heavy menstrual disorders Flashcards
1
Q
HMD
A
heavy menstrual bleeding
- loss of more than > 80 ml of blood per period
- increased cases of the years due to < children and > periods
2
Q
HMD history questions ( 3)
A
- how often do sanitary towels need to be changed?
- clots present?
- soiling - ever spill over towel/clothes/bedding
- tired? - anaemia
3
Q
HMD examinations
A
- Signs for anaemia - conjunctival pallor/
- Abdominal exam
- Pelvic examination - allows pelvic masses to be palpated
- Speculum - cervix for polyps/carcinoma
- Smear
4
Q
HMD investigations
A
- Full blood count
- Coagulation screening
- Pelvic ultrasound scan - if mass palpated/suspected endometrial polyps/drug therapy unsuccessful
- Vaginal + Endocervical swabs - risk factors for PID/unusual discharge
- Endometrial biopsy - if aged > 45/irregular menses/drug therapy failed check for endometrial polyp
- Thyroid function tests
- bimanual exam - enlarged uterus due to fibroids/pelvic tenderness
5
Q
Management - medical treatments
Mefenemic acid
A
- Mefenamic acid + NSAIDs
- inflammation results in phospholipase A2
- phospholipase A2 converts phospholipid into arachidonic acid
- arachidonic acid -> COX 1 converts it into thromboxane and prostaglandin
- > COX 2 converts into prostaglandins but usually only found in sites of pain and inflammation
- Prostaglandins are pro inflammatory molecules - Inhibits COX enzymes thus prevents pro inflammatory molecules like prostaglandins being released
- increases ration of vasoconstrictor PGF2 alpha to the vasodilator PG e2
- effective analgesic so effective in dysmenorrhoea
- contrac w hx of severe asthma/duodenal ulcers
- reduction of mean blood loss of 20-25%
6
Q
Paracrine hormones on the endometrium
A
the endometrium produces ; Vasoconstrictors - 1. Prostaglandin F alpha 2. Endothelin 1 3. Platelet activating factor (PAF) Vasodilators - 4. Prostaglandin e2 5. Prostacyclin 6. Nitric oxide (NO)
7
Q
Management - medical treatments
Tranexamic acid
A
Tranexamic acid
- menstrual blood loss reduction of 50%
- increase risk of venous thrombosis
- only required to be taken on days bleeding is v heavy
- not a contraceptive so compatible w contraception
- antifibrinolytics which inhibit fibrin lysis which prevents blood clots being broken down
8
Q
Management - medical treatments
combined oral contraceptive pills
A
- combination of oestrogen and progesterone supplements which inhibits gonadotropin releasing hormone thus no FSH and LH released so ovulation cannot take place.
- Contra indic -
- increases risk of blood clots/thromboembolism
- unsuitable with FH of breast cancer
- patients who are grossly overweight
9
Q
Management - medical treatments
Noresthisterone
A
- cyclic progesterone taken from day 6 to day 26 of the menstrual cycle
benefits : safe + effective which can regulate bleeding pattern
10
Q
IUS
A
- contraceptive cover comparable to sterilisation
- effective for dysmenorrhea
- Can cause irregular menstrual cycles and/or break through bleeding
11
Q
GnRH agonists
A
- act on the pituitary to stop production of oestrogen which results in amenorrhea
- only used in short term due to hypo oestrogenic state which predisposes to osteoporosis
- can cause irregular bleeding
- side effects : sweating / flushing
12
Q
Surgical treatments
A
- Endometrial ablation - ablate endometrial lining to such depth that it cannot be regenerated and grow back
- results in reduced menstrual loss or amenorrhea - Hysterectomy - removal of the uterus
13
Q
causes of heavy menstrual bleeding (systemic)
A
- clotting disorders
2. thyroid disease
14
Q
causes of heavy menstrual bleeding (local)
A
- Fibroids
- Endometrial polyps
- Endometrial carcinoma
- Pelvic inflammatory disease
15
Q
causes of heavy menstrual bleeding (iatrogenic)
A
- intrauterine contraceptive devices
2. oral anti coagulants
