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Reproductive System > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Blood loss in normal menstrual cycle

A

<80ml over 7 days (16 tsp)

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2
Q

Range of menarche

A

10-16 years

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3
Q

Range of menopause

A

50-55 years

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4
Q

Average duration of menstruation

A

2-7 days

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5
Q

Average length of cycle

A

28 days (24-38 days)

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6
Q

Classification of HMB

A

> 80ml/7 days.
And/or need to change mesntrual products every 1-2 hrs.
And/or passage of clots > 2.5cm.
And/or affecting quality of life

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7
Q

Uterine & ovarian causes of HMB

A 
Uterine fibroids
Endometrial polyps
Endometriosis
Adenomyosis
Pelvic inflammatory disease
Pelvic infections
Endometrial hyperplasia/carcinoma
Polycystic ovary syndrome
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8
Q

Systemic disease and disorders causing HMB

A

Coagulation disorders
Hypothyroidism
Liver disease
Renal disease

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9
Q

Iatrogenic causes of HMB

A

Anticoagulation treatment
Herbal supplements (ginseng, ginko, soya)
Intrauterine contraceptive device

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10
Q

PALM COEIN (mnemonic to remember causes of HMB)

A 
Polyp
Adenomyosis
Leiomyoma/fibroid
Malignancy
Coagulopathy
Ovulation dysfunction
Endometrium/hyperplasia
Iatrogenic
Not yet classified
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11
Q

What are fibroids

A

Non-cancerous growths made of muscle & fibrous tissue

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12
Q

Symptoms of fibroids

A 
Asymptomatic
HMB
Pelvic pain
Urinary symptoms (retention, frequency, difficulty initiating stream)
Pressure symptoms
Backache
Infertility
Miscarriage
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13
Q

Investigation of fibroids

A

US

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14
Q

Management of fibroids

A

HMB +/- small fibroids - COCP, POP, Mirena
Large fibroids & fertility preservation - fibroid embolisation, myomectomy.
Sumbucosal fibroids - hysteroscopic fibroid resection
Previous failure/decline & fertility preservation not required - hysterectomy

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15
Q

What is endometriosis

A

Endometrial tissue present outside lining on uterus

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16
Q

Symptoms of endometriosis

A 
HMB
Pelvic pain
Dysmenorrhoea
Lower back pain
Dyspareunia
Diarrhoea
Nausea
Bloating
Dysuria
Painful bowel movements
Infertility
Fatigue
Systemic symptoms
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17
Q

Endometriosis stage 1 (minimal)

A

Small patches/surface lesions/inflammation on/around organs in pelvic cavity

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18
Q

Endometriosis stage 2 (mild)

A

More widespread and starting to infiltrate pelvic organs

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19
Q

Endometriosis stage 3 (moderate)

A

Peritoneum or other structures effected. Sometimes scarring & adhesions.

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20
Q

Endometriosis stage 4 (severe)

A

Infiltrative & affecting many pelvic organs & ovaries. Distortion of anatomy & adhesions.

21
Q

Common sites of endometriosis

A

Fallopian tube
Ovary
Uterosacral ligaments
Pouch of Douglas

22
Q

Investigations for endometriosis

A

Pelvic examination
US
Diagnostic laparoscopy - gold standard

23
Q

Non-surgical management of endometriosis

A 
COCP
POP
Mirena IUS
Depot provera
GnRH analogues
24
Q

Surgical management of endometriosis

A

Ablation
Hysterectomy endometrioma excision
Pelvic clearance hysterectomy

25
Q

What is adenomyosis

A

Endometrium embedded in myometrium

26
Q

Symptoms of adenomyosis

A

HMB

Dysmenorrhoea

27
Q

Management of adenomyosis

A 
COCP
POP
Mirena IUS
Depo Provera
Hysterectomy
28
Q

What are endometrial polyps

A

Pediculated structures extending into endometrium due to overgrowth of endometrial lining

29
Q

Investigations of endometrial polyps

A

US

Hysteroscopy

30
Q

Management of endometrial polyps

A

Polypectomy

31
Q

Investigations for HMB

A 
Pelvic examination
Clotting profile
Thyroid function
US
Laparoscopy (endometriosis suspicion)
Endometrial biopsy (>44 & refractory to treatment)
32
Q

Hormonal management of HMB

A

Mirena IUS
COCP
POP
Depo provera

33
Q

Non-hormonal management of HMB

A 
Mefenamic acid
Tranexemic acid
GnRH analogues
Endometrial ablation
Fibroid embolisation
Hysterectomy
34
Q

First generation endometrial ablation

A

Diathermy with hysteroscopy

35
Q

Second generation endometrial ablation

A

Thermal balloon

Radio frequency

36
Q

Requirements for endometrial ablation

A

Uterine cavity length <
11cm
Sub mucous fibroids <3cm
Previous normal endometrial biopsy

37
Q

Subtotal hysterectomy

A

Removal of uterus, cervix left

38
Q

Total hysterectomy

A

Removal of uterus & cervix

39
Q

Risks of hysterectomy

A 
Infection
DVT
Bladder/bowel/vessel injury
Altered bladder function
Adhesions
40
Q

Salpingo-oophorectomy

A

Removal of ovaries and fallopian tubes

41
Q

Possible indications for saplingo-oophorectomy

A

Endometriosis

Ovarian pathology

42
Q

Disadvantages of salpingo-oophorectomy

A

Immediate menopause - recommend HRT until 50

43
Q

Advantages of salpingo-oophorectomy

A

Reduces risk of subsequent ovarian cancer

44
Q

What is amenorrhoea

A

Infrequent, absent or abnormally light menstruation

45
Q

Causes of amenorrhoea

A 
Lifestyle - stress, malnourishment, obesity, intense exercise.
Hormones - POP, Mirena, depot injection.
Primary ovarian insufficiency
Polycystic ovarian syndrome
Hyperprolactinemia
Prolactinomas
Thyroid disorders
Obstruction
46
Q

Criteria of polycystic ovarian syndrome (2/3 for diagnosis)

A

US appearance
Biochemical hyperandrogenism
Clinical hyperandrogenism with oligomenorrhoea, hirsutism, acne, infertility & obesity.
Oligomenorrhoea/amenorrhoea

47
Q

Management of polycystic ovarian syndrome

A

Lifestyle changes

Symptoms based

48
Q

What is dysfunctional uterine bleeding

A

Excessive uterine bleeding in premenopausal women not due to pregnancy or uterine/systemic diseases

49
Q

Underlying pathophysiology of dysfunctional uterine bleeding

A

Ovarian hormonla dysfunction

Reproductive System (1 decks)

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