menstrual disorders Flashcards
what are causes of heavy menstrual bleeding
PALM COEIN
polyps, PCOS adenomyosis leiomyoma (fibroids) malignancy/endometrial hyperplasia coagulopathy ovulation dysfunction endocrine - hypothyroidism iatrogenic - anticoagulants, IUDs, CUs not known
what investigations could you do in HMB
history pelvic exam clotting profile TFTs US vaginal swab for infection
what are non-contraceptive management options for HMB
tranexamic acid if no pain
mefenamic acid if associated pain
what are contraceptive options for management of HMB
mirena coil is first line
COPC
provera (cyclical oral progesterone)
what are ablation management options for HMB
endometrial ablation
balloon thermal ablation
what is oligo/amenorrhoea
infequent/absent/light periods
what causes oligo/amenorrhoea
stress - physical or psychological malnourishment/EDs obesity hormones primary ovarian insufficiency hyperprolactinaemia prolactinomas thyroid disorders obstruction of uterus/cervix/vagina
what is endometriosis
endometrial tissue outside uterus
called endometriomas
the tissue follows the menstrual cycle - bleeds
how can endometriosis present
HMB spotting pelvic pain infertility fatigue systemic symptoms dyspareunia cyclical bleeding from other sites - haematuria painful bowel movements and urination diarrhoea, nausea, bloating
what investigations could you do in endometriosis
US - shows endometriomas and chocolate cysts
laparoscopic surgery to get biopsy - confirms diagnosis
what is stage 1 endometriosis
small superficial lesions
what is stage 2 endometriosis
mild but deeper lesions than stage 1
what is stage 3 endometriosis
deeper lesions
lesions on ovaries
mild adhesions
what is stage 4 endometriosis
deep and large lesions effecting ovaries
extensive adhesions
medical management for endometriosis
COCP POP implant mirena coil provera GnzRH agonists
surgical management of endometriosis
laparoscopic surgery - excise or ablate endometriomas
hysterectomy
salpingo-ophrectomy
what is adenomyosis
endometrium becomes embedded in myometrium
in what group of patients is adenomyosis common
later productive years
multiparous
symptoms usually resolve after menopause
how does adenomyosis present
dysmenorrhoea HMB dyspareunia infertility enlarged tender uterus
what investigations could you do in adenomyosis
transvaginal US
MRI
histological examination of uterus after hysterectomy
how can you manage adenomyosis
manage like HMB
endometrial ablation
uterine artery embolism
hysterectomy
what are fibroids
benign tumours of SM of uterus
muscle and fibrous tissue
aka myoma or leiomyoma
intramural fibroid location
grows in uterus muscle and can distort it
subserosal fibroid location
grow below outer layer of uterus and can fill abdominal cavity
submucosal fibroid location
grow on endometrium
pedunculated
fibroid grows on a stalk
how does fibroids present
HMB prolonged menstruation abdominal pain bloating/abdominal fullness dyspareunia reduced fertility miscarrige back ache urinary or bowel symptoms
investigations for fibroids
US id diagnostic
abdominal and bimanual examinations
hysteroscopy for submucosal
MRI if doing surgery
how do you manage fibroids <3cm
can give contraceptive:
COCP
POP
mirena
surgical options:
endometrial ablation, resection, hysterectomy
how do you manage fibroids >3cm
myomectomy
uterine artery embolisation
hysterectomy
GnRH agonists to shrink fibroids before surgery
how can you manage submucosal fibroids
hysteroscopic fibroid resection
what are endometrial polyps
overgrowth of endometrial lining causes polyp formation
polyps are pediculated structures
benign
investigations for endometrial polyps
US
hysteroscopy
endometrial polyp management
polypectomy
what is dysfunctional uterine bleeding
excessive uterine bleeding in premenopausal woman with no explanation/disease/cause
how do you manage dysfunctional uterine bleeding
conservative management
GnRH analogues if patients are nearly menopausal
