Menstrual disorder Flashcards
What stimulates FSH and LH release?
GnRH
Effects of FSH secretion
Stimulates follicular development, and stimulates granulosa cells to secrete oestrogen
What effect does oestrogen secretion have on FSH in the follicular phase and what is the consequence of this?
Negative feedback. Causes atresia of all but the dominant follicle
What causes ovulation?
LH surge
Main hormone secreted by the corpus luteum
Progesterone
When does luteolysis occur and what happens as a result of this?
Around 14 days post ovulation; causes menstruation to begin
Menorrhagia
Prolonged and increased menstrual blood loss
Increased bleeding and frequent cycle
Polymenorrhagia
Amenorrheoa
Absence of menstruation for more than 6 months
Oligomenorrhoea
Menses at intervals of more than 35 days
Causes of organic menorrhagia (local) (6)
Fibroids IUCD Pelvic inflammatory disease Endometriosis Tumours Adenomyosis
What is adenomyosis?
Presence of glandular tissue within the myometrium
Systemic causes of menorrhagia (2)
Hypothyroidism
Disorders of haemostasis
Pregnancy related causes of menorrhagia (2)
Miscarriage
Ectopic pregnancy
What is dysfunctional uterine bleeding?
Heavy and/or abnormal bleeding in absence of known pathology
Two subtypes of DUB
85% anovulatory- extremes of reproductive life.
15% ovulatory- regular heavy periods due to inadequate secretion by corpus luteum
Specific investigations in menorrhagia
FBC Cervical smear TSH Coagulation Transvaginal ultrasound Endometrial sampling
First-line medical therapy for DUB
Mirena (IUS)
Second-line medical therapy for DUB (3)
Combined oral contraceptive
Antifibrinolytics
Antiprostaglandins
Tranexamic acid is an example of a…
Antifibrinolytic
Mefanamic acid is an example of a
Antiprostaglandin
Third-line medical therapy for DUB
GnRH analogues
Surgical management of DUB (2)
Endometrial resection/ablation
Hysterectomy
Physiological causes of amenorrhoea? (4)
Pregnancy
Lactation
Menopause
Pre-menarche
Hypothalamic cause of amenorrhoea?
Anorexia
Pituitary causes of amenorrhoea? (2)
Pituitary adenoma (non-functioning) Prolactinoma
Ovarian causes of amenorrhoea? (2)
Premature ovarian failure
Polycystic ovarian syndrome
Criteria for the diagnosis of polycystic ovarian syndrome? (3)
Two out of:
Polycystic ovaries on imaging (pelvic ultrasound)
Oligo- or amenorrhoea
Biochemical or symptomatic evidence of androgen excess
Why should some form of progesterone be prescribed for patients with PCOS? What form can this take?
Unopposed high levels of oestrogen predispose to endometrial cancer
Mirena IUS
COCP (if not contraindicated)
Three-monthly medroxyprogesterone to induce a withdrawal bleed
