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1. Senior Block- O&G > Menstrual Cycle Disorders > Flashcards

Menstrual Cycle Disorders Flashcards

1
Q

At what age should menarche occur?

A

11-13 yrs old

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2
Q

What happens in day 1-4 of a normal, 28 day menstrual cycle?

A

Endometrium shed due to the spiral arteries collapsing and spasming.
Menses occurs

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3
Q

What happens to oestrogen levels in days 5-13 of the menstrual cycle?

A

Rise- causes endometrial lining to develop and follicles to develop in the ovary

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4
Q

Which hormone rises dramatically on day 13 of the cycle to stimulate ovulation?

A

LH

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5
Q

Which hormone is secreted in large amounts in days 15-28 of the menstrual cycle?

A

Progesterone

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6
Q

What happens to the endometrial lining in the secretory phase (days 15-28) of the menstrual cycle?

A

Gains increased blood supply
Swollen glands
Enlarged stromal tissue
(Ready for implantation)

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7
Q

What is the definition of dysfunctional uterine bleeding (DUB)?

A

Any variation from the normal 28 day menstrual cycle.
Eg. post-coital, intermenstrual, post-menopausal, menorrhagia, as well as cycle irregularities (irregular, too long/short)

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8
Q

Give 4 structural causes of dysfunctional uterine bleeding?

A 
PALM
Polyps
Adenomyosis
Leiomyomas (fibroids)
Malignancy + hyperplasia
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9
Q

Give 4 non-structural causes of dysfunctional uterine bleeding?

A 
COEIN
Coagulopathy
Ovulatory dysfunction 
Endometrial- primary disorder of endometrial haemostasis
Iatrogenic
Not yet specified
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10
Q

What is the objective definition of menorrhagia?

A

Loss of >80ml of blood per menstrual cycle

Normal 37-43ml

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11
Q

What is the clinical definition of menorrhagia?

A

Excessive menstrual blood loss which interferes with physical, social or emotional quality of life.

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12
Q

Give 6 causes of menorrhagia?

A 
Fibroids
Endometriosis
Adenomyosis
Polyps
Uterine cancer
Ovarian cancer
Diabetes
IUD
Von Willebrands
Anticoagulation medications
Hypothyroidism
SLE
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13
Q

What symptoms is it good to ask about to confirm menorrhagia?

A

Passing large blood clots
Regularly changing sanitary products
Flooding
Symptoms of anaemia

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14
Q

What investigations is it important to do in menorrhagia?

A

FBC
TVUS –> endometrial lining thickness
Hysteroscopy +/- endometrial biopsy

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15
Q

What is the 1st line medical management of menorrhagia?

A

Mirena coil

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16
Q

What is the 2nd/3rd line medical management of menorrhagia?

A

2nd:
Tranexamic acid
NSAIDs
COCP

3rd:
Progesterones
GnRH analogues

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17
Q

How can menorrhagia be managed surgically?

A

Endometrial ablation
Hysterectomy
Surgically treat cause eg. fibroid removal

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18
Q

What is the definition of irregular menstrual bleeding?

A

Bleeding between periods or irregular cycles

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19
Q

Give 3 potential causes of irregular menstrual bleeding

A 
Anovulatory cycle- no ovulation 
Fibroids
Polyps
Adenomyosis
Ovarian cysts
Gynaecological cancers
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20
Q

How is irregular menstrual bleeding investigated?

A

FBC
Cervical smear
USS
Endometrial biopsy

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21
Q

How is irregular menstrual bleeding managed?

A

IUS
COCP
Progestogens
Surgical options- endometrial ablation, hysterectomy

22
Q

What is the definition of primary amenorrhoea?

A

Menstruation has not started at age 16

23
Q

What is the definition of secondary amenorrhoea?

A

Menstruation has stopped for >3 months

24
Q

What is the definition of oligomenorrhea?

A

Menstruation only occurs once every 35 days to 6 months

25
Q

Give 6 potential causes of primary amenorrhoea

A 
Constitutional delay (delayed puberty) 
Hypothalamic 
Hypogonadism 
Hyperprolactinemia
Hypo/hyperthyroidism 
Adrenal tumours 
Adrenal hyperplasia
PCOS
Premature ovarian failure
Turner's syndrome 
Androgen insensitivity
Imperforate hymen 
Transverse vaginal septum
26
Q

Give 6 potential causes of secondary amenorrhoea

A 
Pregnancy
Menopause
Lactation 
Drugs- Progestogens, Antipsychotics
Hypothalamic
Hypogonadism 
Hyperprolactinemia
Hypo/hyperthyroidism
Adrenal tumours
PCOS
Premature ovarian failure
Cervical stenosis
Asherman's syndrome
27
Q

What is the definition of post-coital bleeding?

