Menstrual Disorder Flashcards
how long does the menstrual cycle last
28 days
what happens in the follicular phase
FSH stimulates ovarian follicle development and granulosa cells to produce oestrogen
Raising oestrogen and inhibin by dominant follicles inhibits FSH production
decline in FSH levels causes atresia of non-dominant follicles
what happens in ovulation
In response to LH surge
Dominant follicle ruptures and releases oocyte
what happens in luteal phase
formation of corpus luteum
progesterone production due to LH stimulation
breaks down after 14 days post-ovulation leading to a drop in oestrogen and progesterone and menstration occurring
what is normal menstrual loss
Menstrual loss = 4-6 days
Menstrual flows peaks days 1-2
<80ml per mentration
no clots
what is a normal mentrual cycle timing
Average 28 day cycle
Between 21 to 35 days
No IMB (intermenstrual bleeding) or PCB (post coideal bleeding (after sex))
most common cause of amenorrhoea
pregnancy
most common causes of oligomenorrhoea
polycystic ovary syndrome
what are the two groups of causes of menorrhagia (prolonged and increased menstrual flow)
Organic
-Presence of pathology
Non-organic
- no pathology
- 50% of cases
- also called dysfunctional uterine bleeding
what are organic causes of menorrhagia (need to be pre-menopausal to have menorrhagia)
Local disorders:
- fibroids
- adenomyosis
- endocervical or endometrial polyp
- cervical everyone
- endometrial hyperplasia
- intrauterine contraceptive device
- pelvic inflammatory disease
- endometriosis
- malignancy of the cervix or uterus
- hormone producing tumours
- trauma
what are systemic causes of organic menorrhagia
Endocrine disorders
- hyper/hypothyroid
- diabetes
- adrenal disease
- prolactin disorders
Haemostasis disorders
- Von Willebrand’s
- ITP
- factor II, V, VII and XI deficiency
Liver disorders
Renal disease
Drugs
-anticoagulants
Pregnancy
- miscarriage
- ectopic
- gestational trophoblastic disease
- postpartum haemorrhage
how do you diagnose DUB
Made by exclusion
subdivided into
-anovulatory
-ovulatory
characteristics of anovulatory DUB
85% of all DUB
occurs at extremes of reproductive life
Irregular cycle
More common in obese women
characteristics of ovulatory DUB
more common in women aged 35-45
regular heavy periods
due to inadequate progesterone production by corpus luteum
how do you investigate DUB
Full blood count Cervical smear TSH Coagulation screen Renal/liver function tests Transvaginal ultrasound scan -endometrial thickness -presence of fibroids and other pelvic massses Endometrial sampling -pipell biopsy -hysteroscopic directed -dilatation and curettage
