservative management of DUB?
based on severity of symptoms and patient’s wishes
