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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
Why does menstruation happen?
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
What 2 layers does separation within the myometrium occur between?
Spongiosum and basalis layers
27
How does oestrogen cause protection of the endometrial surface after menstruation?
causes mucinous layer of carbohydrate secretion from glandular and stromal cells
28
What drug category are NSAIDs and how do they act to decrease menorrhagia?
COX-1 inhibitor that inhibits prostaglandin synthesis
29
What period of your cycle do you usually take NSAIDs to reduce menorrhagia?
Day 1 to end of menstruation
30
What drug category is tranexamic and what is its daily dose?
antifibrinolytic 2-4g/day
31
% of women with mirena coil that are amenorrhoeic within a year?
20%
32
What does IUS secrete into uterus?
Levonogesterel 20mcg for 5 years
33
What drug is contained within the Depo Provera IM injection that reduces menorrhagia?
Medroxyprogesterone
34
Example of an oral progestogen given to reduce menorrhagia?
Norethisterone 5mg TID D5-26
35
What profile of person is not recommended for the cOCP?
over 35, smoker, overweight, heart problems
36
3 types of endometrial ablation options?
TCRE (trans cervical resection of the endometrium), endometrial laser ablation, diathermy rollerball endometrial ablation
37
What second generation ablation methods are there for endometrium removal?
thermal balloon ablation, microwave endometrial ablation, circulating hot saline, cryotherapy
38
When is minor surgery for the treatment of menorrhagia not going to be successful?
Adenomyosis, fibroids or pelvic adhesions present
39
What does oestrogen do in the proliferative stage of cycle?
Develop endometrial lining
40
Main hormone in proliferative and secretory phases
Pro - oestrogen, secret- progesterone
41
Questions to ask in a period history?
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
What are you looking for on general exam of someone with menorrhagia?
anaemia, BMI/height/weight, PCOS - hirtuism, acne, BMI,
43
Investigations and examinations for menorrhagia?
FBC, clotting screen, TFT, transvaginal USS
44
What endometrial thickness would you perform a hysteroscopy and endometrial biopsy?
10mm
45
Dose of mefanamic acid given for menorrhagia?
500mg tds during menstruation
46
Dose of transenamic acid given for menorrhagia?
1g tds during menstruation
47
What pill helps heavy periods?
cOCP
48
What long acting progesterone can be given to reduce periods?
depo provera, implanon
49
What drugs are Zoldak and Prostrap?
Gonadotrophin releasing hormone (used short term)
50
3 ways that fibroids are removed depending on their severity?
transcervical resection, myomectomy, uterine artery embolization

Obs and Gynae (27 decks)

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