Menstrual Disorder Flashcards
What are the phases of the ovarian cycle?
Follicular phase, ovulation, luteal phase
What happens in the follicular phase of the ovarian cycle?
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
What happens during ovulation?
Prior LH surge
Dominant follicle ruptures and releases oocyte
What happens during the luteal phase of the ovarian cycle?
Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation
What are the phases of the endometrial cycle?
Proliferative phase, luteal phase, menstruation
What occurs in the proliferative phase of the endometrial cycle?
Oestrogen-induced growth of endometrial glands and stroma
What happens in the luteal phase of the endometrial cycle?
Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation
What happens during menstruation?
Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation
What is the normal duration of the menstruation?
Menstrual loss usually lasts for 4-6 days
Flow peaks at day 1-2
What is the normal amount of blood shed during menstruation?
<80ml per menstruation = no clots
What is the normal length of a menstrual cycle?
Between 21-35 days
Average is 28 day cycle
No IMB or PMB
What can the causes of menorrhagia be split into?
Organic and non-organic = non-organic accounts for 50% of cases and is also known as DUB
What are some local disorders that cause menorrhagia?
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
What are some systemic conditions that cause menorrhagia?
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
What conditions associated with pregnancy can cause menorrhagia?
Miscarriage, ectopic pregnancy, gestational trophoblastic disease, postpartum haemorrhage
How common is dysfunctional uterine bleeding (DUB)?
Accounts for 50% of women with abnormal uterine bleeding = diagnosis of exclusion
What is DUB subdivided into?
Anovulatory and ovulatory
What are the features of anovulatory DUB?
Accounts for 85% of all DUB
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women
What are the features of ovulatory DUB?
More common in women aged 35-45
Regular heavy periods
Due to inadequate progesterone production by corpus luteum
What investigations are done for DUB?
FBC, cervical smear, TSH, coagulation screen, liver/renal function test, TVUS, endometrial sampling
What does TVUS assess?
Endometrial thickness
Presence of fibroids and other pelvic masses
What are the different methods of endometrial sampling?
Pipelle biopsies, hysteroscopically directed, dilatation and curettage
What are the non-surgical treatments of DUB?
Medical = progesterones, combined oral contraceptive pill, danazol, GnRH analogues, NSAIDs, anti-fibrinolytics, capillary wall stabilisers
Progestogen-releasing IUCD = Mirena IUS
What are the surgical treatments of DUB?
Endometrial resection/ablation
Hysterectomy
What are the types of endometrial resection/ablation?
Transcervical endometrial resection (TCER)
Rollerball endometrial ablation (REA)
Bipolar mesh endometrial ablation
Thermal balloon ablation and thermal hydroablation
What are the different types of hysterectomy?
Sub total hysterectomy
Total abdominal hysterectomy
Vaginal hysterectomy
LASH, LAVH and TLH
What are the pros and cons of medical management of DUB?
Cheaper, no waiting list, no anaesthetic risk, adverse effects non-permanent, may not be effective, fertility preserved
What are the pros and cons of surgical treatment of DUB?
More expensive, waiting list, anaesthetic risk present, complications possible, very effective, amenorrhoea occurs with hysterectomy, fertility lost
What are the pros and cons of endometrial ablation?
Daycase procedure, shorter operating time and recovery, fewer complications, requires cervical smears, needs combined HRT
What are the pros and cons of hysterectomies?
Major operation, longer operating time and recovery, more complications, no cervical smears needed (for total hysterectomies), oestrogen-only HRT (unless cervix is retained)
