Dysmenorrhoea Flashcards
Structural causes of HMB
Polyps, adenomyosis, leiomyoma, malignancy or hyperplasia
Non-structural causes of HMB
Coagulopathy (Von Willebrand disease), ovulatory disorder, endometrial, iatrogenic (hormone induced), non-specific (AV malformations, CS niche)
Associated symptoms to ask for in HMB
Intermenstrual bleeding
Postcoital bleeding
Dysmenorrhoea
Dyschezia
Dysparenuria
Bladder symptoms
What are fibroids
Also known as uterine leiomyomas, which are benign tumours of smooth muscle of the womb.
How do fibroids change over time
Increasing prevalence with age, and can shink after menopause and grow during pregnancy as they are oestrogen sensitive.
What are the classifications of fibroids
Subserosal
Intramural
Submucosal
Pedunculated
Intracavitary
Where are subserosal fibroids found
On the outside of the uterus, below, can fill the abdominal cavity
Where are intramural fibroids found
Within wall of the myometrium and can distort shape of the uterus
Where are submucosal fibroids found
Impinging on the cavity of the womb, just below the lining of the uterus (endometrium)
What are pedunculated and intracavitary fibroids
Both found on a stem, with pedunculated found outside the womb and intracavitary within the womb
Presentation of fibroids
Can be asymptomatic, or have range of symptoms including:
HMB, abdominal pain, prolonged menstruation, bloating or full feelings, bowel or urinary symptoms if they are pushing on cavities, dysparenuria, reduced fertility
What are the examination, investigations and findings of fibroids
Bimanual – firm mass
Hysteroscopy - submucosal fibroids
PUSS - larger fibroids
MRI - before surgical option but not part of routine work up
Treatment of fibroids which are less than 3cm
Mirena coil
NSAIDs
COCP
Cyclical oral progesterones
Surgical - endometrial ablation, resection or hysterectomy
Treatment of fibroids which are more than 3cm
NSAIDs and TXA
Mirena coil depending on size and shape
COCP
Cyclical oral progesterones
UTerine artery embolisation
Myomectomy
Hysterectomy
What are GnRH agonists used for in fibroids
Goserelin or leuprorelin may be used to reduce the size of fibroids before surgery - working to induce a menopause like state
What does uterine artery embolisation do in fibroid treatment
Catheter is inserted into femoral and uterine artery to block the arterial supply to the fibroid
What is involved in endometrial ablation
Destroying the endometrium and used as second generation non-hysteroscopic technique such as balloon thermal ablation, which involves inserting a specially designed balloon into the endometrial cavity and filling it with a high temperature
Complications of fibroids
HMB leading to anaemia
Reduced fertility
Pregnancy complications
Constipation
Urinary outflow obstruction and UTI
Reduced degeneration of fibroids
Torsion of fibroid
Malignant change is very rare
What are endometrial polyps
Hyperplastic localised overgrowths of endometrial glands and stoma
When are polyps markers for malignancy
> 1cm
associated with abnormal bleeding patterns
Presence in postmenopausal women
Necrotic, vascular or whitish appearance at hysteroscopy
Presentation of polyps
Increased prevalence with age until menopause, may be asymptomatic or affect fertility and contribute to HMB
What is adenomyosis
Endometrial tissue inside the myometrium.
What is the prevalence of adenomyosis
More common in later reproductive years and those that have had several pregnancies - 10% women overall
Presentation of adenomyosis
Painful periods
Heavy periods
Pain during intercourse
Infetility or pregnancy related complications
1/3 are asymptomatic
