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Obs and Gynae > Menorrhagia > Flashcards

Menorrhagia Flashcards

1
Q

How many mls is considered excessive flow?

A

80mls

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2
Q

How long are prolonged menses?

A

over 7 days

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3
Q

what is polymenorrhagia?

A

Bleeding at intervals over or under 21 days

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4
Q

Categories of heavy menstrual bleeding causes?

A

Anatomical, endocrine, coagulation disorders, iatrogenic, chronic disease, idiopathic

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5
Q

6 anatomical causes of menorrhagia?

A

fibroids, polyps, adenomyosis, PID, endometrial hyperplasia, endometrial carcinoma

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6
Q

2 endocrine causes of menorrhagia?

A

hypo/hyper thyroidism, prolactin producing tumour

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7
Q

4 coagulation disorders causing menorrhagia?

A

Von Willebrand disease, coagulopathies, thrombocytopenia, leukaemia

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8
Q

3 chronic diseases causing menorrhagia?

A

Liver disease, renal disease, diabetes

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9
Q

What is the name given to idiopathic menorrhagia?

A

DUB - dysfunctional uterine bleeding

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10
Q

How do you determine the extent of the menorrhagia issue?

A

frequency of periods, length, volume, clots

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11
Q

What would intermenstrual bleeding be indicative of?

A

cervical polyp, cervical cancer (post coital), endometrial polyp/hyperplasia/carcinoma

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12
Q

Painful menstruation leads to what 2 differentials?

A

Adenomyosis, chronic PID

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13
Q

on initial inspection of the vulva before inserting a cuscos speculum what are you looking for?

A

Scarring, hirtuism, dysmorphic features, infection, inflammation, lesions, vaginal discharge, cough related stress incontinence

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14
Q

What do you inspect about the cervix?

A

shape, colour, cervical os, lesions (polyps, warts, tumours), ectropion (bleeding on touch)

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15
Q

What is excitation pain of the cervix a symptom of?

A

PID

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16
Q

What does an enlarged uterus in adolescents indicate?

A

Congenital outflow obstruction leading to haematometra

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17
Q

What features of the uterus are you looking at on palpation?

A

Size, position, shape, fixed or motile, tenderness

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18
Q

What does irregular outlines of the uterus indicate?

A

Fibroids

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19
Q

A tender uterus is indicative of what?

A

Adenomyosis

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20
Q

After manual examination of the patient using a Cusco speculum what other investigations can you undertake to rule out pathology?

A

cervical dilatation and endometrial curettage, hysteroscopy and endometrial biopsy, TVU,

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21
Q

list the 4 investigations that can be performed on the endometrium in order of invasiveness

A

USS, hysteroscopy, biopsy, dilatation and curettage

22
Q

What causes proliferation of endometrium and when does it occur?

A

After menstruation due to influence of oestrogen

23
Q

When does the secretory phase occur?

A

After ovulation with influence of oestrogen and progesterone awaiting embryo

24
Q

Graafian follicle vs corpus luteum

A

Graafian is the developing follicle releasing increasing amounts of oestrogen and then corpus luteum is what remains after ovulation

25
Q

Why does menstruation happen?

A

The corpus luteum starts failing so progesterone and oestrogen levels drop causing spiral arteries to dilate and constrict, endometrium to stasis and become ischaemic

26
Q

What 2 layers does separation within the myometrium occur between?

A

Spongiosum and basalis layers

27
Q

How does oestrogen cause protection of the endometrial surface after menstruation?

A

causes mucinous layer of carbohydrate secretion from glandular and stromal cells

28
Q

What drug category are NSAIDs and how do they act to decrease menorrhagia?

A

COX-1 inhibitor that inhibits prostaglandin synthesis

29
Q

What period of your cycle do you usually take NSAIDs to reduce menorrhagia?

A

Day 1 to end of menstruation

30
Q

What drug category is tranexamic and what is its daily dose?

A

antifibrinolytic 2-4g/day

31
Q

% of women with mirena coil that are amenorrhoeic within a year?

A

20%

32
Q

What does IUS secrete into uterus?

A

Levonogesterel 20mcg for 5 years

33
Q

What drug is contained within the Depo Provera IM injection that reduces menorrhagia?

A

Medroxyprogesterone

34
Q

Example of an oral progestogen given to reduce menorrhagia?

A

Norethisterone 5mg TID D5-26

35
Q

What profile of person is not recommended for the cOCP?

A

over 35, smoker, overweight, heart problems

36
Q

3 types of endometrial ablation options?

A

TCRE (trans cervical resection of the endometrium), endometrial laser ablation, diathermy rollerball endometrial ablation

37
Q

What second generation ablation methods are there for endometrium removal?

A

thermal balloon ablation, microwave endometrial ablation, circulating hot saline, cryotherapy

38
Q

When is minor surgery for the treatment of menorrhagia not going to be successful?

A

Adenomyosis, fibroids or pelvic adhesions present

39
Q

What does oestrogen do in the proliferative stage of cycle?

A

Develop endometrial lining

40
Q

Main hormone in proliferative and secretory phases

A

Pro - oestrogen, secret- progesterone

41
Q

Questions to ask in a period history?

A

Previous cycles, regular, irregular, length of cycle, flow - flooding/clots/double protection/ADL, pregnancies, LMP, any IMB/PCB, dyspareunia, pelvic pain, dysmenorrhoea, discharge, cervical smear, contraception, FH, obstetric, gynae, medical, surgical, DH, allergies, SH

42
Q

What are you looking for on general exam of someone with menorrhagia?

A

anaemia, BMI/height/weight, PCOS - hirtuism, acne, BMI,

43
Q

Investigations and examinations for menorrhagia?

A

FBC, clotting screen, TFT, transvaginal USS

44
Q

What endometrial thickness would you perform a hysteroscopy and endometrial biopsy?

A

10mm

45
Q

Dose of mefanamic acid given for menorrhagia?

A

500mg tds during menstruation

46
Q

Dose of transenamic acid given for menorrhagia?

A

1g tds during menstruation

47
Q

What pill helps heavy periods?

A

cOCP

48
Q

What long acting progesterone can be given to reduce periods?

A

depo provera, implanon

49
Q

What drugs are Zoldak and Prostrap?

A

Gonadotrophin releasing hormone (used short term)

50
Q

3 ways that fibroids are removed depending on their severity?

A

transcervical resection, myomectomy, uterine artery embolization

Obs and Gynae (27 decks)

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