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Obs&Gynae > abnormal bleeding > Flashcards

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
Q

what is mittelschmerz?

A

– ovulation pain (cyclical)

26
Q

what is pathological vaginal bleeding?

A

excessive or foul smelling discharge

27
Q

what can cause vaginal discharge?

A
  • Bacterial vaginosis
  • Candidiasis
  • Chlamydia
  • Gonorrhoea
  • Trichomonas vaginalis
  • Foreign body
  • Cervical ectropion
  • Polyps
  • Malignancy
  • Pregnancy
  • Ovulation (cyclical)
  • Hormonal contraception
28
Q

what is pruritus vulvae?

A

: itching of vulva and vagina

29
Q

what can cause pruritus vulvae?

A
  • Irritants  soaps, detergents, barrier contraception
  • Atrophic vaginitis
  • Infections – candidiasis, public lice
  • Skin conditions – eczema
  • Vulval malignancy
  • Pregnancy related discharge
  • Urinary/ faecal incontinence
  • Stress
30
Q

what is adenomyosis?

A

: refers to endometrial tissue inside myometrium (muscle layer)

31
Q

when is adenomyosis more likely?

A

more common in later reproductive years
- More common in those with several pregnancies

32
Q

what does multiparous mean?

A

multiple pregnancies

33
Q

what other conditions may be seen with adenomyosis?

A
  • Can occur with/ without endometriosis/ fibroids
34
Q

what is the aetiology of adenomyosis?

A

not fully understood
- Linked to sex hormones  does improve after menopause just like endometriosis/ fibroids
- Trauma
- Inflammation

35
Q

how does adenomyosis present?

A
  • Painful presentation: dysmenorrhoea
  • Heavy periods
  • Pain during intercourse
  • Infertility or pregnancy- related complications
  • 1/3 pts are asymptomatic
36
Q

on examantion, how would adenomyosis present?

A

Exam: enlarged/ tender uterus
- It will more soft in comparison to a uterus containing fibroids

37
Q

how do you diagnosis adenomyosis?

A

transvaginal US of pelvis: first line
MRI and transabdominal US: alternative

38
Q

what is the gold standard for proving adenomyosis?

A

Histological exam: gold standard after hysterectomy

39
Q

how do you manage adenomyosis?

A

Depends on symptoms, age, plans for future children
- NICE recommends same management as heavy menstrual bleeding

40
Q

what medical management for adenomyosis can be given if woman does not want contraception?

A
  • Tranexamic acid: if no pain (antifibrinolytic)
  • Mefenamic acid: if pain associated (NSAID – reduces pain)
41
Q

what are the contraceptive options for managing adenomyosis?

A
  1. Mirena coil
  2. Combined pill
  3. Cyclical oral progesterone
    - POP, implant, depo injection may used
42
Q

what are the specialist options for managing adenomoysis?

A
  • GnRH analogues to induce menopause like state
  • Endometrial ablation
  • Uterine artery embolization
  • Hysterectomy
43
Q

how adenomyosis affect pregnancy?

A
  • Infertility
  • Miscarriage
  • Preterm birth
  • Small for gestation age
  • Preterm rupture of membranes
  • Malpresentation
  • Need for C section
  • Postpartum haemorrhage
44
Q

how much blood is normal to lose in menstruation?

A

40ml

45
Q

how much blood is excessive to lose during period?

A

80ml

46
Q

how would you classify excessive bleeding?

A
  • Based on symptoms eh changing pads every 1-2hrs
  • Bleeding lasting more than 7days
  • Passing large clots – larger than 50p pieces
47
Q

what are the causes of menorrhagia?

A
  • 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
Q

what pathology should be excluded when investigating menorrhagia?

A

anaemia, fibroids, bleeding disorders, cancer

49
Q

when is tranexamic acid indicated?

A

: when no associated pain  antifibrinolytic reducing bleeding

50
Q

when is mefenamic acid indicated?

A

when associated pain  NSAID reducing bleeding and pain

51
Q

why are NSAIDs good for period pain?

A

NSAID: works by reducing prostaglandin which causes period contraction

52
Q

what contraception options are good for menorrhagia?

A

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
Q

what is final/ surgical management of menorrhagia?

A

Final management: endometrial ablation and hysterectomy

54
Q

what is endo ablation?

A
  • Endo ablation: destroys endometrium
55
Q

what is second gen non-hysteroscopic?

A

balloon into cavity and filling with high temp and burning lining (balloon thermal ablation)

56
Q
A

Obs&Gynae (17 decks)

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