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abnormal bleeding Flashcards

1
Q

what is amenorrhoea?

A

lack of menstrual periods

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2
Q

what is primary amenorrhoea?

A

pt has never developed periods

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3
Q

what can cause primary amenorrhoea?

A
  • Abnormal functioning of hypothalamus/ pituitary gland (hypogonadaotrphic hypogonadism)
  • Abnormal functioning of gonads  hypergonadotropic hypogonadism
  • Imperforate hymen or structural pathology
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4
Q

what is secondary amenorrhoea?

A

previously had periods that then stopped

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5
Q

what can cause secondary amenorrhoea?

A
  • Pregnancy (most common)
  • Menopause
  • Physiological stress 
  • Premature ovarian insufficiency
    thyroid abnormalities
    excessive prolactin from prolactinoma
    cushings
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6
Q

what are physiological stress that can cause amenorrhoea?

A

excessive exercise, low body weight, chronic disease, psychosocial factors

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7
Q

what is - Premature ovarian insufficiency

A

menopause before 40
occurs in 1 in 100

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8
Q

what is oligomenorrhoea?

A

irregular periods
abnormal uterine bleeding refers to irregularities in menstrual cycle

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9
Q

what does oligomenorrhoea affect?

A

affecting: cycle, duration, frequency, regularity of cycle length and volume of menses

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10
Q

what is anovulation?

A

lack of ovulation) or irregular ovulation

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11
Q

what can cause irregular periods?

A
  • Extremes of reproductive ages  early or menopause
  • PCOS
  • Psychological stress
    medications
    hormonal imbalance
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12
Q

what medications can cause oligomenorrhoea?

A

progesterone only contraception, antidepressants and antipsychotics
anticoags

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13
Q

what can cause hormonal imbalances?

A

thyroid abnormalities, cushings, high prolactin

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14
Q

what is intermenstrual bleeding?

A

any bleeding occurring between peroids

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15
Q

what is IMB a red flag for?

A

ovarian cancer, cervical

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16
Q

what can cause IMB?

A
  • Hormonal contraception
  • Cervical ectropion, polyps, cancer
  • Sexually transmitted infection
  • Endometrial polyps or cancer
  • Vaginal path – cancer
  • Pregnancy
  • Ovulation – may cause spotting in some women
  • Medications
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17
Q

what is dysmenorrhoea?

A

painful periods

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18
Q

what are the causes of dysmenorrhoea?

A
  • Primary dysmenorrhoea (no underlying pathology)
  • Endometriosis, adenomyosis
  • Fibroids
  • Pelvic inflame disease
  • Copper coil
  • Cervical/ ovarian cancer
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19
Q

what is menorrhagia?

A

heavy bleeding when on period

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20
Q

what can cause menorrhagia?

A
  • Dysfunctional uterine bleeding – no identifiable cause
  • Extremes of reproductive age
  • Fibroids
  • Endometriosis and adenomyosis
  • Pelvic inflame disease (infection)
  • Contraceptives – copper coil
  • Anticoag medications
  • Bleeding disorders (Von Willebrand  often when diagnosis appears)
  • Endocrine disorders – diabetes/ hypothyroidism
  • Connective tissue disorder
  • Endometrial hyperplasia/ cancer
  • PCOS
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21
Q

what is post coital bleeding?

A

post sex bleeding

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22
Q

what can cause post-coital bleeding?

A
  • Ectropion, infection
  • Trauma
  • Atrophic vaginitis
  • Polyps
  • Endometrial cancer
  • Vaginal cancer
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23
Q

what can cause pelvic pain?

A
  • UTI
  • Dysmenorrhea
  • IBS – irritable and inflam
  • Ovarian cysts
  • Endometriosis
  • Pelvic inflame disease
  • Ectopic pregnancy
  • Appendicitis
  • Mittelschmerz
    pelvic adhesions
    ovarian torsion
24
Q

what referred pain can be seen with ectopic pregnancies?

