Menstrual Disorder Flashcards

1
Q

What are the phases of the ovarian cycle?

A

Follicular phase, ovulation, luteal phase

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2
Q

What happens in the follicular phase of the ovarian cycle?

A

FSH stimulates follicle development and granulosa cells to produce oestrogen
Raising oestrogen and inhibin by dominant follicle inhibits FSH production
Declining FSH levels cause atresia of all but dominant follicle

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3
Q

What happens during ovulation?

A

Prior LH surge

Dominant follicle ruptures and releases oocyte

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4
Q

What happens during the luteal phase of the ovarian cycle?

A

Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation

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5
Q

What are the phases of the endometrial cycle?

A

Proliferative phase, luteal phase, menstruation

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6
Q

What occurs in the proliferative phase of the endometrial cycle?

A

Oestrogen-induced growth of endometrial glands and stroma

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7
Q

What happens in the luteal phase of the endometrial cycle?

A

Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation

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8
Q

What happens during menstruation?

A

Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation

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9
Q

What is the normal duration of the menstruation?

A

Menstrual loss usually lasts for 4-6 days

Flow peaks at day 1-2

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10
Q

What is the normal amount of blood shed during menstruation?

A

<80ml per menstruation = no clots

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11
Q

What is the normal length of a menstrual cycle?

A

Between 21-35 days
Average is 28 day cycle
No IMB or PMB

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12
Q

What can the causes of menorrhagia be split into?

A

Organic and non-organic = non-organic accounts for 50% of cases and is also known as DUB

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13
Q

What are some local disorders that cause menorrhagia?

A

Fibroids, adenomyosis and endometriosis
Endocervical/endometrial polyps
Cervical eversion and endometrial hyperplasia
IUCD and pelvic inflammatory disease
Cervical/uterine cancer or hormone producing tumour
Trauma or AVM

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14
Q

What are some systemic conditions that cause menorrhagia?

A
Hyper/hypothyroidism or adrenal disease
Prolactin disorder, ITP or diabetes
Von Willebrand's disease, liver or renal disease 
Deficiency of factor 2, 5, 7 or 11
Anticoagulants
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15
Q

What conditions associated with pregnancy can cause menorrhagia?

A

Miscarriage, ectopic pregnancy, gestational trophoblastic disease, postpartum haemorrhage

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16
Q

How common is dysfunctional uterine bleeding (DUB)?

A

Accounts for 50% of women with abnormal uterine bleeding = diagnosis of exclusion

17
Q

What is DUB subdivided into?

A

Anovulatory and ovulatory

18
Q

What are the features of anovulatory DUB?

A

Accounts for 85% of all DUB
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women

19
Q

What are the features of ovulatory DUB?

A

More common in women aged 35-45
Regular heavy periods
Due to inadequate progesterone production by corpus luteum

20
Q

What investigations are done for DUB?

A

FBC, cervical smear, TSH, coagulation screen, liver/renal function test, TVUS, endometrial sampling

21
Q

What does TVUS assess?

A

Endometrial thickness

Presence of fibroids and other pelvic masses

22
Q

What are the different methods of endometrial sampling?

A

Pipelle biopsies, hysteroscopically directed, dilatation and curettage

23
Q

What are the non-surgical treatments of DUB?

A

Medical = progesterones, combined oral contraceptive pill, danazol, GnRH analogues, NSAIDs, anti-fibrinolytics, capillary wall stabilisers
Progestogen-releasing IUCD = Mirena IUS

24
Q

What are the surgical treatments of DUB?

A

Endometrial resection/ablation

Hysterectomy

25
Q

What are the types of endometrial resection/ablation?

A

Transcervical endometrial resection (TCER)
Rollerball endometrial ablation (REA)
Bipolar mesh endometrial ablation
Thermal balloon ablation and thermal hydroablation

26
Q

What are the different types of hysterectomy?

A

Sub total hysterectomy
Total abdominal hysterectomy
Vaginal hysterectomy
LASH, LAVH and TLH

27
Q

What are the pros and cons of medical management of DUB?

A

Cheaper, no waiting list, no anaesthetic risk, adverse effects non-permanent, may not be effective, fertility preserved

28
Q

What are the pros and cons of surgical treatment of DUB?

A

More expensive, waiting list, anaesthetic risk present, complications possible, very effective, amenorrhoea occurs with hysterectomy, fertility lost

29
Q

What are the pros and cons of endometrial ablation?

A

Daycase procedure, shorter operating time and recovery, fewer complications, requires cervical smears, needs combined HRT

30
Q

What are the pros and cons of hysterectomies?

A

Major operation, longer operating time and recovery, more complications, no cervical smears needed (for total hysterectomies), oestrogen-only HRT (unless cervix is retained)