Menstrual Disorder Flashcards
FSH stimulates ______ ______ development & ______ cells to produce oestrogen
FSH stimulates ovarian follicle development & granulosa cells to produce oestrogen
Raising oestrogen & inhibins by dominant follicles inhibit ___ production
Raising oestrogen & inhibins by dominant follicles inhibit FSH production
Declining FSH levels cause ____ of all but dominant follicle
Declining FSH levels cause atresia of all but dominant follicle
Describe ovulation
Prior LH surge, dominant follicle ruptures and releases oocytes
Describe the luteal phase
Formation of corpus lute
Progesterone production
When does luteolysis occur?
14 days post-ovulation
Describe the proliferative phase
Oestrogen-induced growth of endometrial glands and stroma
Describe the luteal phase
- Progesterone-induced glandular secretory activity
- Decidualisation in late secretory phase
- Endometrial apoptosis and subsequent menstruation
Describe menstruation
Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation
What is a normal level of menstrual loss?
Usually lasts 4-6 days
Menstrual flow peaks day 1-2
<80 ml per menstruation
No clots
What is a normal menstrual cycle?
Average 28 day cycle
Between 21 to 35 days cycle
No IMB or PCB
Define menorrhagia
Prolonged and increased menstrual flow
Define metrorrhagia
Regular intermenstrual bleeding
Define polymenorrhoea
menses occurring at a <21 day interval
Define menometrorrhagia
Prolonged menses and intermenstrual bleeding
Amenorrhoea
Absence of menstruation > 6 months
Oligomenorrhoea
Menses at intervals of > 35 days
What are the two categories of menorrhagia?
Organic
Non-organic
What is non-organic menorrhagia also known as?
Dysfunctional uterine bleeding
What are the causes of local organic menorrhagia
Local disorders
- fibroids
- adenomyosis
- endocervical or endometrial polyp
- cervica eversion
- endometrial hyperplasoa
- IUCD
- PID
- endometriosis
- malignancy of cervix or uterus
- hormone producing tumours
- trauma
- AV malformation
What are the causes of systemic organic menorrhagia
Endocrine disorders Disorders of haemostasis Liver disorders Renal disease Drugs
What endocrine disorders cause menorrhagia?
Hyper/hypothyroidism
Diabetes mellitus
Adrenal disease
Prolactin disorders
What disorders of haemostats cause menorrhagia?
Von willebrand’s disease
ITP
Factor II, V, VII and XI
Which drugs cause menorrhagia?
Anticoagulants
What complications of pregnancy cause menorrhagia?
Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
postpartum haemorrhage
What is Dysfunctional uterine bleeding divided into?
Anovulatory (85%)
Ovulatory
When does anovulatory DUB occur
Extremes of reproductive life
When does ovulatory DUB occur?
Women aged 35-45 years
What causes ovulatory DUB?
Inadequate progesterone production
What investigation should be done for DUB?
- FBC
- cervical smear
- TSH
- Coagulation screen
- renal/liver function tests
- transvaginal ultrasound
> endometrial thickess
> fibroids and other pelvic masses
-endometrial sampling
>pipette biopsies
hysteroscopic directed
dilatation and curettage (D &C)
What is the non-surgical management of DUB?
Medical
- progestogens
- COCP
- Danazol
- GnRH
- NSAIDs
- Anti-fibrinolytics
- capillary wall stabilisers
Progestogen-releasing IUCS
- mirena IUS
What is the surgical management of DUB?
Endometrial resection/ablation
Hysterectomy
