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Reproduction SB > Menstrual Disorder > Flashcards

Menstrual Disorder Flashcards

1
Q

what are the 3 phases of the menstrual cycle

A

Follicular phase
Ovulation
Luteal Phase

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2
Q

what stimulates the ovarian follicle development

A

FSH

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3
Q

what happens in the follicular phase

A

FSH stimulates ovarian follicle development & granulosa cells to produce oestrogens

Rising oestrogen & inhibin by dominant follicles inhibit FSH production

Declining FSH levels cause atresia of all BUT dominant follicle

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4
Q

what happens in the ovulation stage

A

Prior LH surge

Dominant follicle ruptures and releases oocyte

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5
Q

what happens in the luteal phase

A

Formation of corpus luteum

Progesterone production

Luteolysis 14 days post-ovulation [breakdown of corpus luteum]

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6
Q

what are the stages of the endometrial events in the menstrual cycle

A

proliferative phase
luteal phase
menstruation

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7
Q

over what days is the proliferative phase

A

day 5 to 14

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8
Q

what happens in the proliferative phase

A

Oestrogen-induced growth of endometrial glands and stroma

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9
Q

what happens in the luteal phase (endometrial events)

A

Progesterone-induced glandular secretory activity

Endometrial apoptosis and subsequent menstruation

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10
Q

what happens in the menstruation phase

A

Arteriolar constriction and shedding of functional endometrial layer

Fibrinolysis inhibits scar tissue formation

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11
Q

what is normal menstrual loss

A

lasts about 4-6 days
< 80 ml
no clots

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12
Q

what is menorrhagia

A

prolonged and increased menstrual flow

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13
Q

what is metrorrhagia

A

regular intermenstrual bleeding

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14
Q

what is Polymenorrhoea

A

menstruation occurring at < 21 day interval

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15
Q

what is polymenorrhagia

A

increased bleeding and frequent cycles [due to the cycles being shorter]

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16
Q

what is menometrorrhagia

A

prolonged menstruation and intermenstrual bleeding

17
Q

what is amenorrhoea

A

absence of menstruation > 6 months

18
Q

what is Oligomenorrhoea

A

menstruation at intervals of > 35 days

19
Q

how can causes of menorrhagia be split

A

organic
- presence of pathology

non-organic

  • absence of pathology
  • a.k.a dysfunctional uterine bleeding
20
Q

what are some examples of organic cases of menorrhagia

A 
fibroids 
adenomyosis 
endocervical/endometrial polyp
IUCD - copper coil 
PID
endometriosis 
malignancy

Von Willebrand’s disease
ITP Factor II, V, VII and XI deficiency
Anticoagulants

Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Post partum haemorrhage

21
Q

how is a diagnosis of dysfunctional uterine bleeding (DUB) made

A

by exclusions

22
Q

how can causes of DUB be split

A

Anovulatory

Ovulatory

23
Q

what is anovulatory DUB

A

85% of all DUB

Occurs at extremes of reproductive life

Irregular cycle

More common in obese women

24
Q

what is ovulatory DUB

A

More common in women aged 35-45 years

Regular heavy periods

Due to inadequate progesterone production by corpus luteum

25
Q

Ix of DUB

A 
FBC
Cervical smear
TSH
Coagulation screen 
Renal/Liver function tests

Transvaginal ultrasound scan
Endometrial sampling

26
Q

what would you look at in a transvaginal ultrasound scan in a woman being investigated for DUB

A

Endometrial thickness

Presence of fibroids and other pelvic masses

27
Q

Mx of DUB

A

Progestogens

Combined oral contraceptive pill

Danazol

GnRH analogues

NSAID

28
Q

what is Danazol

A

synthetic steroid mainly used for Tx of endometriosis

29
Q

what contraceptive device can also be used as management of DUB

A

Mirena IUS

30
Q

what is the potential surgical management of DUB

A

Endometrial resection/ablation

Hysterectomy
- sub-total or total

31
Q

what is the difference between endometrial ablation and hysterectomy

A

EA

  • day case, shorter op + recovery, fewer complications
  • require cervical smears
  • combined HRT required

Hysterectomy

  • major op, longer op + recovery, more complications
  • no cervical smears
  • oestrogen only HRT required
32
Q

what is a radical hysterectomy

A

complete removal of the uterus, cervix and upper vagina

33
Q

what is a total hysterectomy

A

complete removal of the uterus and cervix

with or without oophorectomy

34
Q

what is a oophorectomy

A

removal of the ovaries

35
Q

what is a subtotal hysterectomy

A

removal of the uterus, leaving the cervix in situ

Reproduction SB (30 decks)

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