Menstrual Cycle Disorders Flashcards
- What does continuous administration of exogenous progestogens result in in terms of the cycle?
Results in the maintenance of a secretory endometrium therefore delaying mensuration (surely its important to let it go at some point?)
The acronym for the main categories of causes of AUB?
PALM-COEIN:
What does the PALM side refer to?
Structural causes diagnosed on imaging/biopsy.
What does the COEIN side refer to?
Underlying medical disturbances resulting in AUB. Essentially non-structural causes.
PALM stands for?
Polyps; Adenomyosis; Leiomyomas (fibroids; submucosal or other); Malignancy and hyperplasia
COEIN stands for?
Coagulopathy; Ovulatory dysfunction; Endometrial (i.e. disorder of mechanisms that stop local bleeding); Iatrogenic or, Net yet specified
Most common cause of HMB that is usually found with a patient?
Most have no histological issue so may result from abnormalities of haemostasis, or prostaglandin levels. Usually ovulatory cycles (in comparison to irregular)
HMB: When a pathology is found what is the most common types?
Fibroids (30%) and polyps (10%)
What investigations would you want to do to assess heavy menstrual bleeding?
FBC Hb - for anaemia; Thyroid function & coagulation - for systemic causes (if suggestive); Transvaginal ultrasound (TVU) for local structures
HMB: When should you consider an endometrial biopsy?
Age >40, HMB unresponsive to medical therapy, HMB w/ IMB, RFs for endometrial cancer, or if TVU suggests.
What are some RFs in younger women for endometrial cancer?
Obesity, diabetes, nulliparity, PCOS. (basically unopposed oestrogen increases risk)
What are most common causes of IMB/irregular
Either anovulatory cycles (esp after menarche and before menopause) and pelvic pathology (non-malignant: poplyps, fibroids, adenomyosis, cysts and chronic pelvic infection OR malignant: ovarian/cervical and esp endometrial)
Ix for IMB & irregular menstruation?
FBC Hb; then exclude malignancy: smear, TVU for over 35s (& in younger if Tx failed)… then same reasons to take an endometrial biopsy if indicated.
Mx 1st line for IMB/irregular
IUD or COCP. plus second line options like for HMB or including progestogens to simulate a normal cycle via on and off.
What are some general categories that can be used to classify causes of amenorrhoea?
Either physiological (i.e. pregnancy etc) Pathological (HPA axis, thyroid, ovary, uterus) drugs (such as progestogens, GnRH analogues)
3 most common pathological causes of 2ndry amenorrhoea/oligomenorrhoea?
- Premature menopause 2. PCOS 3. Hyperprolactinaemia
What are some causes of postcoital bleeding?
Cervical carcinoma/ectropion/polyps. Or cervicitis, vaginitis. (basic cause is cervix not being covered in healthy squamous epithelium)
Definition of precocious puberty?
Menstruation occurs before 9. Usually no pathological cause. Use GnRH agonists.
So in summary the causes of HMB vs irregular bleeding are usually?
HMB: usually ovulatory. No actual pathology. (maybe anatomical)
Irregular: often anovulatory; PCOS (sometimes anatomical)
Summarise the investigations for menstrual disorders
FBC, TVU.
If IMB, >40, thickened endometrium or risk factors for endometrial cancer +- endometrial biopsy (w/ hysteroscopy)
Summarise the investigations for menstrual disorders
FBC, TVU.
If IMB, >40, thickened endometrium or risk factors for endometrial cancer +- endometrial biopsy (w/ hysteroscopy)
So the 3 phases are? And which is always the same length?
Menstrual, proliferative (oestrogen) and secretory (always 14 days for egg to travel and corpus luteum alive)
First line for HMB (vs IMB)
Heavy will be the coil as very effective w/ fewer side effects (compared to either for IMB)
What are we worried about in HMB and so what do we do if they are old enough?
Worried about endometreosis. So pipelle biopsy if > 40. Or if they have RFs for endometrial cancer or HMB + IMB
