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Mariam Reproductive System > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is the menstrual cycle?

A

Menstrual cycle = time from first day of a woman’s period to the day before her next period

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2
Q

For the menstrual cycle what is: normal loss, average loss, average duration, length of cycle?

A
  • Normal loss less than 80ml over 7 days
  • Average loss 30-40ml
  • Average duration 2-7 days
  • Length of cycle 28 days (average 24-35 days)
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3
Q

What is menarche?

A

A womans first period

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4
Q

What is the average age for menarche and menopause?

A
  • Menarche 10-16 years (average 12 years)
  • Menopause 50-55 years
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5
Q

What are some examples of disturbances of menstruation?

A
  • Disturbances of menstrual frequency
    • Infrequent or frequent
  • Irregular menstrual bleeding
    • Absent or irregular
  • Abnormal duration of flow
    • Prolonged or shortened
  • Abnormal menstrual volume
    • Heavy or light
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6
Q

What terminology is used for describe frequency and what are the normal and abnormal limits?

A
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7
Q

What terminology is used for describe regularity and what are the normal and abnormal limits?

A
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8
Q

What terminology is used for describe duration and what are the normal and abnormal limits?

A
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9
Q

What terminology is used for describe volume and what are the normal and abnormal limits?

A
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10
Q

What are some indicators for heavy menstrual bleeding?

A
  • Bleeding > 8 days
  • And/or need to change menstrual products every one to two hours
  • And/or passage of clots greater than 2.5cm
  • Bleeding through clothes
  • And/or very heavy periods as reported by woman –affecting quality of life
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11
Q

What is the aetiology of heavy menstrual bleeding?

A
  • Uterine and ovarian pathologies
    • Uterine fibroids
    • Endometrial polyps
    • Pelvic inflammatory disease and pelvic infection
    • Endometrial hyperplasia or carcinoma
    • Polycystic ovary syndrome
  • Systemic diseases
    • Coagulative disorders
    • Hypothyroidism
    • Liver or renal disease
  • Iatrogenic causes
    • Anticoagulant treatments
    • Herbal supplements
    • Intrauterine contraceptive device
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12
Q

What investigations should be done for heavy menstrual bleeding?

A
  • Pelvic USS
  • Examination
  • Blood tests
    • Clotting profile, thyroid function
  • Endometrial biopsy
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13
Q

What blood tests should be done for heavy menstrual bleeding?

A
  • Blood tests
    • Clotting profile, thyroid function
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14
Q

Describe the management for heavy menstrual bleeding?

A
  • Laparoscopy if endometriosis suspected – gold standard
  • Hysterectomy (surgical removal of uterus)
  • Options depend on
    • Impact on QoL, underlying pathology, desire for future fertility and woman’s preferences
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15
Q

What is a possible complication of heavy menstrual bleeding?

A

Anaemia

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16
Q

What is a hysterectomy?

A

Surgical removal of uterus

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17
Q

What are fibroids?

A

Non-cancerous growths made of muscle and fibrous tissue, also called myoma or leiomyoma

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18
Q

What is the presentation of fibroids?

A
  • May be asymptomatic
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19
Q

What investigations should be done for fibroids?

A
  • USS
    • Used to diagnose
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20
Q

Describe the management for fibroids?

A
  • Symptom based
  • For large fibroids
    • Fibroid embolization or myomectomy
  • For submucosal fibroids
    • Hysteroscopic fibroid resection
  • If all else has failed and fertility not required
    • Hysterectomy
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21
Q

What are possible complications of fibroids?

A
  • Can cause HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility, miscarriage
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22
Q

What is endometriosis?

A

Endometrial tissue present outside the lining of uterus, during menstruation this ectopic tissue behaves the same as endometrium and bleeds

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23
Q

What are the 4 stages of endometriosis?

