Menorrhagia Flashcards
How many mls is considered excessive flow?
80mls
How long are prolonged menses?
over 7 days
what is polymenorrhagia?
Bleeding at intervals over or under 21 days
Categories of heavy menstrual bleeding causes?
Anatomical, endocrine, coagulation disorders, iatrogenic, chronic disease, idiopathic
6 anatomical causes of menorrhagia?
fibroids, polyps, adenomyosis, PID, endometrial hyperplasia, endometrial carcinoma
2 endocrine causes of menorrhagia?
hypo/hyper thyroidism, prolactin producing tumour
4 coagulation disorders causing menorrhagia?
Von Willebrand disease, coagulopathies, thrombocytopenia, leukaemia
3 chronic diseases causing menorrhagia?
Liver disease, renal disease, diabetes
What is the name given to idiopathic menorrhagia?
DUB - dysfunctional uterine bleeding
How do you determine the extent of the menorrhagia issue?
frequency of periods, length, volume, clots
What would intermenstrual bleeding be indicative of?
cervical polyp, cervical cancer (post coital), endometrial polyp/hyperplasia/carcinoma
Painful menstruation leads to what 2 differentials?
Adenomyosis, chronic PID
on initial inspection of the vulva before inserting a cuscos speculum what are you looking for?
Scarring, hirtuism, dysmorphic features, infection, inflammation, lesions, vaginal discharge, cough related stress incontinence
What do you inspect about the cervix?
shape, colour, cervical os, lesions (polyps, warts, tumours), ectropion (bleeding on touch)
What is excitation pain of the cervix a symptom of?
PID
What does an enlarged uterus in adolescents indicate?
Congenital outflow obstruction leading to haematometra
What features of the uterus are you looking at on palpation?
Size, position, shape, fixed or motile, tenderness
What does irregular outlines of the uterus indicate?
Fibroids
A tender uterus is indicative of what?
Adenomyosis
After manual examination of the patient using a Cusco speculum what other investigations can you undertake to rule out pathology?
cervical dilatation and endometrial curettage, hysteroscopy and endometrial biopsy, TVU,
list the 4 investigations that can be performed on the endometrium in order of invasiveness
USS, hysteroscopy, biopsy, dilatation and curettage
What causes proliferation of endometrium and when does it occur?
After menstruation due to influence of oestrogen
When does the secretory phase occur?
After ovulation with influence of oestrogen and progesterone awaiting embryo
Graafian follicle vs corpus luteum
Graafian is the developing follicle releasing increasing amounts of oestrogen and then corpus luteum is what remains after ovulation
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
What 2 layers does separation within the myometrium occur between?
Spongiosum and basalis layers
How does oestrogen cause protection of the endometrial surface after menstruation?
causes mucinous layer of carbohydrate secretion from glandular and stromal cells
What drug category are NSAIDs and how do they act to decrease menorrhagia?
COX-1 inhibitor that inhibits prostaglandin synthesis
What period of your cycle do you usually take NSAIDs to reduce menorrhagia?
Day 1 to end of menstruation
What drug category is tranexamic and what is its daily dose?
antifibrinolytic 2-4g/day
% of women with mirena coil that are amenorrhoeic within a year?
20%
What does IUS secrete into uterus?
Levonogesterel 20mcg for 5 years
What drug is contained within the Depo Provera IM injection that reduces menorrhagia?
Medroxyprogesterone
Example of an oral progestogen given to reduce menorrhagia?
Norethisterone 5mg TID D5-26
What profile of person is not recommended for the cOCP?
over 35, smoker, overweight, heart problems
3 types of endometrial ablation options?
TCRE (trans cervical resection of the endometrium), endometrial laser ablation, diathermy rollerball endometrial ablation
What second generation ablation methods are there for endometrium removal?
thermal balloon ablation, microwave endometrial ablation, circulating hot saline, cryotherapy
When is minor surgery for the treatment of menorrhagia not going to be successful?
Adenomyosis, fibroids or pelvic adhesions present
What does oestrogen do in the proliferative stage of cycle?
Develop endometrial lining
Main hormone in proliferative and secretory phases
Pro - oestrogen, secret- progesterone
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
What are you looking for on general exam of someone with menorrhagia?
anaemia, BMI/height/weight, PCOS - hirtuism, acne, BMI,
Investigations and examinations for menorrhagia?
FBC, clotting screen, TFT, transvaginal USS
What endometrial thickness would you perform a hysteroscopy and endometrial biopsy?
10mm
Dose of mefanamic acid given for menorrhagia?
500mg tds during menstruation
Dose of transenamic acid given for menorrhagia?
1g tds during menstruation
What pill helps heavy periods?
cOCP
What long acting progesterone can be given to reduce periods?
depo provera, implanon
What drugs are Zoldak and Prostrap?
Gonadotrophin releasing hormone (used short term)
3 ways that fibroids are removed depending on their severity?
transcervical resection, myomectomy, uterine artery embolization
