Menstrual Disorder Flashcards
what are the 3 phases of the menstrual cycle
Follicular phase
Ovulation
Luteal Phase
what stimulates the ovarian follicle development
FSH
what happens in the follicular phase
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
what happens in the ovulation stage
Prior LH surge
Dominant follicle ruptures and releases oocyte
what happens in the luteal phase
Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation [breakdown of corpus luteum]
what are the stages of the endometrial events in the menstrual cycle
proliferative phase
luteal phase
menstruation
over what days is the proliferative phase
day 5 to 14
what happens in the proliferative phase
Oestrogen-induced growth of endometrial glands and stroma
what happens in the luteal phase (endometrial events)
Progesterone-induced glandular secretory activity
Endometrial apoptosis and subsequent menstruation
what happens in the menstruation phase
Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation
what is normal menstrual loss
lasts about 4-6 days
< 80 ml
no clots
what is menorrhagia
prolonged and increased menstrual flow
what is metrorrhagia
regular intermenstrual bleeding
what is Polymenorrhoea
menstruation occurring at < 21 day interval
what is polymenorrhagia
increased bleeding and frequent cycles [due to the cycles being shorter]
what is menometrorrhagia
prolonged menstruation and intermenstrual bleeding
what is amenorrhoea
absence of menstruation > 6 months
what is Oligomenorrhoea
menstruation at intervals of > 35 days
how can causes of menorrhagia be split
organic
- presence of pathology
non-organic
- absence of pathology
- a.k.a dysfunctional uterine bleeding
what are some examples of organic cases of menorrhagia
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
how is a diagnosis of dysfunctional uterine bleeding (DUB) made
by exclusions
how can causes of DUB be split
Anovulatory
Ovulatory
what is anovulatory DUB
85% of all DUB
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women
what is ovulatory DUB
More common in women aged 35-45 years
Regular heavy periods
Due to inadequate progesterone production by corpus luteum
Ix of DUB
FBC Cervical smear TSH Coagulation screen Renal/Liver function tests
Transvaginal ultrasound scan
Endometrial sampling
what would you look at in a transvaginal ultrasound scan in a woman being investigated for DUB
Endometrial thickness
Presence of fibroids and other pelvic masses
Mx of DUB
Progestogens
Combined oral contraceptive pill
Danazol
GnRH analogues
NSAID
what is Danazol
synthetic steroid mainly used for Tx of endometriosis
what contraceptive device can also be used as management of DUB
Mirena IUS
what is the potential surgical management of DUB
Endometrial resection/ablation
Hysterectomy
- sub-total or total
what is the difference between endometrial ablation and hysterectomy
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
what is a radical hysterectomy
complete removal of the uterus, cervix and upper vagina
what is a total hysterectomy
complete removal of the uterus and cervix
with or without oophorectomy
what is a oophorectomy
removal of the ovaries
what is a subtotal hysterectomy
removal of the uterus, leaving the cervix in situ
