Menstrual abnormalities Flashcards
Questions to ask in history of abnormal uterine bleeding
pregnancy
age
nature of bleeding - menstrual, non-menstrual
intermenstrual/post-coital bleeding
severity
related sx - pelvic pain, pressure, dyspareunia
cyclicity of symptoms
fertility
smear test
personal or family hx coagulation disorders
FH gynae cancer
When are smear tests offered?
women 25-65y
every 3 years 25-50
every 5 years 50-65
Red flag features uterine bleeding
persistent intermenstrual bleeding
>45y treatment failure
post-coital bleeding
post-menopausal bleeding (bleeding after periods stopped >1y)
pelvic mass
suspicious cervix
PALM-COEIN causes of abnormal uterine bleeding
Polyp - endometrial, cervical
Adenomyosis
Leiomyoma (fibroid)
Malignancy + hyperplasia
Coagulopathy
Ovulatory dysfunction - PCOS, CAH, hypothyroidism, Cushing’s, hyperprolactinaemia
Endometrial
Iatrogenic - tamoxifen, COCPs, IUD
Not yet classified
Difference between polyp and fibroid?
polyp = arise from inner lining of uterus
fibroid = arise from muscular layer of uterus
Who are fibroids more prevalent in?
afro-caribbean
nulliparity
What hormones are fibroids dependent on?
oestrogen
Fibroids symptoms
gynae - abnormal uterine bleeding, heavy menstrual bleeding, pelvic pain, dyspareunia, pelvic/abdominal mass
anaemia due to heavy bleeding
obstetric - infertility, miscarriage, abdo pain, preterm labour, malpresentation, caesarean section, postpartum haemorrhage
compression of organ symptoms
What is red degeneration of fibroids?
Red degeneration of fibroids, also known as carneous degeneration, is a rare type of fibroid degeneration, primarily occurring during pregnancy, where a fibroid undergoes hemorrhagic infarction and necrosis due to disrupted blood supply, leading to severe abdominal pain
Natural history of fibroids
tend to grow until menopause
shrink after
remain in uterus as calcified lesions
may outgrow own blood supply - degeneration, acute pain
Fibroids complications
hyaline degeneration
red degeneration in pregnancy
calcification (‘womb stone’)
sarcomatous (malignant) change
infection
torsion of pedunculated fibroids
When is conservative treatment of fibroids indicated
requires fertility
asymptomatic
pregnant
menopause approaching
small fibroids
Conservative management of fibroids
treat menorrhagia - NSAID, progesterones
GnRH analogue shrinkage of fibroids
Permanent fibroid treatment
hysteroscopic surgery/resection of polyps
laparoscopic ablation/myomectomy
embolisation of uterine arteries
abdominal myomectomy
hysterectomy
Define endometrial hyperplasia
proliferation of glands of irregular size and shape with an increase in glands/stroma ratio
Endometrial hyperplasia risk factors
obesity
diabetes
hypertension
unopposed oestrogen
nulliparity
PCOS
tamoxifen
Management of endometrial hyperplasia without atypia
identify reversible risk factors and manage
majority will regress spontaneously
progesterone increases regression - oral/IUS
treatment minimum 6 months
6 monthly biopsy surveillance until 2 negative biopsies
Management of heavy menstrual bleeding
treat anaemia
fertility management
manage associated sx eg. pain, pressure
remove polyps
remove fibroids if entering uterine cavity
Medical management of heavy menstrual bleeding
LNG-IUS (levonorgestrel) if not planning pregnancy
for at least 6 months
Tranexamic acid MOA
anti-fibrinolytic
Define amenorrhoea
absence or abnormal cessation of menses
Physiological causes of amenorrhoea
pre-puberty
pregnancy
menopause
Define primary amenorrhoea
amenorrhoea in girls up to 14 who have no secondary sexual characteristics
or when a patient has not reached menarche by age of 16 in the presence of normal secondary sexual characteristics
Define secondary amenorrhoea
when menses have ceased for longer than 6 months without any physiological reason
