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GOSH > Disorders of menstrual cycle > Flashcards

Disorders of menstrual cycle Flashcards

1
Q

What is the objective definition of heavy menstrual bleeding?

A

blood loss >80ml per period

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2
Q

Causes of menorrhagia?

A
  • fibroids: 30% of women, 20% at reproductive age
  • Endometrial polyps: 10% (abnormal growth from mucous membrane)
  • adenomyosis (endometrial tissue grows into wall of uterus)
  • pelvic infection (PID)
  • coagulation disorders
  • IUDs
  • obesity (increased oestrogen)
  • endometrial/ cervical/ ovarian carcinoma
  • thyroid disease
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3
Q

how would you illicit a heavy flow from history?

A
  • flooding: spilling onto clothes, pants or bedding
  • length of cycle and IMB
  • affecting daily life
  • what sanitary pads used
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4
Q

What associated symptoms might they have? (apart from menhorragia)

What might discharge associated with menhorragia indicate?

What endocrine disorder may cause it?

A
  • anaemia: tiredness, dyspnoea, cv symptoms
  • dyspareunia
  • irregular, IMB, post-coital: endometrial or cervical polyp
  • cervical ectropion
  • PID
  • hyperthyroidism and menhorragia
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5
Q

what may you find on abode exam in menhorragia?

A
  • bulky uterus: suggests fibroids

- tenderness: endometriosis, PID or adenomyosis

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6
Q

what investigations should be done in menhorragia to illicit cause?

A
  • bloods: clotting screen, FBC, TFTs
  • TV pelvic USS: fibroids or polyps
  • High vaginal and endocervical swab: unusual vaginal discharge and RF for PID
  • endometrial biopsy: those aged 45+ or suspicion of cancer ( PCB, IMB)
  • hysteroscopy
  • colposcopy
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7
Q

what are the red flag symptoms for gynae?

A
  • PCB: STI, cervical ectropion, cervical polyps
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8
Q

what contraceptives can cause IMB?

A
  • depot
  • missed COCP
  • POP
  • IUCDs
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9
Q

What is the first and 2nd line treatment for menhorragia?

what are the SE’s of TXM and what is the benefits?

A
  • Mirena: localised levonogesterol- progestogen
  • mefenamic acid: NSAID (benefit in dysmenorrhoea, CI in asthmatics)
  • TXM Acid: antifibrinolytic, only take during menstruation
  • COCP: doubles up as contraceptive, regulates cycle so good if IMB
  • S/E: GI symptoms and tinnitus
  • NSAIDs and TXM good for those wanting to conceive!
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10
Q

when should you not give the combined OCP?

A
  • DVT risk factor groups

- overweight

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11
Q

What is 3rd line treatment for HMB?

A
  • GnRH agonists: complete amenorrhoea, causes menopause e.g. goserelin
  • Norethisterone: (progestogens)
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12
Q

what is the downside of GnRH agonist use?

A
  • can only be used for 6 months, no long term solution
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13
Q

What is the surgical options for heavy menstrual bleeding?

A
  • hysteroscopy: endometrial ablation, polyp removal, resection of fibroid
  • hysterectomy
  • myomectomy
  • UAE
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14
Q

what is the aetiology behind post-coital bleeding?

what is the differential diagnoses?

A
  • lack of healthy squamous epithelium on cervix
  • PID
  • cervical malignancy
  • cervical ectropion
  • cervical/ pedunculate polyp
  • pedunculate fibroid
  • atrophic vaginitis
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15
Q

what investigations should you do for post-coital bleeding?

A
  • smear test
  • ultrasound
  • hysteroscopy
  • pipelle (endometrial biopsy)
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16
Q

what happens in cervical ectropion?

A
  • endocervical columnar epithelium protrudes through external os onto vaginal portion
  • undergoes squamous metaplasia, transforms to stratified squamous epithelium
  • transforms due to acidity of vagina
17
Q

how would cervical ectropion be distinguished from cancer?

what are the associated symptoms?

A
  • pap smear or biopsy
  • excessive, non-purulent vaginal discharge (> surface area of columnar epithelium containing mucus-secreting glands)
  • possible post-coital bleeding
18
Q

what is the treatment for ectropion?

what may make ectropion malignant change?

A
  • none if asymptomatic
  • discontinue oestrogen hormone: causes os to open
  • ablation of metaplasia
  • HPV infection
19
Q

How does ectropion look on the cervix?

A
  • red, velvet like area
  • raw-looking granular appearance
  • associated with hormonal changes
20
Q

what is dysmenorrhoea?

where can it radiate to?

A
  • cramping abdominal pains during periods

- lower back, legs and may be associated with GI symptoms or malaise

21
Q

what is dysmenorrhoea caused by?

what non-gynae symptoms are associated?

A
  • increased prostaglandins in endometrium
  • uterine contraction and ischaemia
  • vomiting, migraine, bloating, emotional symptoms
22
Q

when does primary dysmenorrhoea occur?

what is involved in aetiology?

A
  • begins with onset of ovulatory cycles, most common in adolescents
  • pain is most severe on day of menstruation
  • PGE2 and PGF2a in menstrual fluid, increased contractility and pain
23
Q

how do you treat primary dysmenorrhoea pain?

what contraceptives?

A
  • NSAID reduces production of PGF2a and thus dysmenorrhoea
  • Mefanamic acid and ibuprofen effective
  • offer paracetamol if NSAIDs contraindicated
  • COCP: suppression of ovulation reduces severity of dysmenorrhoea
  • Depot progestogens: injectable progestogen only contraceptive supresses ovulation
  • Mirena: reduces blood loss and effective with pain
24
Q

what conditions are secondary dysmenorrhoea associated with?

when does the pain present typically?

A
  • pelvic pathology
  • onset many years after menarche
  • commonly associated with:
    endometriosis, adenomyosis, PID, fibroids and cervical stenosis
  • normal copper coil can also aggravate
  • pain precedes and relieved by onset of menstruation
25
Q

what are typical associated symptoms of secondary dysmenorrhoea? (think causes)

A
  • deep dyspareunia
  • irregular menstruation
  • menorrhagia
26
Q

how may you treat secondary dysmenorrhoea?

A
  • genital tract swabs to exclude pelvic infection (PID)
  • USS if fibroids suspected
  • laparoscopy if PID or endometriosis suspected

GOSH (18 decks)

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