Disorders of Menstruation Flashcards
Where is GnRH secreted from and what role does it play?
GnRH is released from the hypothalamus.
It stimulates the release of FSH and LH.
What is the role of FSH?
Stimulates follicular growth.
What secretes progesterone?
Corpus luteum
What chemicals are released to cause uterine spiral arterioles to constrict, shedding the endometrium as a period?
Prostaglandins
Which layer of the endometrium is cast out as a period?
Stratum functionalis - the other layer (stratum basalis) remains.
What are pre-menstrual disorders?
Normal menstrual symptoms that inhibit daily function.
They are cyclical, occuring in the luteal phase.
How are pre-menstrual disorders treated?
Combined OC or GnRH agonist - the aim is to suppress ovulation.
SSRIs can also help.
What may result from solitary oestrogen therapy?
Endometrial hyperplasia (this is a pre-cancerous state).
What is the first-line treatment for heavy menstrual bleeding?
Mirena coil
If mirena coil is unsuccessful in preventing heavy menstrual bleeding what is given?
Give tranexamic acid or combined OC.
If still persists, give PO pill.
Surgery is the last-line of therapy.
What is premenstrual syndrome?
A complex of symptoms experienced in the days immediately prior to menstruation.
Causes a wide range of symptoms.
What is the difference in PMS symptoms compared to normal period?
The key to diagnosis is the severity of impact experienced on normal life.
If conception does not occur, what happens?
Progesterone and oestrogen levels drop, allowing menstruation to occur.
What is suggested as the cause of PMS?
Sensitivity to progesterone.
Not yet fully understood.
How is PMS diagnosed?
Symptom diary over 2 cycles.
What is first-line treatment for PMS?
Exercise CBT Vitamin B6 supplementation Combined OC pill Continuous/Luteal phase only SSRI
What is second-line for PMS?
Estradiol patches Microionised progesterone (this is aimed at protecting the endometrium). Increased dose SSRIs (can be continuous or luteal phase only).
What is third-line for PMS?
GnRH analogues and HRT.
What is the aim of PMS treatment?
To suppress progesterone/ovulation.
Treat continuously rather than cyclically.
Is estradiol/HRT a contraceptive?
No, need a contraceptive alongside this.
Which hormone stimulates the growth of the endometrium?
Oestrogen
What is the risk of suppressing progesterone?
Oestrogen will now be unopposed. Risk of cancer.
Give mirena coil/microionised progesterone to counteract this.
What must be given alongside GnRH antagonists?
Contraception as it can virilise a female foetus.
When are GnRH analogues used in PMS?
Severe disease or for diagnosis only.
They are very effective but affect bone mass density significantly.
If necessary to give these, then perform DEXA scan each year.
What surgery options are available in PMS?
Hysterectomy
Bilateral oophorectomy
Only considered if medical management fails.
What is recommended if GnRH analogues effectively manage symptoms?
Surgery
What is dysfunctional uterine bleeding?
Irregular uterine bleeding that reflects disruption of the normal menstrual cycle.
