Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

WH- menstrual dysfunction > Assessment of menorrhagia and vaginal bleeding > Flashcards

Assessment of menorrhagia and vaginal bleeding Flashcards

1
Q

What is the definition of menorrhagia?

A

This is defined as blood loss of greater than 80 ml per month during cyclic menses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of menorrhagia clinically?

A

The term is commonly used to denote excessive volume and/or excessive duration (>1 week) of menstrual bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which age group is menorrhagia prevalent in?

A

Women of reproductive age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which sex hormones regulates normal cyclic menstrual bleeding?

A

Oestrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do the sex hormones regulate normal cyclic menstrual bleeding?

A

During normal cyclic menstrual bleeding, oestrogen and progesterone from the ovary induce the production of prostaglandins, cytokines, and matrix metalloproteinases (MMPs). These are directly responsible for the cyclic regeneration of the functional layer of the endometrium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What goes wrong in menorrhagia?

A

Abnormal uterine bleeding represents a disruption in the orderly progression of menstrual bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the endocrine causes of menorrhagia?

A 
PCOS (most common cause) 
Hyperprolactinaemia 
Thyroid dysfunction (particularly hypothyroidism) 
Dysfunction of the HPO axis
Dysfunctional corpus luteum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the structural causes of menorrhagia?

A 
Uterine fibroids (leiomyomas) 
Endometrial polyps 
Endometriosis 
Adenomyosis 
Uterine and cervical cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is adenomyosis?

A

Endometrial glandular growth into myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pregnancy complications that can result in vaginal bleeding?

A

Miscarriage
Choriocarcinoma
Ectopic pregnancy (uncommon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the infectious causes of menorrhagia?

A

Endometritis

Salpingitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the haematological causes of menorrhagia?

A

Menorrhagia can be a manifestation of several systemic diseases, including coagulation disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the Iatrogenic causes of menorrhagia?

A

IUS
Anticoagulant therapy
Tamoxifen
Hormonal therapies with exogenous oestrogen
Herbal supplements (ginseng, ginkgo and soya)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Systemic causes of menorrhagia

A

Chronic liver disease

Renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the urgent considerations for menorrhagia?

A
  • Urgent medical attention is required for women with symptomatic anaemia.
  • Women with abnormal coagulation profiles that place them at risk for significant bleeding
  • Women with current haemorrhage.
  • IV fluids and blood transfusion for haemodynamically unstable patients.
  • Transexamic acid should be considered ASAP in anyone with severe vaginal bleeding.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medical treatments for haemodynamically stable patients requiring urgent control of vaginal bleeding

A

High-dose conjugated equine oestrogen
Medroxyprogesterone
Combined oral contraceptive pill
Levonorgestrel-releasing intrauterine device
GnRH agonists such as leuprolide depot
Antifibrinolytic medications (e.g., tranexamic acid).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Surgical treatments for haemodynamically stable patients requiring urgent control of vaginal bleeding

A

Dilation and curettage (D and C). This approach has the added advantage of providing tissue for diagnosis.
Myomectomy, endometrial ablation, or uterine artery embolisation. These may be options for fibroid tumours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common differentials for menorrhagia

A 
PCOS 
Fibroids 
Miscarriage 
Endometritis 
Salpingitis 
Dysfunctional uterine bleeding 
Endometrial polyp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Uncommon differentials for menorrhagia

A 
Uterine malignancy Adenomyosis 
Gestational trophoblastic disease (choriocarcinoma) 
Ectopic pregnancy 
Disorders of haemostatics 
Hypothyroidism 
Endometriosis 
IUD 
Anticoagulant administration 
Cervical cancer 
Hepatic failure 
Renal failure
20
Q

What is the examination for menstrual dysfunction?