A
  • Minimal
    • Small patches, surface lesions or inflammation on or around organs in pelvic cavity
  • Mild
    • More widespread and starting to infiltrate pelvic organs
  • Moderate
    • Peritoneum (pelvic side walls) or other structures, sometimes scarring
  • Severe
    • Infiltrative and affecting many pelvic organs, often with distortion of anatomy
24
Q

What sites are often affected by endometriosis?

A
25
Q

Descibe the epidemiology of endometriosis (prevalence and age group)?

A
  • Affects woman of reproductive age
  • 3% prevalence of woman
26
Q

What is the presentation of endometriosis?

A
  • Heavy menstrual bleeding (HMB)
  • Painful menstrual cramps that get worse over time
  • Abnormal bleeding or spotting between menstrual periods
  • Pain during and after sexual intercourse
  • Lower back pain
  • Pelvic pain
  • Multi-system involvement
    • Fatigue and systemic symptoms
27
Q

What investigations should be done for endometriosis?

A
  • Pelvic examination
  • USS
    • Diagnostic laparoscopy
28
Q

What is the management of endometriosis?

A
  • Analgesia
  • Medical
    • COCP, POP, mirena IUS, depot provera, GnRH analougues
  • Surgical
    • Ablation, hysterectomy endometrioma excision, pelvic clearance, hysterectomy
29
Q

What are possible complications of endometriosis?

A
  • Severely effects quality of life, can be devastating
  • Infertility
30
Q

What is adenomyosis?

A

Condition where endometrium becomes embedded in myometrium

31
Q

What is the presentation of adenomyosis?

A
  • Heavy menstrual bleed
  • May have significant dysmenorrhea (painful periods or menstrual cramps)
32
Q

What is the medical term for painful periods or menstrual cramps?

A

Dysmenorrhea

33
Q

What is the management of adenomyosis?

A
  • May respond to hormones
  • Definitive treatment is hysterectomy
34
Q

What are endometrial polyps?

A

Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium

35
Q

Are endometrial polyps benign or malignant?

A

Mostly benign

36
Q

How are endometrial polyps diagnosed?

A
  • By USS or hysteroscopy
37
Q

What is the management of endometrial polyps?

A

Polypectomy

38
Q

Describe the treatment options for menstrual disorders?

A
39
Q

Describe the medical treatment options for menstrual disorders?

A
  • Tranexamic acid
    • Mode of action - antifibrinolytic
    • Effect - reduces blood loss by 60%
  • Mefenamic acid
    • Mode of action - prostaglandin inhibitor
    • Effect - reduces blood loss 30% and pain
  • Hormonal options
    • Combined contraceptive pill (COPC)
      • Effect – makes periods lighter, regular and less painful
    • LNG IUS and depo-provera
      • Effect – reduces bleeding
      • Side effects – may cause irregular bleeding, anaemia
    • Oral progestogens
      • Such as Provera 10mg
      • Effect – if day 5-25 cycle reduce bleeding and regulates, if day 15-25 cycle may regulated but does not reduce bleeding
40
Q

What are hormonal options as management for menstrual disorders?

A
  • Combined contraceptive pill (COPC)
    • Effect – makes periods lighter, regular and less painful
  • LNG IUS and depo-provera
    • Effect – reduces bleeding
    • Side effects – may cause irregular bleeding, anaemia
  • Oral progestogens
    • Such as Provera 10mg
    • Effect – if day 5-25 cycle reduce bleeding and regulates, if day 15-25 cycle may regulated but does not reduce bleeding
41
Q

What are surgical options for menstrual disorders?

