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Gynaecology > Menstrual Cycle and its Disorders > Flashcards

Menstrual Cycle and its Disorders Flashcards

1
Q

what is menarche and what does it mean

A

beginning on menstruation, beginning of the end of puberty

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2
Q

what is the average age and normal range for menarche in the western world?

A

9-16, average age 13/14

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3
Q

what hormonal changes occur around 8 years old that lead to the menarche

A

GnRH release increases in frequency leading to steadily increasing oestrogen level from the ovary leading to thelarche, adrenarche and menarche with an accompanying release in GH

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4
Q

what are the stages of the 28 day menstrual cycle

A

days 1-4 menstruation
days 5-13 proliferative phase
days 14-28 luteal/secretory phase

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5
Q

what occurs in days 1-4 of the menstrual cycle

A

endometrium is shed and myometrium contracts

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6
Q

what occurs in days 5-13 of the menstrual cycle

A

GnRH release is increased causing follicular release and development

the most developed follicle releases oestradiol which suppresses FSH

oestradiol release leads to an LH surge which peaks at day 14, also encourages endometrium development

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7
Q

what occurs in days 14-28 of the menstrual cycle

A

day 14 = peak of LH surge = ovulation
corpus luteum releases progesterone
progesterone leads to glandular development of the endometrium

if egg is not fertilised and placenta development is not initiated corpus luteum begins to fail and progesterone /oestradiol production falls causing menstruation

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8
Q

what is the lower normal age limit for menopause

A

40

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9
Q

what is the normal length of time for menses/bleeding

A

1-7 days

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10
Q

what is the normal amount of blood loss in menstruation

A

<80ml

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11
Q

what is the normal range in menstrual cycle lengths

A

23-35 days

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12
Q

what is the definition of menorrhagia

A

> 80ml of blood loss in a 23-35 day cycle lasting <8 days in an appropriately aged woman with an impact in function

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13
Q

what is the aetiology of menorrhagia

A

majority have normal histology and ovulation is not affected, and it is thought to be due to subtle differences in the endometrial fibrinolytic/prostaglandin sensitivity systems

pathologically, fibroids (30%) and polyps (10%)

rarely it is VW disease, hypothyroidism, anticoagulation therapy

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14
Q

what are the clinical features of menorrhagia

A

passing of clots
‘flooding’
symptoms of anaemia

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15
Q

how should you investigate menorrhagia

A 
history + exam 
FBC
TFT/clotting if indicated 
transvaginal USS
biopsy if endometrial thickness >10mm on USS, polyps suspected, >40, non resolving 
hysteroscopy is also an option
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16
Q

how do you treat menorrhagia

A

1st line if not trying to conceive - IUS
if trying to conceive: tranexamic acid (only during bleeding)

2nd line: tranexamic acid IUS fails
NSAIDS (mefanamic acid) - consider gastroprotection
COCP

3rd line
progestogens
GnRH agonists

surgical management
if polyp is found - excise
fibroids = myo/hysterectomy
uterine artery embolisation (for fibroids in women who dont want a hysterectomy)

outside of fibroids hysterectomy may be last resort anyway

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17
Q

what are common causes for irregular cycles/intermenstrual bleeding

A

anovulatory cycles - common in early and late reproductive years

pelvic pathology: fibroids, polyps, adenomyosis, chronic pelvic infection, ovarian cysts

malignancy in older women

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18
Q

what are possible investigations for irregular cycles/intermenstrual bleeding

A

check Hb for anaemia
cervical smear for malignancy
USS (>35, <35 if medical treatment has failed, fibroids and ovarian masses)

biopsy if endometrial thickness >10mm on USS, >40, polyps are suspected or medical management has failed

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19
Q

what is the medical treatment for irregular cycles/intermenstrual bleeding and when is medical treatment considered

A

when there is no anatomical cause considered and patients functioning is impaired