A

Bleeding following intercourse that is not normal menstrual loss.

28
Q

Give 3 causes of post-coital bleeding

A

Cervical carcinoma
Cervical ectropion
Cervical polyps
Cervicitis

29
Q

How is post-coital bleeding managed?

A

Cervical smear
Treat obvious cause eg. ectropion
Colposcopy
Histology

30
Q

What is the definition and cause of dysmenorrhoea?

A

Painful menstruation.

Due to high prostaglandin levels in the endometrium secondary to contraction and uterine ischaemia

31
Q

What is primary dysmenorrhoea?

A

No organic cause found. Often occurs at the start of menstruation and is very common.

32
Q

How is primary dysmenorrhoea managed?

A

NSAIDs
COCP
Reassurance to young patients

33
Q

What is secondary dysmenorrhoea?

A

Pain due to pelvic pathology. Pain precedes menstruation and is relieved by the start of menstruation.

Occurs alongside deep dyspareunia, menorrhagia and irregular periods.

34
Q

What are the main causes of secondary dysmenorrhoea?

A 
Fibroids
Adenomyosis
Endometriosis
PID
Ovarian tumours
35
Q

What is the definition of precocious puberty?

A

Menstruation occurs before the age of 9

36
Q

Give 2 potential pathological mechanisms for precocious puberty

A

Increased GnRH secretion (meningitis, encephalitis, CNS tumours, hydrocephaly)

Increased oestrogen secretion (hormone producing tumours of ovary or adrenal gland)

37
Q

How is precocious puberty managed?

A

GnRH analogue
Removal of tumours
Anti-androgenic progestogen

38
Q

What is the definition of premenstrual syndrome?

A

Psychological, behavioural and physical symptoms experienced on a regular basis when in the luteal phase of menstruation

39
Q

Give 5 clinical features of PMS

A 
Bloating
GI upset
Tender breasts
Headaches 
Spots
Altered sex drives
Altered appetites
Trouble sleeping 
Mood swings
Emotional 
Irritable
Depressed 
Aggressive
40
Q

How can PMS be managed conservatively?

A 
Regular exercise
Healthy diet
No smoking 
7-8hrs sleep
Reduce stress
Reduce alcohol 
Evening primrose oil
41
Q

How can PMS be managed medically?

A 
SSRIs
COCP
GnRH analogues
NSAIDs
Vitamin B6
CBT- psychological help
42
Q

What is the definition of Polycystic Ovary Syndrome?

A

Polycystic ovaries are defined as having 12 or more 2-8mm follicles on an enlarged ovary seen on a transvaginal ultrasound.

Need 2/3 criteria:

  • PCO on USS
  • Irregular periods (>35 days apart)
  • Hirsutism (increased testosterone/clinically)
43
Q

Give 3 risk factors for PCOS

A 
Genetic
Family Hx
Increased stress
Insulin resistant
Obesity
COCP use
FHx of diabetes
44
Q

What is the suggested pathophysiology of COCP?

A

High levels of insulin are known to make the ovaries produce excess testosterone. This interferes with follicle development and normal ovulation. High levels of LH also affect normal ovulation.

45
Q

Give 10 clinical features of PCOS

A 
Thinning hair 
Poor eyesight 
Depression 
Oily skin 
Dry eyes
Unwanted facial hair (hirsutism)
Insomnia 
Fatigue
Anxiety 
Deeper voice
Skin tags
Obesity
Cramping pains
Decreased libido 
Irregular periods
Miscarriages
46
Q

Give 4 long term complications of PCOS

A 
Infertility 
Type II diabetes 
Depression 
Sleep apnoea 
High BP 
High cholesterol 
Endometrial cancer
Ovarian enlargement
47
Q

How is PCOS investigated?

A 
Bloods: 
LH (raised) 
FSH (normal) 
AMH (raised) 
Testosterone (raised) 
TSH 
Fasting glucose 
Cholesterol screen

Transvaginal ultrasound- string of pearls appearance

48
Q

How is PCOS managed medically?

A

COCP= regulates menstruation, reverses hursuitism
Metformin= restores ovulation, reduces insulin levels
Cyproterone acetate= blocks effects of testosterone
Spironolactone= blocks effects of testosterone
Eflornithine cream= topical antiandrogen

49
Q

How is PCOS managed surgically?

A

Laparoscopic ovarian diathermy

50
Q

How can fertility be increased in PCOS?

A

Clomiphene- anti-oestrogen in hypothalamus and pituitary

Gonadotropins- injection of LH and FSH

51
Q

What are the increased complications of PCOS in pregnancy?

A

Hypertension
Preeclampsia
Gestational diabetes
Miscarriage

1. Senior Block- O&G (11 decks)

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