Menstrual disorders Flashcards
1
Q
Terminology
A
- Menorrhagia = heavy periods (>80ml/ cycle)
- Dysmenorrhea = painful periods
- Inter-menstrual bleeding (IMB) = bleeding between periods
- Post-coital bleeding (PCB) = bleeding after intercouse
- Oligomeorrhea = infrequent periods
2
Q
Definition of fibroids
A
- Smooth muscle growth known as leiomyoma
- Commonly asymptomatic
- Higher incidence in Afro-caribbean women
- Diagnosed
- Clinical exam → irregularly enlarged uterus
- Ultrasound
- Hysteroscopy
3
Q
Definition of adenomyosis
A
- Endometrial tissue present in the myometrium
- Symptoms
- Heavy painful periods
- Bulky, tender uterus
- Usually in parous women
- May co-exist with endometriosis
- Diagnosis → MRI but generally diagnosed after hysterectomy
- Management
- LNG IUS (Mirena)
- Progestogen
- Combined oral contraceptive pill
4
Q
Diagnosis of endometriosis
A
- Laparoscopy → clear, red, bluish black or white lesions
- MRI → deep endometriosis
- Ultrasound → ebdonetrioma (chocolate cyst)
5
Q
Management of endometriosis
A
- Medical
- Progestogen - oral/ injection/ levonorgestrel IUS
- Combined oral contraceptive pill
- GnRH analogue
- Surgical
- Excision of deposits from peritoneum/ ovary
- Diathermy/ laser ablation of deposits
- Removal of ovaries +/- hysterectomy
- Disease may recur after treatment
6
Q
Red flame endometriosis
A
- Visible implantation of endometriosis along pelvic peritoneum
- Causes inflammation and irritation of the peritoneum → blistering
7
Q
Endometrial powder burn
A
- Black lesion on pelvic peritoneum
- Lesions grow and bleed each month during period
8
Q
Chocolate cyst
A
- Non-cancerous fluid filled cyst, deep within ovaries
- Brown, tar-like appearance
- Ovarian endometrioma
9
Q
Investigation in menstrual disorders
A
- Heavy periods → FBC, thyroid function test, coagulation, endometrial biopsy (over 45/ persistent/ intermestrual bleeding)
- Intermenstrual and PCB - chlamydia test
- Pregnancy test
- Transvaginal ultrasound
- Hysteroscopy → persistent IMB, suspected endometrial pathology on US
10
Q
Examination in menstrual disorders
A
- General exam
- Abdominal exam
- Speculum
- Bimanual palpation
11
Q
Menstrual history (CAPS)
A
- Clots/ flooding/ pads + tampon
- Ask about effect of symptoms on lifestyle and quality of life
- Pain (with heavy flow or premenstrual)
- Subjective → patients perception
12
Q
Normal menstruation
A
- Normal loss: less than 80ml over 7 days
- Average loss: 30-40 mil
- Average duration: 2-7 days
- Length of cycle: 28 day s
- Menarche: 10-16 years, average 12
- Menopause: 50-55 years
13
Q
Presentation of endometriosis
A
- Premenstrual pelvic pain
- Dysmenorrhoea
- Deep dyspareunia
- Subfertility
- Tender nodules in rectovaginal septum
- Limited uterine mobility
- Adnexal mass
14
Q
Endometriosis
A
- Endometrial tissue found outside the uterine cavity
- Oestrogen-dependant chronic disease
- Commonly found in ovary, pouch of Douglas or pelvic peritoneum
- Can be asymptomatic
- Many theories of pathogenesis
- Retrograde menstruation
- Coelomic metaplasia
- Haematogenous spread
- Direct transplantation
15
Q
Dysfunctional uterine bleeding (DUB)
A
- Abnormal bleeding but no structural/ endocrine/ neoplastic/ infectious cause found
- Subjective
- Geographic variation
- 50% hysterectomies for menorrhagia for DUB
