Menstrual abnormalities Flashcards
In the menstrual cycle, when do these occur?
- bleeding
- ovulation
- proliferation of endometrium
Bleeding day 1-7
Ovulation day 14
Proliferation day 7-14
Describe the menstrual cycle?
- Hypothalamus releases GnRH which stimulates pituitary to release FSH and LH
- FSH binds to ovaries causing:
- maturation of follicles
- secretion of OE - One follicle will out-compete the rest and the others die, this is the Graafian follicle
- Graafian follicle secretes OE
- OE causes endometrial thickening and initially inhibits LH
- When OE levels get high enough they stimulate LH
- LH levels spike, causing Graafian follicle to release the oocyte (ovulation)
- Oocyte goes into uterus via fallopian tube
- FSH and LH cause empty follicle to become corpus luteum, which releases P.
- P makes endometrium receptive to blastocyst
- Negative feedback of OE, P at hypothalamus cause FSH and LH levels to drop
- This causes degeneration of corpus luteum, so P drops
- Lack of P causes breakdown of endometrium = period
What is the Graafian follicle and the corpus luteum?
What do they produce?
The Graafian follicle is the best follicle out of the ones that mature in the menstrual cycle. Produces OE
The corpus luteum is what is left when the follicle releases the oocyte. It produces P
What’s the normal length of a period and a cycle?
What’s a normal amount of blood loss?
Period 2-8 days
Cycle 21-35 days
Blood loss 60-80ml
What is menorrhagia?
Heavy menstrual bleeding that interferes with the woman’s physical, emotional and social life
What are the causes of menorrhagia?
Most commonly, dysfunctional vaginal bleeding, idiopathic
Fibroids Polyps Adenomyosis Endometriosis Coagulopathy Hypothyroid Cancer (unlikely)
Investigations of menorrhagia?
Does this vary with age?
Bloods: FBC, TFTs, clotting
STI screen
Pregnancy test
If under 45 no more investigations needed, just treat
If they don’t respond to treatment, or are over 45
Transvaginal USS
Endometrial biopsy
Hysteroscopy
What are you looking for on a transvaginal USS of a woman with menorrhagia?
Fibroids
Polyps
Endometrial thickness
Management of women with menorrhagia?
Reassurance
Mirena coil
Drugs:
- Anti-fibrinolytics
- NSAIDs
- Progestagens
- COCP
Surgical:
- ablation
- hysterectomy
How does the mirena coil help treat menorrhagia?
It releases progesterone directly into the uterus
Progesterone thins the endometrium
How does the COCP help treat menorrhagia?
It contains OE
Which inhibits ovarian function, reducing menses volume
What are progestogens, and how do they help treat menorrhagia?
Synthetic version of progesterone
They prevent oestrogen from excessively proliferating the endometrium?
How do NSAIDs help treat menorrhagia?
Give an example of one that’s used.
Reduce volume of menses
And help with pain
Mefenamic acid
What are anti-fibrinolytics and how do they help treat menorrhagia?
Give an example of one.
They inhibit tissue plasminogen activator (which is a protein that breaks down blood clots)
More clotting = lower menses volume
Tranexamic acid
Define primary and secondary amenorrhoea?
Primary: no menarche by 16 years
Secondary: menarche as normal, but then amenorrhoea for 6 months