A

You should check that the woman is not clinically anaemic.
Abdominal palpation to check for any pelvic masses such as large fibroids.
Speculum examination will exclude an obvious vaginal or cervical lesion. Although cervical pathology does not cause menorrhagia, it may cause irregular vaginal bleeding. It is also good practice within gynaecology to always confirm a woman’s smear history.
Bimanual examination may find an enlarged uterus which may suggest the presence of fibroids.

21
Q

What is abnormal vaginal bleeding?

A

Abnormal vaginal bleeding can be menstrual related (e.g., menorrhagia) or non-menstrual related (e.g., intermenstrual or postcoital bleeding). This includes:

  • Menorrhagia
  • Polymenorrhoea
  • Metrorrhagia
  • Premenarchal bleeding
  • Postmenopausal bleeding
22
Q

What is polymenorrhoea?

A

Menstruation more frequent than every 3 weeks

23
Q

What is metrorrhagia?

A

Abnormal uterine bleeding between menstrual periods.

24
Q

What is premenarchal bleeding?

A

Vaginal bleeding that occurs before a girl is 9 years old.

25
Q

What is postmenopausal bleeding?

A

Vaginal bleeding that occurs >12 months after menopause has been established.

26
Q

Causes of premenarchal bleeding?

A
  • Always abnormal.
  • Precocious puberty- associated with early development of secondary sexual characters, in particular breast development.
  • Local inflammation of the vagina due to infection (including STDs) or a foreign body.
  • Childhood genital malignancy of the vagina.
  • For girls in the first year of menarche, heavy bleeding associated with irregular cycles may be due to dysfunctional uterine (anovulatory) bleeding.
27
Q

Causes of bleeding during reproductive years?

A

Menorrhagia
Physiological bleeding- resulting from the abrupt decline of the rising estradiol that reaches maximum levels just ahead of ovulation.
- Causes of metrorrhagia/ post coital/ contact bleeding- cervical or endometrial cancer, cervical or endometrial polyp, sub-mucous fibroids, cervical ectropion, cervicitis and endometritis
- Salpingitis
- Uterine cancers (endometrial, cervical and leiomyosarcomas)
- Coagulation disorders, chronic liver disease, renal failure, blood malignancies, VWD.

28
Q

Causes of bleeding during pregnancy?

A 
Always abnormal. 
Ectopic pregnancy 
Cervicitis 
Miscarriage 
Placenta praevia 
Placenta abruption
29
Q

What is ectopic pregnancy?

A

Ectopic pregnancy is defined as a fertilised ovum implanting and maturing outside of the uterine endometrial cavity (e.g., in the fallopian tube, ovary, or abdomen).

30
Q

Classic symptoms of ectopic pregnancy?

A

Classic symptoms are abdominal pain, amenorrhoea, and vaginal bleeding.

31
Q

Red flags in a woman with ectopic pregnancy

A

Red flags include unstable vital signs or signs of intraperitoneal bleeding (e.g., acute abdomen, shoulder pain, cervical motion tenderness);

32
Q

Risk factors for ectopic pregnancy

A

Progesterone-releasing IUDs Tubal sterilisation surgery Multiple sexual partners
First sexual encounter under the age of 18 years

33
Q

What is miscarriage?

A

Involuntary spontaneous loss of a pregnancy before 22 completed weeks.

34
Q

What is placental abruption?

A

Placental abruption, defined as premature separation of the placenta from the uterus, may be caused by trauma, hypertension, or coagulopathy.

Common cause of bleeding in the third trimester

35
Q

What is placenta praevia?

A

Placenta praevia is defined as the placenta overlying the cervical os. It can be complete, partial or marginal, and may resolve as pregnancy progresses
Presents as painless vaginal bleeding if symptomatic

36
Q

Risk factors for placenta praevia?

