Menstrual Disorders Flashcards
How would you attempt to quantify heavy menstrual bleeding?
- Need to change pads every 1-2 hours
- Passage of clots greater than 2.5cm
- Bleeding through clothes
What is the acronym for causes of menstrual disorders?
PALMCOIEN
What does the acronym PALMCOEIN stand for?
P - polyp A - adenomyosis L - leiomyoma/fibroid M - malignancy C - coagulopathy O - ovulation dysfunction E - endometrial hyperplasia I - iatrogenic N - not yet classified
What are the main categories of causes for heavy menstrual bleeding?
- Uterine/ovarian pathologies
- Systemic diseases and disorders
- Iatrogenic causes
What are the uterine/ovarian causes of heavy menstrual bleeding?
- Fibroids
- Polyps
- Endometriosis
- Endometrial hyperplasia/carcinoma
- PCOS
What are the systemic disease causes of heavy menstrual bleeding?
- Coagulation disorders
- Hypothyroidism
- Liver or renal disease
What are the iatrogenic causes of heavy menstrual bleeding?
- Anticoag treatment
- Herbal supplements
- IUDs
What is the management for polyps?
Polypectomy
What is adenomyosis?
Condition where endometrium becomes embedded in myometrium. Causes painful, heavy menstrual bleeding.
What is the management for adenomyosis?
May respond to hormones partially
What is endometriosis?
Endometrial tissue outside the uterus. Multi system involvement.
How does endometriosis present?
- Dysmenorrhea
- Dyspareunia
- Lower back pain
- Intermenstrual bleeding
- Diarrhoea, nausea and bloating
- Painful bowel movements or urination
Principles of managing heavy menstrual bleeding?
- Impact on QoL
- Underlying pathology
- Desire for further fertility
- Women’s preferences
What are the investigations for heavy menstrual bleeding?
- Thorough history
- Pelvic examination and remember to look at the cervix
- Clotting profile
- Thyroid function
- Pelvic USS
- Laparoscopy if suspected endometriosis
- Endometrial biopsy
What is the medical management for heavy menstrual bleeding?
• Tranexamic acid (blood loss)
• Mefenamic acid (prostaglandin inhibitor)
- preserving fertility or avoiding hormones
• Hormonal: COCP, Oral progestogens
What is the surgical management for heavy menstrual bleeding?
Endometrial ablation
Hysterectomy
What is endometrial ablation?
Permanent destruction of endometrium using different energy sources
What is the difference in method between the first ablation and second ablation?
- First ablation: under hysteroscopic vision
* Second ablation: thermal beam radiotherapy
What is the uterine cavity length requirement for ablation?
<11cm
What are the submucosal fibroids size requirement for ablation?
<3cm
What are the different methods of performing hysterectomies?
- Abdominal
- Vaginal
- Laparoscopic
What are the different types of hysterectomies?
- Subtotal
- Total
- Total hysterectomy with bilateral salpingo-oophrectomy
- Wertheim’s hysterectomy
What is a subtotal hysterectomy?
Uterus not cervix
What is a total hysterectomy?
Uterus, cervix and beginning of fallopian tubes
What is a total hysterectomy with bilateral salpingo-oophorectomy?
Uterus, cervix, fallopian tubes, ovaries
What is the follow-up for THBSO?
HRT till 50 y/o to prevent osteoporosis
What is Wertheim’s hysterectomy?
Same as THBSO
+ surrounding area and upper part of vagina
What’s the recovery like for a hysterectomy?
1-5 days in hospital, 2-3 months full recovery
What are the risks of a hysterectomy?
- Infection
- DVT
- Injury to surrounding structures (bladder/bowel/vessel injury) •Adhesions
