2 - Gynae - Menstrual Cycle and its disorders - Menorrhagia Flashcards
menorrhagia = ?
clinical definition and objective definition?
XSive bleeding in otherwise normal menstrual cycle
cl def - XS menstrual bl loss that interferes with ladys phys, emoti, social, maternal QoL, occuring alone or with other Sx
obj def - BL >80mL in otherwise normal cycle (max amount woman w normal diet can lose per cycle w/o becoming Fe def)
% of women complaining of heavy periods at some point?
most have no ??? abnormality.
most with regular cycles are ?? and menorrhagia may be due to????
most common pathologies found?
1/3
histological abnormality
ovulatory
subtle abnormalities of endometrial haemostasis or uterine prostaglandin levels
uterine fibroids (~30%) and polyps (~10%)
what 3 things usually cause irreg bleeding?
what are 3 rare causes for irreg bleeding?
coagulopathy may be suggested by Hx of??
chronic pelvic infection, ovarian tumours, endometrial/cervical malignancy
rare - haemostatic diseases eg vWD, anticoagulant therapy, thyroid disease
XS bleeding post-surgery/trauma, or easy bruising
Hx points:
- bleeding - what info?
- what indicates excessive loss?
- important to ascertain what?
amount and timing of bleeding
flooding and passing large clots indicates excessive loss
ascertain method of contraception
Ex points:
- common finding?
- what are often absent?
- what suggests fibroids?
- what suggests adenomyosis?
- what may be felt?
- anaemia
- pelvic signs often absent
- irreg enlargement of uterus
- tenderness w/wo enlargement
- may feel ovarian mass/fibroids
Ix points:
- Hb checked- why?
- how to exclude systemic causes?
- how to exclude organic causes?
- after scan what might you do?
- assess effect of BL and fitness
- coagulation and thyroid Fx checked if Hx suggests
- transvaginal USS -> endometrial thickness, exclude fibroid/ovarian mass, and detect larger intrauterine polyps
- hysteroscopy
When is an endometrial biopsy done? to exclude what?
endo thickness >10mm OR polyp suspected OR >40 with recent onset HMB/also has IMB OR has not responded to trt
-exclude mal/premalignancy
mgmt depends on what? what is not an option if wanting to conceive?
depends on contraceptive needs
if so - intrauterine progesterone not an option
medical mgmt - 1st line
IUS - prog only (myrena)
-reduces menstrual flow by >90%, less SE than systemic prog, pt compliance not an issue - also contraceptive
medical mgmt - 2nd line (3 parts)
- afibrinolytics - tranexamic acid - taken during menstruation - reduced BL by 50% - few SEs
- NSAIDS (mefanamic acid) - red BL by 30% - SE similar to aspirin - also useful for dysmenorrhoea
- COC - not used in older pts (due to complx) - induces lighter menstruation (less effective if pelvic pathology)
medical mgmt - 3rd line (2)
progestogens - IM/high dose oral -> amenorrhea
GnRH agonists -> produce amenorrhea - duration 6m unless add back HRT used
concerns about osteoporosis and CVD
3 non-radical surgical approaches
3 more radical surgical approaches
non-rad - hysteroscopic polyp removal, endometrial ablation techniques, transcervical resection of fibroid (TCRF)
rad - hysterectomy, myomectomy, uterine artery embolisation (UAE)
TCRF - what is done? why? what else may be done?
resect submucosal fibroids - reduce Blood flow and improve fertility
can do TCREndometrium (ablation technique) also if fertility not desired)
Endometrial ablation techniques - involves what? what usually follows? less what than hysterectomy? effect on fertility?
removal/destruction of endometrium
amenorrhea or lighter periods
hosp stay/complx
reduces fertility but not sterilizing so still use contraception
Myomectomy - involves what? what often used first? why? used if ?
fibroid removal from myometrium
GnRH agonists often used to reduce fibroid size
used if fibroids cause Sx but fertility still required
