Menstrual Cycle and Abnormalities Flashcards
1
Q
Menarche
A
- average in Uk is 13y
- investigate <8y or >16 y
- Family history
- Secondary sexual characteristics
2
Q
Menopause
A
- average 51 y
- Any PMB
- Any HRT
- Menopausal symptoms (hot flushes, skin changes, mood)
3
Q
Heavy menstrual bleeding definition
A
Bleeding that has an adverse impact on a womens quality of life
- quantity only used in research
- menorhaggi - old terminology
- most common cause of iron-deficency anaemia in affluent world
4
Q
HMB Causes
A
- Uterine pathology - fibroids, endometrial polyps, adenomyosis, pelvic infection, endometrial cancer
- HMB in absence of uterine pathology (DUB) - anovultory or ovulatory
- medical disorders - clotting disorders
5
Q
Fibroid definition
A
Overgrowth of the myometrium (muscle layer) of the uterus
6
Q
Types of fibroids
A
- Intramural - within the myometrium
- Submucosal - within the myometrium and extending out into the uterine cavity
- subserosal - Within the myometrium and extending out into the surrounding cavity
7
Q
History and investigation of HMB
A
- History and examination (abdominal + bimanual)
- blood tests
- FBC - anaemia?
- Do not routinely measure serum ferritin
- TFTs if indicated
- Coagulation screen - if indicated in history
- Biopsy - IMB in pateints >45 or ineffective treatment
- imaging
- the uterus is palpable abdominally
- Vaginal examination reveals a mass of uncertain origin
- pharmaceutical treatment fails
- ultrasound is the 1st line diagnostic tool for indentifying structural abnormalities
8
Q
Treatment of HMB with pelvic anatomy and normal endometrial histology
A
- No treatment
- Non- hormonal - tranexamic acid or mefanamic acid
- Hormonal - systemic - psuedo-pregnancy
- Hormonal - systemic - pseudo-menopause
- Hormonal - local - mirena IUS
- Hormonal - esyma (progesterone receptor modulator)
- Surgical
9
Q
Non- Hormonal treatment
A
- mefanamic acid
- prostaglandin synthase inhibitor
- take during menses
- Tranexamic acid
- anti-fibrinolytic
- take during menses
10
Q
Hormonal -systemic- Pseudo/Pregnancy
A
- oestrogens
- COCP (can tricycle - take three packs)
- progestogens
- POP
- nexplanon
- local effects
- mirena IUS
11
Q
Hormonal - Pseudo-menopause
A
GNRH analgoues - GNRH is release in a pulsatile manner normally from the hypothalamus, continous levels switch of FSH and LH release from the putuitary
- only licenced for short term use - 6 months
- Improves symptoms and shrinks fibroids by 40%
- May produce psuedo-menopause like symptoms - hot flushes
- improves haemoglobin
- Can be combined with HRT add back for long term use
- adminster by injection
12
Q
Mirena Coil - IUS
A
- useful for
- small fibroids <5mm
- sub-serosal or intramural
- not suitable for cavity distortion
- Progesterone component of HRT
- Contraception
- increases haemoglobin levels
13
Q
Hormonal - Esyma
A
Progesterone receptor modulation
- agonist and antagonistic effects
- works at progesterone receptors only
- Little effect on ovarian function
- act directly on myometrium
- induce amenorrhoea
- shrink fibroids 20-40%
- well tolerated, oral medication
14
Q
Surgical management of HMB
A
- hysteroscopy and resection
- allows evaluation of the uterine cavity
- allows sampling of polyps
- allows resection of small polyp
- outpatient
- myomectomy
- removal of uterine fibroids
- lapartomy/ laparoscopy
- pre-op GNRH or esyma
- fertility sparing option
- uterine artery embolisation
- iterruption of blood supply
- 50% shrinkage
- fertility sparing
15
Q
Endometrial alblation
A
- local or GA
- alblation of endometrium to border with myometrium
- 70-80% satisfication
