Gynaecological problems Flashcards
definition of menorrhagia?
prolonged and increased (>80ml per period) menstrual flow (heavy menstrual bleeding)
definition of metorrhagia?
reuglar intermenstrual bleeding
definition of polymenorrhoea?
menses occurings at <21 day interval
definition of polymennorrhagia?
increased bleeding and frequent cycle
definition of menometorrhagia?
prolonged menses and intermenstrual bleeding
definition of amenorrhea?
absence of menstruation > 6 months
definition of oligomenorrhea?
menses at intervals of >35 days OR presence of five or fewer menstrual cycles over a year
what is dysfunctional uterine bleeding?
non-organic menorrhagia, occuring in the absence of pathology
what is anovulatory DUB?
most common 85%
occurs at extremes of reproductive life
irregular cycle
more common in obese women
what is ovulatory DUB?
more common in women aged 35-45
regular heavy periods
due to inadequate progesterone production by the corpus luteum
how would you investigate DUB?
- FBC
- thyroid function tests
- coagulation screen
- renal / liver function tests
- TVUS (endometrial thickness, presence of fibroids or other pelvic masses)
- endometrial sampling
progesterone releasing IUCD (mirena) in treating DUB?
- best option for compliance
- first line
- 95% reduction in blood loss
- contraception
- breakthrough bleeds
- helpful to avoid using oral progesterones or COCP
COCP in treating DUB?
- 30% reduction in blood loss
- unsuitable for many
antifibrinolytics in treating DUB?
eg tranexamic acid
- taken during menstruation
- decreases blood loss by 50%
- use when woman is concieving
NSAIDS in treatment of DUB?
eg mefanamic acid
- taken during menstruation
- appropriate when woman is considering concieving
- decreases blood loss by 20-25%
- apototic process producing prostaglandings
when are NSAIDS contraindicated?
duodenal ulcer or asthma
oral progesterones in treatment of DUB?
eg norethisteron and medrocyprogesterone acetate
GnRh analogues / antagonists in the treatment of DUB?
act on the pituitary to stop oestrogen production, resulting in amenorrhea, long-term use casues OP unless combined with HRT
- eg goserelin, decapeptyl. buserelin
causes of intermenstrual bleeding?
cervical ectropion, PID, DTI, endometrial and cervical polyps, cervical cancer, endometrial cancer, undiagnosed pregnancy / complications, hyatidform molar disease
when do you investigate endometrial thickness?
if it is >4mm, do a biopsy
what is the Rotterdam criteria for diagnosing PCOS?
- clinical or biochemical evidence of hyperandrogenism (hirsuitism, acne, high free tstosterone, low sex hormone binding globulin, high free androgen index respectively)
- Polycystic ovaries on US (defined as an increase in ovarian volume to >10cm3, at least 12 follicles in one ovary measuring 2-9mm in diameter)
- oligo / amenorrhoea
what are the hormonal changes in PCOS?
increase in LH:FSH level
LH levels are very high and FSH levels are low or normal
what is dysmenorrhoea?
painful periods
how to manage dysmenorrhoea (painful periods)?
NSAIDS eg mefanamic acid and ibuprofen
COCP
levonogestrel IUS
what size are ovarian cysts?
<5cm in maximum diameter
what is Bartholin’s glands?
pair of glands located next to the enterance of the vagina
sit at 5 and 7 oclock
size of a pea but can become infected and enlarged - forming an abscess
first line treatment for uterine fibroids?
minera IUS
symptoms of uterine fibroids?
lower abdominal pain during menstruation
symptoms of ovarian torsion
sudden onset of deep colicky pain associated with vomiting and distress
adnexel tenderness / acute abdomen
classic US sign of ovarian torsion?
whirlpool sign
treatment for ovarian torsion ?
laparoscopy to untwist ovary and remove cyst
