Aub Flashcards
Types of menstrual cycle abnormalities
Amenorrhea -absence of menstruation
Oligomenorrhoea- infrequent and irregulars episodes of bleeding,interval more than 35 days
Polymenorhea- frequent episodes ,interval of 21 days or less
Menorrhagia- regular timed episodes that are excessive in amount>80ml,or duration >5 days
Metrorrhagia - irregularly timed eps superimposed on normal cyclical bleeding
Menometrorhagia- excessive and prolonged bleeding that occurs at irregularly timed and frequent intervals
Hypomenorrhea- regurlay timed but scanty
Intermenstrual bleeding- bleeding between normal menstrual cycles
Precocious menstruation- menarche before 10
Post coital bleeding
Normal menstrual blood loss
50-80 ml
What meds cause hypomenorrhea-
Ocp
Why polymenorrhagia observed in women who resume menstrual activity after a delivery
Persistence of activity of anterior love of pituitary gland initiated during pregnancy into the post natal phase. The excessive stimulation by the gonadotropins cause frequent ovulation and menstruation
Mittelschmerz
Mid menstrual bleeding,lasting from a few hours to one day,a profuse sticky discharge and intermittent crampy pain of short duration
DD of post coital bleeding in elderly women
Neoplasm
Types of dysmenorrhea
. Spasmodic- cramping pains
. Congestive- increasing pelvic discomfort and pelvic pain
. Membranous- endometrium shed as cast
Why pain in dysmenorrhea
Myometrial contractions due to increased Pgf 2 Alpha secreted under progestrone effect
Diff between primary and secondary dysmenorrhea
- 2
Onset. Within 2 yrs of menarche;
20-30
Desc. Cramping. Dull ache
Sympt. Nausea,. Dyspareunia
Vom. Infertility
Diarrhea,headache
Fatigue
Pelvic findings normal. Variable
Etio. Inc myometrial cont. Endomet,pid,adenomyosis
Mngmtn of PMS
. Psychosomatic- vit b1,b6,e, selective serotonin reuptake inhibitor,setraline,citalopram anxiolytics
. Breast pain- danazol,bromocriptine gnrh
. Pelvic pain and bloatedness- Yasmin,primrose,prostaglandin inhibitors OC,progestogen,mirena IUCD
What is chronic aub
Bleeding that is abnormal in volume,regularity and timing for past 6 months
What is acute aub
An episode of heavy menstrual bleeding of sufficient quantity to require immediate intervention to prevent further loss
Why aub
Immaturity of hypothalamic pituitary ovarian axis leading to anovulatory cycles
Normal control of menstrual bleeding
Once bleeding starts,latelet aggregation forms clots in the opened vessels. Prostaglandin F2 alpha causes myometrial contractions and constricts the endometrial vessels. The repair and epithelial regeneration begin on the third and fourth day of period,by growth of epithelial cells from the open endometrial glands aided by the vascular endothelial,epidermal and fibrolast growth factors.
Etiology of menorrhagia
. General causes
. Blood dyscrasia
. Coagulopathy
. Thyroid dysfunction
. Genital tb
. Pelvic cause
. Pid,pelvic adhesions
. Uterine fibroids,adenomyosis
. Feminizing tumour of ovary
. Endometriosis,pelvic congestion,varicose veins in pelvis
. Contraceptive use
. IUCD
. Posttubal sterilization
. Progestogen only pills
. Hormonal
. Ovulatory- irregular ripening or irregular shedding
. Anovulatory - resting endometrium-80%
. Metropathia hemorrhagica
Inv for aub
. Complete hemogram
. Bleeding and clotting time
. Thyroid profile
. Pelvic sonography
. Diagnostic hysteroscopy
. Endometrial tissue sampling by d and c
.diagnostic laparoscopy
. Sonosalphinhography
. Pelvic angiography
Mngmtn of aub
. General measures(diet,rest,vitamins)
. Treat cause
. Nsaids like mefenamic acid 500 mg tid ,or naproxen,ibuprofen
. Tranexamic acid 500-1000 mg two or three times a day
. Cyclic ocp
. Progestogen
. Mirena IUCD
. Endometrial thermal ablation,resection
. Hysterectomy
.
