Menstrual Cycle And Disorders Flashcards
What investigations are necessary in menorrhagia?
Haemoglobin - anaemia
Coagulation and TFTs
Transvaginal ultrasound for anatomical causes
If thick endometrium (>4mm) on USS- biopsy
Consider hysteroscopy and biopsy
What are the causes of menorrhagia?
Unexplained: dysfunction uterine bleeding
Systemic;
Thyroid disease
Clotting disorder
Anticoagulant therapy
Anatomical: Fibroids Uterine/cervical polyps Adenomyosis Endometriosis Chronic pelvic infection Ovarian tumours Endometrial cancer Cervical cancer
How is menorrhagia managed medically?
Medical:
Antifibrinolytics- tranexamic acid taken during menstruation
NSAIDs- inhibit prostaglandins and reduce blood loss
COCP - induces lighter menstruation
IUS
GNRH agonist
Progestogen
How is menorrhagia managed surgically?
Hysteroscopic:
Polyp removal
Endometrial resection, ablation diathermy
Radical:
Myomectomy of fibroid- often Gnrh agonist first to reduce size
Hysterectomy - last resort
What are causes of post menopausal bleeding?
Atrophic vaginitis - due to low oestrogen Endometrial hyperplasia Endometrial polyps Endometrial malignancy Cervical malignancy Uterine sarcoma
What is primary amenorrhoea?
When menstruation has not started by the age of 16
What is secondary amenorrhoea?
When previously normal menstruation ceases for 6 or more months
What is oligomenorrhoea?
When menstruation occurs less frequently than every 35 days
What outflow tract problems may cause amenorrhoea?
Imperforate hymen or transverse vaginal septum - these obstruct menstrual flow which accumulates in vagina (haematocolpos) or the uterus (haematometra)
Androgen insensitivity
Mullerian a genesis- congenital absence of vagina/uterus
Cervical stenosis
Ashermans syndrome - excessive curretage results in adhesions
What is primary dysmenorrhea?
Painful menstruation when no cause can be found
Usually coincides with the start of menstruation and is very common
Treat with NSAIDs, GTN patch or COCP to suppress ovulation
What is secondary dysmenorrhea ?
Painful menstruation in the presence of an identifiable pathologic cause
Often associated with pathology such as endometriosis, fibroids, or iatrogenic, such as IUD insertion or LLETZ
What are causes of dysmenorrhea ?
Endometriosis Adenomyosis PID Intrauterine adhesions Cervical stenosis
What are symptoms of PMS?
Bloating Cyclic weight gain Mastalgia Cramps Fatigue Headache Depression Irritability
What criteria need to be met to diagnose PMS?
Symptoms are cyclic and occur only during the luteal phase
Symptoms increase in severity as the cycle progresses
Symptoms are absent by day 3 of period
There must be a PMS free period of at least 7 days
Symptoms interfere with daily activities
How is secondary dysmenorrhea treated?
Hot water bottle TENs machine NSAIDs COCP Depo provera (progestogens)
Refractory treated with laparoscopic uterosacral nerve ablation