A
  • Endometrial ablation
    • Permanent destruction of endometrium using different energy sources
      • First generation ablation – under hysteroscopic vision, uses diathermy
      • Second generation ablation – thermal balloon, radio frequency
    • Pre-requisites
      • Uterine cavity length < 11cm
      • Sub mucous fibroids < 3cm
      • Previous normal endometrial biopsy
  • Hysterectomy
    • Surgical removal of uteris
    • Different kinds – abdominal, vaginal, laparoscopic (laparoscopically assisted vaginal hysterectomy (LAVH), or total laparoscopic hysterectomy (TLH) or laparoscopically assisted subtotal hysterectomy)
    • Total hysterectomy is cervix and uterus removed, subtotal is only the uterus
    • Risks – infection, DVT, bladder/bowel/vessel injury, altered bladder function, adhesions
  • Salpingo-oophorectomy
    • Removal or ovaries with uterus
    • Indication – ovarian pathology, endometriosis
    • Advantages – reduces risk of ovarian cancer
    • Disadvantages – immediate menopause
42
Q

What is endometrial ablation?

A
  • Permanent destruction of endometrium using different energy sources
    • First generation ablation – under hysteroscopic vision, uses diathermy
    • Second generation ablation – thermal balloon, radio frequency
43
Q

What are pre-requisites for endometrial ablation?

A
  • Uterine cavity length < 11cm
  • Sub mucous fibroids < 3cm
  • Previous normal endometrial biopsy
44
Q

What are the different kinds of hysterectomy?

A
  • Different kinds – abdominal, vaginal, laparoscopic (laparoscopically assisted vaginal hysterectomy (LAVH), or total laparoscopic hysterectomy (TLH) or laparoscopically assisted subtotal hysterectomy)
  • Total hysterectomy is cervix and uterus removed, subtotal is only the uterus
45
Q

What is salpingo-oophorectomy?

A
  • Removal or ovaries with uterus
46
Q

What is oligo/amenorrhea?

A

Infrequent, absent or abnormally light menstruation

47
Q

What is the aetiology of oligo/amenorrhea?

A
  • Life changes such as stress or eating disorders or obesity or intense exercise
  • Hormones such as POP, mirena or depot injection
  • Primary ovarian insuffiency
  • Polycystic ovarian syndrome
  • Hyperprolactinaemia (elevated levels of prolactin in the blood)
  • Prolactinomas (adenomas on the anterior pituitary gland)
  • Thyroid disorders
    • Graves disease
  • Obstruction of uterus, cervix and/or vagina
48
Q

What is polycystic ovarian syndrome?

A

Metabolic syndrome with diagnosis if 2 of 3 criteria met:

  • USS appearance of ovary
  • Biochemical hyperandrogenism
  • Clinical hyperandogenism with oligomenorrhoea, hirsuitism, acne, infertility and obesity
49
Q

How is polycystic ovarian syndrome diagnosed?

A

Metabolic syndrome with diagnosis if 2 of 3 criteria met:

  • USS appearance of ovary
  • Biochemical hyperandrogenism
  • Clinical hyperandogenism with oligomenorrhoea, hirsuitism, acne, infertility and obesity
50
Q

What is the presentation of polycystic ovarian syndrome?

A
  • Oligomenorrhoea/amenorrhea
51
Q

What is the management of polycystic ovarian syndrome?

A
  • Lifestyle adjustments, aim of normal BMI
  • Symptom based treatment
  • 3 withdrawal bleeds required per year to prevent hyperplasia or endometrial protection
    • Achieved with either COCP, POP, mirena IUS or norethisterone
52
Q

What does DUB stand for?

A

Dysfunctional uterine bleeding

53
Q

What is dysfunctional uterine bleeding?

A

Common disorder of excessive uterine bleeding affecting premenopausal woman that is not due to pregnancy or any recognisable uterine or systemic diseases

54
Q

What is teh aetiology of DUB?

A
  • Underlying pathophysiology due to ovarian hormonal dysfunction
55
Q

What is the management for DUB?

A
  • Exclude common causes of excessive bleeding
  • Conservative, medical or surgical treatment based on severity of symptoms and patients wishes
  • GnRH analogues, good for bridging patients who are nearly menopausal and not responded to other medical and surgical treatment
    • Effect – anti-oestrogen so produce a pseudo-menopause

Mariam Reproductive System (35 decks)

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