5: Menstrual disorders Flashcards
What are the two important gonadotrophins?
FSH
LH
Where are FSH and LH produced?
Posterior pituitary gland
In the first 12 days of the menstrual cycle, which hormones
a) stimulate development of ovarian follicles
b) trigger ovulation?
a) FSH
b) LH
What hormone is produced by the corpus luteum?
Progesterone
How long does an average menstrual cycle last?
28 days
Which hormone, produced in the proliferative phase of the menstrual cycle, stimulates thickening of the endometrium?
Oestrogen
Why does menstruation occur?
Endometrium outgrows blood supply
How long does menstruation last?
4 - 6 days of 28 day menstrual cycle
When does peak menstruation occur?
Days 1 - 2 of menstruation
Menstruation should be (light / heavy).
light
< 80ml
Menstrual loss should not contain ___.
clots
What is menorrhagia?
Prolonged, increased menstrual bleeding
What is metrorrhagia?
Regular intermenstrual bleeding
What is amenorrhoea?
No menstruation for > 6 months
What is oligomenorrhoea?
Menstruations more than 35 days apart
What is polymenorrhoea?
Menstruations less than 21 days apart
In the context of menorrhagia, what is dysfunctional uterine bleeding?
Non-organic menorrhagia
No organic cause or pathology
What is meant by a local cause of organic menorrhagia?
Limited to genital tract
What is the usual causal organism of pelvic inflammatory disease?
What structures does it tend to affect?
Chlamydia
Fallopian tubes
Which malignancies commonly cause menorrhagia?
Cervical carcinoma
Uterine carcinoma
Which specific lining of the uterus may develop carcinomas?
Endometrium
What is endometriosis?
Growth of endometrial tissue OUTWITH the uterus
Which hormone, which thickens the endometrial lining in the uterus, does endometriosis grow in response to?
Oestrogen
Organic causes of menorrhagia can be ___ or ___.
local or systemic
What endocrine disease notably causes amenorrhoea and menorrhagia?
Hyperprolactinaemia
systemic causes of amenorrhoea
Why can liver disease cause menorrhagia?
Damaged liver doesn’t produce as much clotting factors
Which class of drug, used to treat cardiovascular disease, may cause menorrhagia?
Anticoagulants e.g warfarin, NOACs
Which abnormal pregnancy outcomes may cause menorrhagia?
Miscarriage
Ectopic pregnancy
Molar pregnancy
Dysfunctional uterine bleeding is a diagnosis of ___.
diagnosis of exclusion
dysfunctional uterine bleeding
When are the ovaries’ best quality eggs released?
Teens / 20s
Why does ovulatory DUB occur?
Defective corpus luteum doesn’t secrete as much progesterone, so secretory phase ends sooner and endometrium sheds more often
What investigations should be done for a woman with dysfunctional uterine bleeding?
FBC (including coagulation. LFTs)
Cervical smear test
Liver, renal and thyroid function tests
USS (transvaginal)
Endometrial biopsy
What are the two most common endometrial causes of organic menorrhagia?
Cervical/Endometrial? carcinoma
Fibroids
What device is used to perform an endometrial biopsy?
Pipelle
revise anatomy re: differentiating cervix and upper uterus
Which device can be used to look inside the uterine cavity for polyps or tumours?
Hysteroscope
pharma management of DUB
give progestrogen five days into cycle i.e five days after cycle
stop at 25 days
repeats
combined oral contraceptive pill also contains progestrogen
makes periods lighter and more frequent
Which NSAID is often used for dysfunctional uterine bleeding?
Why?
Mefenamic acid
Inhibits prostaglandin production
Which device can be fitted to slowly release progesterone to treat dysfunctional uterine bleeding?
Intrauterine coil
What are two surgical treatments for dysfunctional uterine bleeding?
Resection / ablation of endometrium
Hysterectomy (surgical removal of the uterus)
sub-total hysterectomy - cervix retained, body of uterus removed
What is a consequence of doing a hysterectomy for DUB?
Infertility
What is the technical name for bleeding after giving birth?
Post-partum haemorrhage
Performing a hysterectomy renders a woman ___.
infertile
Giving a patient excessive oestrogen (why would you do this)?? increases the risk of what?
Endometrial carcinoma
