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Exam - M - Reproduction System (Megan and Rachel) > menstrual disorders > Flashcards

menstrual disorders Flashcards

1
Q

what are causes of heavy menstrual bleeding

A

PALM COEIN

polyps, PCOS
adenomyosis 
leiomyoma (fibroids)
malignancy/endometrial hyperplasia 
coagulopathy 
ovulation dysfunction 
endocrine - hypothyroidism 
iatrogenic - anticoagulants, IUDs, CUs 
not known
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2
Q

what investigations could you do in HMB

A 
history 
pelvic exam 
clotting profile 
TFTs 
US
vaginal swab for infection
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3
Q

what are non-contraceptive management options for HMB

A

tranexamic acid if no pain

mefenamic acid if associated pain

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4
Q

what are contraceptive options for management of HMB

A

mirena coil is first line
COPC
provera (cyclical oral progesterone)

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5
Q

what are ablation management options for HMB

A

endometrial ablation

balloon thermal ablation

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6
Q

what is oligo/amenorrhoea

A

infequent/absent/light periods

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7
Q

what causes oligo/amenorrhoea

A 
stress - physical or psychological 
malnourishment/EDs 
obesity 
hormones 
primary ovarian insufficiency 
hyperprolactinaemia 
prolactinomas 
thyroid disorders 
obstruction of uterus/cervix/vagina
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8
Q

what is endometriosis

A

endometrial tissue outside uterus
called endometriomas
the tissue follows the menstrual cycle - bleeds

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9
Q

how can endometriosis present

A 
HMB
spotting 
pelvic pain 
infertility 
fatigue 
systemic symptoms 
dyspareunia 
cyclical bleeding from other sites - haematuria 
painful bowel movements and urination 
diarrhoea, nausea, bloating
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10
Q

what investigations could you do in endometriosis

A

US - shows endometriomas and chocolate cysts

laparoscopic surgery to get biopsy - confirms diagnosis

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11
Q

what is stage 1 endometriosis

A

small superficial lesions

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12
Q

what is stage 2 endometriosis

A

mild but deeper lesions than stage 1

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13
Q

what is stage 3 endometriosis

A

deeper lesions
lesions on ovaries
mild adhesions

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14
Q

what is stage 4 endometriosis

A

deep and large lesions effecting ovaries

extensive adhesions

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15
Q

medical management for endometriosis

A 
COCP
POP
implant 
mirena coil 
provera 
GnzRH agonists
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16
Q

surgical management of endometriosis

A

laparoscopic surgery - excise or ablate endometriomas
hysterectomy
salpingo-ophrectomy

17
Q

what is adenomyosis

A

endometrium becomes embedded in myometrium

18
Q

in what group of patients is adenomyosis common

A

later productive years
multiparous

symptoms usually resolve after menopause

19
Q

how does adenomyosis present

A 
dysmenorrhoea 
HMB
dyspareunia 
infertility 
enlarged tender uterus
20
Q

what investigations could you do in adenomyosis

A

transvaginal US
MRI
histological examination of uterus after hysterectomy

21
Q

how can you manage adenomyosis

A

manage like HMB

endometrial ablation
uterine artery embolism
hysterectomy

22
Q

what are fibroids

A

benign tumours of SM of uterus
muscle and fibrous tissue
aka myoma or leiomyoma

23
Q

intramural fibroid location

A

grows in uterus muscle and can distort it

24
Q

subserosal fibroid location

A

grow below outer layer of uterus and can fill abdominal cavity

25
Q

submucosal fibroid location

A

grow on endometrium

26
Q

pedunculated

A

fibroid grows on a stalk

27
Q

how does fibroids present

A 
HMB
prolonged menstruation 
abdominal pain 
bloating/abdominal fullness 
dyspareunia 
reduced fertility 
miscarrige 
back ache 
urinary or bowel symptoms
28
Q

investigations for fibroids

A

US id diagnostic
abdominal and bimanual examinations
hysteroscopy for submucosal
MRI if doing surgery

29
Q

how do you manage fibroids <3cm

A

can give contraceptive:
COCP
POP
mirena

surgical options:
endometrial ablation, resection, hysterectomy

30
Q

how do you manage fibroids >3cm

A

myomectomy
uterine artery embolisation
hysterectomy
GnRH agonists to shrink fibroids before surgery

31
Q

how can you manage submucosal fibroids

A

hysteroscopic fibroid resection

32
Q

what are endometrial polyps

A

overgrowth of endometrial lining causes polyp formation
polyps are pediculated structures
benign

33
Q

investigations for endometrial polyps

A

US

hysteroscopy

34
Q

endometrial polyp management

A

polypectomy

35
Q

what is dysfunctional uterine bleeding

A

excessive uterine bleeding in premenopausal woman with no explanation/disease/cause

36
Q

how do you manage dysfunctional uterine bleeding

A

conservative management

GnRH analogues if patients are nearly menopausal

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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