Menstrual Disorders Flashcards
define endometriosis
a disorder causing the growth of endometrium-like tissue on the outside the uterine cavity
risk factors of endometriosis
early menarche late menopause delayed childbearing FH of endometriosis late first sexual encounter
clinical features of endometriosis
dysmenorrhoea dyspareunia (painful intercourse) subfertility chronic pelvic pain cyclical GI and/or urinary symptoms
possible examination findings in endometriosis
reduced organ motility + enlargement
tender modularity of posterior vaginal fornix
visible vaginal endometriotic lesions
investigations of endometriosis
bloods (FBC, U+Es + β-hCG)
transvaginal US
MRI pelvis
laparoscopy
medical management of endometriosis
analgesia artificial menopause (e.g. COCP or GnRH agonists)
surgical management of endometriosis (preserving fertility)
laparoscopic excision via a laparoscopic diathermy and adhesiolysis
surgical management of endometriosis (no preservation of fertility)
hysterectomy with salpingo-oopherectomy
define menorrhagia
episodes of regular excessive blood loss that cause interference with a patient’s daily life
define excessive blood loss in cases of menorrhagia
a loss of 80ml or more or a menstrual cycle lasting >7 days
having to change menstrual products every 1-2hrs
passage of clots >2.54cm
clinical features of menorrhagia
excessive heavy blood flow
intermenstural bleeds
post-coital bleeds +/- dyspareunia
pelvic pain
additional questions to ask those experiencing menorrhagia
cycle regularity and length menarche age cervical screening history sexual history medical history drug history
investigations of menorrhagia
bloods (FBC + U+Es)
transvaginal US
additional investigations of menorrhagia if have specific clinical suspicion
TFTs
clotting factors
hysteroscopy
vaginal or cervical swab
medical management of menorrhagia if no underlying pathology or fibroids < 3cm
levonogestrel intrauterine system (e.g. Mirena Coil)
tranexamic acid
cyclical oral progestogen
medical management of menorrhagia if fibroids > 3cm
specialist referral
tranexamic acid + NSAID
myomectomy or hysterectomy
define premature ovarian insufficiency syndrome (POI)
the development of menopause in women below 40yrs of age
describe the characteristic symptoms of POI
amenorrhoea
elevated gonadotrophins
oestrogen insufficiency
clinical features of POI
amenorrhoea
hot flushes
vaginal dryness
vasomotor symptoms
investigations of POI
bloods (FBC, TFTs, serum FSH, estradiol, prolactin + AMH)
DXA bone scan
common findings in FSH levels in POI
FSH > 40IU/L in two samples taken 4wks apart
conservative management of POI
education of patient
advise healthy lifestyle and dietary measures (e.g. Vitamin D and calcium)
medical management of POI
HRT until menopausal age