A

shoulder pain

25
what is mittelschmerz?
– ovulation pain (cyclical)
26
what is pathological vaginal bleeding?
excessive or foul smelling discharge
27
what can cause vaginal discharge?
- Bacterial vaginosis - Candidiasis - Chlamydia - Gonorrhoea - Trichomonas vaginalis - Foreign body - Cervical ectropion - Polyps - Malignancy - Pregnancy - Ovulation (cyclical) - Hormonal contraception
28
what is pruritus vulvae?
: itching of vulva and vagina
29
what can cause pruritus vulvae?
- Irritants  soaps, detergents, barrier contraception - Atrophic vaginitis - Infections – candidiasis, public lice - Skin conditions – eczema - Vulval malignancy - Pregnancy related discharge - Urinary/ faecal incontinence - Stress
30
what is adenomyosis?
: refers to endometrial tissue inside myometrium (muscle layer)
31
when is adenomyosis more likely?
more common in later reproductive years - More common in those with several pregnancies
32
what does multiparous mean?
multiple pregnancies
33
what other conditions may be seen with adenomyosis?
- Can occur with/ without endometriosis/ fibroids
34
what is the aetiology of adenomyosis?
not fully understood - Linked to sex hormones  does improve after menopause just like endometriosis/ fibroids - Trauma - Inflammation
35
how does adenomyosis present?
- Painful presentation: dysmenorrhoea - Heavy periods - Pain during intercourse - Infertility or pregnancy- related complications - 1/3 pts are asymptomatic
36
on examantion, how would adenomyosis present?
Exam: enlarged/ tender uterus - It will more soft in comparison to a uterus containing fibroids
37
how do you diagnosis adenomyosis?
transvaginal US of pelvis: first line MRI and transabdominal US: alternative
38
what is the gold standard for proving adenomyosis?
Histological exam: gold standard after hysterectomy
39
how do you manage adenomyosis?
Depends on symptoms, age, plans for future children - NICE recommends same management as heavy menstrual bleeding
40
what medical management for adenomyosis can be given if woman does not want contraception?
- Tranexamic acid: if no pain (antifibrinolytic) - Mefenamic acid: if pain associated (NSAID – reduces pain)
41
what are the contraceptive options for managing adenomyosis?
1. Mirena coil 2. Combined pill 3. Cyclical oral progesterone - POP, implant, depo injection may used
42
what are the specialist options for managing adenomoysis?
- GnRH analogues to induce menopause like state - Endometrial ablation - Uterine artery embolization - Hysterectomy
43
how adenomyosis affect pregnancy?
- Infertility - Miscarriage - Preterm birth - Small for gestation age - Preterm rupture of membranes - Malpresentation - Need for C section - Postpartum haemorrhage
44
how much blood is normal to lose in menstruation?
40ml
45
how much blood is excessive to lose during period?
80ml
46
how would you classify excessive bleeding?
- Based on symptoms eh changing pads every 1-2hrs - Bleeding lasting more than 7days - Passing large clots – larger than 50p pieces
47
what are the causes of menorrhagia?
- Dysfunctional uterine bleeding – no cause - Extremes of reproductive age - Fibroids - Endometriosis and adenomyosis - Pelvic inflam disease - Contraceptives – copper coil - Anticoag medications - Bleeding disorder – Von Willebrand - Endo disorder – diabetes and hypothyroidism - Connective tissue disorder - Endometrial hyperplasia/ cancer - PCOS
48
what pathology should be excluded when investigating menorrhagia?
anaemia, fibroids, bleeding disorders, cancer
49
when is tranexamic acid indicated?
: when no associated pain  antifibrinolytic reducing bleeding
50
when is mefenamic acid indicated?
when associated pain  NSAID reducing bleeding and pain
51
why are NSAIDs good for period pain?
NSAID: works by reducing prostaglandin which causes period contraction
52
what contraception options are good for menorrhagia?
Contraception: 1. Mirena coil 2. Combined oral contraceptive pill 3. Cyclical oral progesterone’s eg norethisterone 5mg TDS for day 5 to 26. - Associated to progestrogenic side effects due to increased risk of VTE 4. Progesterone only contraception  can suppress menstruation (pill or long acting – depo injection or implant) 5. Secondary care: if failed management
53
what is final/ surgical management of menorrhagia?
Final management: endometrial ablation and hysterectomy
54
what is endo ablation?
- Endo ablation: destroys endometrium
55
what is second gen non-hysteroscopic?
balloon into cavity and filling with high temp and burning lining (balloon thermal ablation)
56

Obs&Gynae (17 decks)

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