menstrual cycle and disorders Flashcards
normal limits for:
1) frequency of menses
2) regularity
3) duration of bleeding
4) volume
1) 24-38d
2) <7-9 days
3) <8d
4) a volume of blood that does not interfere with a woman’s life
what is abnormal uterine bleeding
Any variation from the parameters of a normal menstrual cycleconstitutes abnormal uterine bleeding (AUB)
what is intermenstrual bleeding?
When AUB occurs between well-defined cyclical menses, the symptom is called intermenstrual bleeding (IMB)
what is post coital bleeding
Non-menstrual genital tract bleeding immediately (or shortly after) intercourse is called post coital bleeding (PCB)
define heavy menstrual bleeding
The National Institute for Care and Excellencedefines heavy menstrual bleeding(HMB) as excessive menstrual blood loss (MBL) that interferes with the physical, social, emotional and/or material quality of life
The classic objective criteria of blood loss >80 mL/cycle
what is classified as infrequent menses
> 38days
what is classified as frequent menses
<24d
3 physiological causes of amenorrhoea
pregnancy
lactation
menopause
causes of abnormal uterine bleeding (PALM COEIN)
Structural: Polyps- endometrial or cervical Adenomyosis Leiomyoma Malignancy or premalignancy
Non-structural:
Coagulopathy e.g. thrombocytopenia
Ovulatory function disorders e.g. PCOS, CAH, Cushing’s disease
Endometrial disorders e.g. endometriosis
Iatrogenic e.g. COCP
Non-structural rare causes e.g. AV malformation
Ix for abnormal uterine bleeding
Full blood count Cervical smear Pelvic ultrasound Pelvic infection screening (genital tract swab testing) Hysteroscopy and biopsy MRI
5 symptoms of gynae cancer
PCB PMB IMB Pelvic mass cervix lesion
when do you need to get an endometrial biopsy?
persistent IMB
>45 with treatment failure
irregular bleeding while on HRT or tamoxifen
2 causes of enlarged uterus
fibroids
adenomyosis
define polyp
Endometrial polyps are localised hyperplastic overgrowths of endometrial glands and stroma which form projections over the endometrial surface.
symptoms of polyps
Dysmenorrhoea PCB Menorrhagia- increases surface area of endometrium Irregular bleeding IMB Infertility- problems with implantation
define adenomyosis
Adenomyosis is the presence of endometrial glands and stroma in the myometrium. It causes heavy, painful periods.
define fibroids
Uterine fibroids are smooth muscle tumours of the uterus
tx of heavy menstrual bleeding and fibroids
contraceptive tranexamic acid and NSAIDs hysteroscopic myomectomy uterine artery ablation Hysterectomy
what is endometrial hyperplasia
Endometrial hyperplasia is defined as a proliferation of glands of irregular size and shape with an increase in the glands/stroma ratio. Atypical hyperplasia progresses to carcinoma in 23% of cases over a mean duration of 4 years
4 causes of primary amenorrhoea
Gonadal dysgenesis (43%)
Mullerian agenesis (15%)
Constitutional (14%)
PCOS (7%)
3 causes of secondary amenorrhoea
40% ovarian in origin
35% hypothalamic in origin
5% uterine in origin.
causes of secondary amenorrhoe
PCOS POF Hyperprolactinaemia weigh related hypogonadotrophic hypogonadism hypopituitarism exercise related
Ix for amenorrhoea
Exclude Pregnancy FSH, LH levels Prolactin, TFTs Testosterone, SHBG, Free androgen index, DHEAS levels TA USS/ TVUS/ MRI Hysteroscopy Karyotyping