1st line - IUS/COCP

2nd line - Transexamic acid, NSAIDS, progestogens, GnRH agonists

20
Q

whats the surgical treatment for irregular cycles/intermenstrual bleeding

A

same as menorrhagia
if polyp is found - excise
fibroids = myo/hysterectomy
uterine artery embolisation (for fibroids in women who dont want a hysterectomy)

outside of fibroids hysterectomy may be last resort anyway

21
Q

whats the definition of oligomenorrhea

A

> 35 day cycle for more than 6 months

22
Q

what are the most common causes of secondary amenorrhea

A

PCOS
premature menopause
hyperprolactinaemia

23
Q

what is hypothalamic hypogonadism

A

physiological stress (anorexia/excessive exercise) leading to low GnRH release causing amenorrhea

may be a tumour but thats rare

24
Q

how do you treat hypothalamic hypogonadism

A

supportive, hormone replacement via COCP/HRT

25
Q

what is a common cause of hyperprolactinaemia

A

pituitary hyperplasia

benign adenomas

26
Q

how do you treat hyperprolactinaemia

A

dopamine agonists

surgery

27
Q

what is sheehans syndrome

A

severe PPH causing pituitary necrosis and varying degrees of hypopituitarism

28
Q

what is an adrenal cause of amenorrhea/oligomenorrhea

A

congenital adrenal hyperplasia

29
Q

what are some genetic causes of a/oligomenorrhea

A

turners (XO)
gonadal dysgenesis
adrenal insensitivity

30
Q

what are some anatomical causes of oligomenorrhea/amenorrhea

A

imperforate hymen
transverse vaginal septum
cervical stenosis
ashermans syndrome

31
Q

what are causes of post-coital bleeding

A

cervical abrasions
ectropions
cervical cancer
benign polyp

32
Q

how do you investigate post-coital bleeding

A

normal smear = treat any polyp/ectroption with cryotherapy

smear = colposcopy review

33
Q

what is the definition of dysmenorrhea

A

painful menstruation

34
Q

what is the treatment for primary dysmenorrhea

A

NSAIDS/ovulatory suppression (IUS)

35
Q

what would treatment failure in primary dysmenorrhea indicate

A

pelvic pathology

36
Q

what is secondary dysmenorrhea caused by usually

A

pelvic pathology

fibroids
adenomyosis 
endometriosis
PID
ovarian pathology
37
Q

what are the symptoms of secondary dysmenorrhea

A

deep dyspareunia
oligomenorrhea
menorrhagia

38
Q

how should you investigate secondary dysmenorrhea

A

pelvic USS/laporoscopy

39
Q

what is the definition of precocious puberty

A

menstruation in <10 year olds or secondary sexual characteristics for <8 year olds

40
Q

what is the end result of precocious puberty

A

reduced final height

41
Q

what is the aetiology of precocious puberty

A

80% have none

centrally - increased GnRH from tumours/CNS infection, hydrocephalus or hypothyroidism

peripherally - increased oestrogen from adrenal/ovarian tumours, or McCune-Albright syndrome

42
Q

what are features of McCune-Albright syndrome

A

cafe-au-lait spots
precocious puberty
ovarian cysts
bone cysts

43
Q

how do you treat McCune albright syndrome

A

cyproterone acetate (anti-androgenic progestogen)

44
Q

what is premenstrual syndrome (PMS)

A

Psychological, behavioural and physical symptoms experienced by women in the luteal phase of menstruation, usually resolving at the end of menstruation `

45
Q

what is the prevalence of PMS

A

95%

46
Q

what are common symptoms of premenstrual syndrome

A

Tension

Irriability

Aggression

Depression

Loss of control

47
Q

what are treatments for premenstrual syndrome

A

SSRIs are effective

Endometrial ablation

Continuous oral contraceptives

HRT oestrogen patch

GnRH agnoist and add-back oestrogen therapy (pesudomenopause) - only for severe cases

Gynaecology (14 decks)

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