A

Multiple previous pregnancies Uterine scarring (e.g., due to prior caesarean section)
Multiple miscarriages
Previous induced abortion Placental abnormalities
Short inter-pregnancy intervals
Illicit drug use

37
Q

Complications of placenta praevia

A

FGR

Premature delivery

38
Q

Causes of postmenopausal bleeding

A

Abnormal
Most common cause is iatrogenic hormonal withdrawal in menopausal women receiving hormonal replacement.
Malignancies of the uterus and ovaries.
Atrophic vaginitis (associated with hypo-oestrogenism)

39
Q

When is bleeding associated with atrophic vaginitis encountered?

A

Bleeding associated with atrophic vaginitis is usually encountered after mechanical trauma associated with intercourse and in association with the use of imperfectly fitting vaginal pessaries in women with incontinence and/or genital prolapse.

40
Q

Management of placenta abruption?

A

-FBC for evidence of anaemia. Haematocrit (Hct) and haemoglobin (Hb) levels may be low
-Coagulation profile looking for evidence of impaired coagulation. Low fibrinogen levels and a prolonged PT are suggestive of impaired coagulation due to disseminated intravascular coagulopathy (DIC)
-Monitoring of the patient’s haemodynamic status (BP, pulse, volume intake, and urine output)
-Continuous fetal monitoring
-Anti-D immunoglobulin in Rh-negative women
-Fluid, blood, or blood product replacement, as indicated
-Sonographic examination for placental location and for evidence of abruption. Placenta praevia found on sonography makes placental abruption unlikely.
In cases of a live foetus at term, prompt delivery is indicated. When there is evidence of fetal compromise, delivery by caesarean section is usually indicated

41
Q

Common differentials of vaginal bleeding?

A 
Cervical cancer 
Thyroid dysfunction 
Miscarriage 
Pelvic inflammatory disease 
Endometritis
Uterine fibroids 
Endometrial polyp
Cervical polyp 
Ectropion 
Menorrhagia 
PCOS 
Dysfunctional uterine bleeding
42
Q

Uncommon differentials of vaginal bleeding?

A 
Endometrial cancer
Ovarian cancer 
Vaginal cancer 
Acute leukaemia 
Lymphoma 
Renal failure 
Ectopic pregnancy 
Placental abruption 
Placenta praevia 
Endometriosis
43
Q

Which questions are important to ask when assessing vaginal bleeding?

A

oThe woman’s age - Women over the age of 45 should be considered at higher risk of serious underlying pathology.
oIs the bleeding regular? - Irregular bleeding raises concern of underlying pathology so should always been considered as a worrying feature and malignancy must be excluded.
oDoes she complain of other symptoms that may be associated with fibroids? - A heaviness in the pelvis, urinary symptoms, or maybe fibroids were seen on a previous scan.
oAre there any other issues in her history to raise concern? - Does she have a bleeding disorder such as von Willebrands? Does she have symptoms to suggest thyroid dysfunction? Does she take medication such as anti-coagulants?
oWhat medication is she taking? Is she on any contraception, for example the copper coil can make periods heavier? In that case, changing her contraception maybe the treatment of choice. Does she take medication such as anti-coagulants?
oDoes she have any family history of coagulation disorders?
oYou also need to consider whether the woman wants to have more children in the future as this will affect your choice of treatments.

44
Q

What is normal endometrial thickness?

A

<16 mm.

45
Q

What is the endometrial thickness at different stages of the menstrual cycle?

A
  • during menstruation: 2-4 mm 1,4
  • early proliferative phase (day 6-14): 5-7 mm
  • late proliferative / preovulatory phase: up to 11 mm
  • secretory phase: 7-16 mm
  • following dilatation and curettage or spontaneous abortion: <5 mm,
46
Q

When is the endometrial at its thickest?

A

Secretory phase

47
Q

What are the red flag symptoms for abnormal vaginal bleeding?

A

1) Age >45yrs
2) Intermenstrual bleeding
3) Postcoital bleeding
4) Postmenopausal bleeding
5) Abnormal examination findings e.g. pelvic mass or lesion on cervix
6) Treatment failure after 3 months.

WH- menstrual dysfunction (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions