3.2 lecture: abnormalities of menstruation

Question 1

how long does menstruation normally last for?

Answer 1

24-32 days

Question 2

when is menstruation most regular?

Answer 2

between 20-40 years

Question 3

when is menstruation longer and shorter?

Answer 3

longer after menarche

shorter pre-menopause

Question 4

what is the median blood loss during menstruation?

Answer 4

37-43ml/cycle

mostly during first 48 hours

Question 5

how much blood do 9-14% female loose? most present with?

Answer 5

> 80ml/cycle

60-70% anaemic

Question 6

what are the 2 things to look for in menstruation (when defining abnormalities)?

Answer 6

pattern

amount

Question 7

what is heavy periods known as?

Answer 7

menorrhagia

Question 8

causes of menorrhagia?

Answer 8

abnormal clotting
pathology: fibroids, IUCD
medical disorders: cancer, progesterone contraception

Question 9

what are fibroids?

Answer 9

benign growth of the uterine cavity

can mimic pregnancy / tumour

Question 10

what are the different types of uterine fibroids?

Answer 10

ovary, fallopian tube, uterus, cervix, vagina
intracavitary (within womb)
submucosal (within mucosa)
intramural (within myometrium)
subserosal (within serosa)
pedunculated

Question 11

what is dysfunctional uterine bleeding (DUB)?

Answer 11

no other cause has been found to account for the heavy periods (indeterminate cause)
in 60% of cases
heavy bleeding
no recognisable pelvic pathology, pregnancy / general bleeding disorders

Question 12

how do you view endometrial cancer?

Answer 12

1. hysteroscopic view (gold standard) - endometrium view as bumpy and not smooth (can invade myometrium)
2. ultrasound - thickened endometrium
3. pelvic MRI

Question 13

what is endometrial ablation of the endometrium?

Answer 13

burn lining of endometrium with laser - hoping to think it, to reduce the amount patient bleeds every month, sometimes requires repeating of procedure
high success rate

Question 14

what is a common cause of irregular bleeding?

Answer 14

hormonal contraceptives (only first 3 months can consider irregular, but beyond that, think about differential diagnosis)

Question 15

what is an example of irregular bleeding?

Answer 15

bleeding between periods

Question 16

which hormonal contraceptions are common causes of irregular bleeding?

Answer 16

combined oral contraceptive pill
progesterone only contraceptive pill
contraceptive patch (transdermal patch)
contraceptive implant / injection
intrauterine system (IUS)

Question 17

what can cause irregular bleeding whilst on a hormonal contraceptive pill?

Answer 17

1. missed combined / progesterone only pill (forgot to take pill)
2. vomiting / diarrhoea whilst on the COCP
3. certain prescriptions / medications - drug interference e.g. St John’s wort (herbal)

Question 18

what is amenorrhoea?

Answer 18

when the expected period isn’t present e.g. skipped periods

Question 19

what are causes of amenorrhoea?

Answer 19

prepubertal
pregnancy
menopause
uterine / endometrial (anatomical abnormalities)
ovarian defects
pituitary defects
hypothalamic defects

Question 20

what are the physical impacts of menstrual disorders?

Answer 20

tiredness, anaemia

Question 21

what are the psychological impacts of menstrual disorders?

Answer 21

depression
irritability
mood swings
anxiety

Question 22

what are the social impacts of menstrual disorders?

Answer 22

impact on ability to socialise / swim / perform sports