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Obstetrics & Gynae RIA > menorrhagia > Flashcards

menorrhagia Flashcards

1
Q

primary amenorrhoea is

A

failure to start menses by 16 years old

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2
Q

3 causes of primary amenorrhoea

A
  • Turners syndrome
  • Testicular feminisation
  • CAH
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3
Q

define secondary amenorrhoea

A

cessation of established regular menstruation for 6 months of longer

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4
Q

3 causes of secondary amenorrhoea

A
  • pregnancy
  • PCOS
  • Sheehans syndrome
  • Hypothalamic amehorrhea
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5
Q

what is ENDOMETRIOSIS

A

presence of endometrial tissue outside the uterine cavity.

Will respond to hormones & undergo cyclical bleeding, healing leading to fibrosis & development of adhesiona causes pain & infertility

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6
Q

gold standard diagnosis of endometriosis

A

Laparoscopy

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7
Q

symptoms of endometriosis

A
  • Dyspareunia
  • severe dysmenorrhoea
  • chronic pelvic pain
  • pain on defecation
  • dysuria
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8
Q

risk factors for endometriosis

A
  • early menarche
  • obesity
  • red meat
  • late menopause
  • genetics
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9
Q

causes of Pelvic inflammatory disease

A

ascending infection from endocervix

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10
Q

What is adenomyosis

A

deposits of endometrial tissue in the myometrium of the uterus

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11
Q

what are endometrioma

A

cystic structures developing on the ovaries in endometriosis - referred to as chocolate cysts due to appearance of the contained, old and altered blood

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12
Q

Hormonal therapy for Endometriosis

A

GnRH - e.g. Goserelin: shut down ovaries temporarily - inducing menopause

Cyclical pain management with - hormonal contraceptives to stop ovulation

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13
Q

symptoms of PELVIC INFLAMMATORY DISEASE

A
  • lower abdo pain
  • fever
  • heavy menstrual bleeding
  • dyspareunia
  • ## mucopurulent vaginal discharge
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14
Q

examination findings in PID

A
  • Cervical excitation
  • inflamed cervix
  • purulent discharge
  • pelvic tenderness
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15
Q

what is Fitz Hugh curtis syndrome?

A

inflammation and infection of the liver capsule (Glisson’s capsule), leading to adhesions between the liver and peritoneum

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16
Q

derm finding due to insulin resistance

A

acathosis nigricans

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17
Q

3 signs of androgen excess

A
  • acne
  • hirstuism
  • oligomenorrhoea
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18
Q

hormonal imbalance seen in PCOS

A

elevated LH

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19
Q

what does abnormal LH/FSH ratio lead to?

A

excess androgens produced by theca cells in ovary

20
Q

criteria used to diagnose PCOS

A

Rotterdam criteria

21
Q

outline Rotterdam criteria

A

2 of 3 :

1) Polycystic ovaries on USS
2) Anovulation/oligoovulation - absent/irregular periods
3) Clinical/biochemical signs of hyperandrogenism

22
Q

gold standard for visualising the ovaries in PCOS

A

Pelvic ultrasound

23
Q

diagnostic criteria for when visualising the ovaries in PCOS

A

12 or more developing follicles in one ovary

or

ovarian volume of more than 10 cm3

24
Q

what is ‘string of pearls’ appearance?

A

the follicles arranged around the periphery of ovary seen on TVUS of PCOS

25
Q

glucose level 2 hours post 75g glucose drink?

  • impaired glucose tolerance
  • diabetes
A

Impaired glucose tolerance: 7.8 - 11.1

Diabetes: > 11.1

26
Q

mechanism of orlistat?

A

lipase inhibitor that stops the absorption of fat in intestines

27
Q

3 options offered by specialist to improve fertility if weight loss fails

A
  • Clomifene
  • Laparoscopic ovarian drilling
  • IVF
28
Q

topical trx of facial hirstuism

A

topical eflornithine

takes 6-8 weeks to see a significant improvement

29
Q

other options for managing hirstuism - offered by specialist

A
  • electrolysis
  • laser hair removal
  • spironolactone
  • finasteride
  • flutamide
  • cyproterone acetate
30
Q

mechanism of spironolactone

A

mineralocorticoid antagonist with anti androgen effects

31
Q

mechanism of finasteride

A

5α-reductase inhibitor that decreases testosterone production

32
Q

management of acne

A

Topical adapalene (a retinoid)

Topical antibiotics (e.g. clindamycin 1% with benzoyl peroxide 5%)

Topical azelaic acid 20%
Oral tetracycline antibiotics (e.g. lymecycline)

33
Q

definition of heavy menstrual bleeding

A

excessive menstrual blood loss which interfers with a woman’s physical, social, emotional QoL

34
Q

Causes of ABNORMAL MENSTRUAL BLEEDING

pneumonic

A

PALMCOEINS

P - polyps
A - Adenomyosis 
L - Leiomyoma/fibroids 
M - Malignancy 
C - Coagulopathy 
O - Ovulatory disrder (PCOS) 
E - Endometrial process
I - Iatrogenic 
N - not yet classified 
S - STD
35
Q

red flag symptoms associated with abnormal menstrual bleeding

A
  • Age > 45
  • persistent intermenstrual bleeding
  • Post coital bleeding
  • Enlarged uterus
  • Pelvic mass
  • Lesion on cervix
  • Post - menopausal bleeding
36
Q

1st, 2nd & 3rd line for heavy menstrual periods in individual requiring contraception

A

1st line = levonorgestrel releasing IUS

2nd line = COCP

3rd line = long acting progestogens (Depo provera)

37
Q

options for managing heavy menstrual bleeding & not requiring contraception

A

Tranexamic acid
or
NSAIDs - mefenamic acid

38
Q

directions for taking tranexamic acid

A

take tablet 3 times a day for up to 4 days

take as soon as your periods start

39
Q

how does mefenamic acid work?

A

reduced bodys production of a prostaglandin & can relieve period pain

40
Q

invasive treatment offered to women no longer wishing to conceive, with menorrhagia

A

Endometrial ablation

- heat to thin the endometrium

41
Q

invasive treatment used to treat menorrhagia caused by fibroids

A

Uterine artery emolization

42
Q

what are fibroids?

A

benign tumours of the smooth muscle of the uterus

43
Q

examination findinds in fibroids

A

Abdominal and bimanual examination may reveal a palpable pelvic mass or an enlarged firm non tender uterus

44
Q

medication that can be used to shrink size of fibroids, prior to surgery

A

GnRH agonists e.g. Goserelin

45
Q

the only treatment known to improve fertility in patients with fibroids?

A

Myomectomy

46
Q

1st line Invx for uterine fibroids

A

Pelvic ultrasound

Obstetrics & Gynae RIA (9 decks)

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