Palm coein classification
. Polyp
USG,saline sonography,hysteroscopy
. Adenomyosis
USG ,kri, subdivided depending on depth of endometrial myometrial invasion
. Leiomyoma
Primary classification - presence or absence
Secondary classification - involve uterine cavity or not
Tertiary classification - involves submucosal growths,number,size and location
. Malignancy
D and c biopsy
. Coagulopathy
Vin willebrsnd disease
. Ovulatory-
May be consequence of luteal out of phase(LOOP) events with deficient progesterone. Some are caused by hypothyroidism or hyperprolactinemia
. Endometrial
. Iatrogenic
Contraceptive,IUCD,anticoags,phenothiazine,tricyclic antideps
.not classified
Av malformations varicose veins of uterine vessels ir myohyoerplasia
Metropathica hemorrhagica
Anovulatory aub
40-45 yrs
Continuos painless vaginal bleeding starting at onset of menses,or preceded by 6-8 weeks of amenorrhea
Characteristic endometrium in metropathica hemorrhagica
Swiss cheese pattern
Absence of cork screw glands
Medical therapy of aub
. Combined ocp
. Progestogens (5-10 mg for 3 weeks cyclically)
. Gestrinone 2.5 mg twice weekly
. Danazol 100-200 mg daily
. Gnrh analogues 4 weekly injections
. Tranexamic acid 1g,6 hourly
. Nsaids mefenamic acid 500 mg tid
. Ethansyklate 500mg for times daily
. Mirena IUCD 52 mg levonorgestrel
. Ormeloxifene 60 mg twice weekly
Disadvantages of mirena
. Difficult to insert
. Takes 3 months to become effective
. Amenorrhea in 20-25 percent
. Ectopic pregnancy
. Hysterectomy cuz of recurrence of menorrhagia
Minimal surgical methods for treating menorhagia
Ablative techniques
First gen
Hysterscopic ablation endometrium resectoscope roller ball laser(TCRE)
second gen
RITEA, balloon therapy,microwave ablation
Uterine tamponade in acute bleeding
Bilateral uterine artery embolization
Contraind of endomet ablation
Uterine size>12 weeks
Uterine fibroid
Scarred uterus
Young woman who wants pregnancy
Adenomyosis
Genital infection
Cancer
Advantages of RITEA
Less skill required
Less risk
Cavaterm balloon therapy numbers
Balloon distended with 15-30 ml sterile solution such as 5% glucose or 1.5% glycine. Heating element raises temp to 87 degree Celsius,maintained for 8 minutes over a pressure of 160-180 mm hg. About 6 mm of endometrium gets destroyed
Contraind of vaginal hysterectomy
. Uterus grossly enlarged
. Previous surgery with adhesions
. Endometriosis or adnexal mass
Complications of hysterectomy
. Ovarian atrophy
. Adhesion of ovary to vaginal vault
. Vault prolapse
. Sexual dysfunction
. Chronic abd pain
. Urinary and bowel symptoms due to denervation
. Psychological disturbances
Halban disease
Irregular shedding due to persistent corpus luteum. Progestogen can suppress the bleeding but on tapering dose for 20 days to complete the cycle
Adenomatous endometrial polyp occurs in
. Endometrial hyperplasia(anovulatory cycles)
. Metropathica hemorrhagica (diffuse polyposis
. A woman on tamoxifen
. Some cases of fibroid
Types of amenorrhea
Primary- failure of onset of menstruation beyond the age of 16 yrs,regardless of development of sec sexual characters
Secondary - failure of occurence of menstruation for 6 months or longer in women who have previously menstruated
Onset of menarche
10-16, with mean of 12.5
Tanner evaluation
For maturation status of secondary sexual characteristic and observation of any genetic or endocrine stigmata
Mayer rokitansky kuster Hauser syndrome
Absent vagina and non functioning uterus
Kallmann disease
Low or absent gnrh is due to either autosomal dominant or x linked autosomal recessive gene. Characterized by anosmia and maldevelopment of neurons in the arcuate nucleus
Savage syndrome
Receptor defect of gonadotropic hormones in ovaries and resembles autoimmune disease and resistant ovary syndrome. The height is normal,ovaries contain follicles but serum Fsh is raised
