menstrual disorders

Question 1

what is normal in terms of menstruation?

loss, duration, length, menarche, menopause

Answer 1

average loss: 30 - 40 ml or 6 - 8tsp (normal: < 80ml or 16 tsp)

average duration: 2 - 7 days

average length: 24 - 35 days (normal: 28 days)

average menarche age: 12 years (normal: 10 - 16)

average menopause age: 50 - 55 years

Question 2

<p>what is the menstrual cycle?</p>

Answer 2

<p>time from first day of a woman’s period to the day before her next period</p>

Question 3

<p>what is menarche?</p>

Answer 3

<p>woman's first period</p>

Question 4

what is the average age for menarche and menopause?

Answer 4

menarche: 12 years
menopause: 50-55 years

Question 5

<p>what are some examples of disturbances of menstruation?</p>

Answer 5

<p>frequency: infrequent, normal, frequent</p>

<p>regularity: absent, regular, irregular</p>

<p>volume: heavy, normal, light</p>

<p>duration: prolonged, normal, shortened</p>

<p></p>

Question 6

<p>what are some indicators for heavy menstrual bleeding?</p>

Answer 6

• bleeding > 8 days
• clots greater than 2.5cm
• need to change menstrual products every 1 - 2 hours
• bleeding through clothes
• periods affecting quality of life

Question 7

<p>what is the aetiology of heavy menstrual bleeding?</p>

Answer 7

uterine and ovarian pathologies (PALM COEIN)

• polyps
• adenomyosis (endometrial hyperplasia or carcinoma)
• leiomyoma/fibroids
• malignancy
• coagulopathy
• ovulation dysfunction
• endometrial/hyperplasia
• iatrogenic
• not yet classified

Question 8

<p>what investigations should be done for heavy menstrual bleeding?</p>

Answer 8

<ul><li>pelvic USS</li><li>examination</li><li>blood tests: clotting profile, thyroid function</li><li>endometrial biopsy</li></ul>

Question 9

<p>describe the management for heavy menstrual bleeding?</p>

Answer 9

<ul><li>laparoscopy if endometriosis suspected – gold standard</li><li>hysterectomy (surgical removal of uterus)</li><li>options depend on<ul><li>impact on QoL, underlying pathology, desire for future fertility and woman’s preferences</li></ul></li></ul>

Question 10

<p>what is a hysterectomy?</p>

Answer 10

<p>surgical removal of uterus</p>

Question 11

what are fibroids (aka myoma or leiomyoma)

Answer 11

non-cancerous growths made of muscle and fibrous tissue

diagnosis: uss
complications: HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility, miscarriage

Question 12

<p>describe the management for fibroids?</p>

Answer 12

• fibroid embolisation
• hysteroscopic fibroid resection
• hysterectomy

Question 13

<p>what is endometriosis?</p>

Answer 13

endometrial tissue present outside the lining of uterus

during menstruation this ectopic tissue behaves the same as endometrium and bleeds

affects women of reproductive age

Question 14

<p>what is the presentation of endometriosis?</p>

Answer 14

<ul><li>heavy menstrual bleeding (HMB)</li><li>pelvic pain</li><li>painful menstrual cramps</li><li>abnormal bleeding/spotting between menstrual periods</li><li>pain during and after sexual intercourse</li><li>lower back pain</li><li>fatigue and systemic symptoms</li></ul>

Question 15

<p>what are the investigations and management for endometriosis?</p>

Answer 15

investigation
- pelvic examination, USS, laparoscopy

management:
analgesia
hormonal
- COCP, POP, mirena IUS, depot provera, GnRH analogues

surgical

• endometrial ablation
• hysterectomy

Question 16

<p>what is adenomyosis?</p>

Answer 16

endometrium becomes embedded in myometrium

management: hysterectomy

Question 17

what are endometrial polyps?

Answer 17

overgrowth of endometrial lining can lead to formation of pediculated structures

diagnosis: USS, hysteroscopy
management: polypectomy

Question 18

<p>Describe the treatment options for menstrual disorders?</p>

Answer 18

Question 19

<p>what are the different kinds of hysterectomy?</p>

Answer 19

total hysterectomy: cervix and uterus removed

subtotal hysterectomy: uterus removed

Question 20

<p>what is salpingo-oophorectomy?</p>

Answer 20

<p>Removal or ovaries with uterus</p>

Question 21

what is oligo/amenorrhea?

Answer 21

infrequent, absent or abnormally light menstruation

Question 22

what are the causes of oligo/amenorrhea?

Answer 22

life changes: stress, eating disorders, obesity, intense exercise

hormones: POP, mirena or depot injection

primary ovarian insufficiency, polycystic ovarian syndrome, hyperprolactinaemia (elevated levels of prolactin in the blood), prolactinomas (adenomas on the anterior pituitary gland)

thyroid disorders: graves disease

obstruction of uterus, cervix and/or vagina

Question 23

<p>what is polycystic ovarian syndrome?</p>

Answer 23

metabolic syndrome with diagnosis if 2 of 3 criteria met:

• USS appearance of ovary
• biochemical hyperandrogenism
• clinical hyperandogenism with oligomenorrhoea, hirsuitism, acne, infertility and obesity

Question 24

<p>what is the management of polycystic ovarian syndrome?</p>

Answer 24

<ul><li>lifestyle adjustments: aim of normal BMI</li><li>symptom based treatment</li><li>3 withdrawal bleeds required per year to prevent hyperplasia or endometrial protection<ul><li>Achieved with either COCP, POP, mirena IUS or norethisterone</li></ul></li></ul>

Question 25

<p>what is dysfunctional uterine bleeding?</p>

Answer 25

excessive uterine bleeding affecting premenopausal woman that is not due to pregnancy or any recognisable uterine or systemic diseases

Question 26

<p>what is the aetiology of DUB?</p>

Answer 26

<p>underlying pathophysiology due to ovarian hormonal dysfunction</p>

Question 27

<p>what is the management for DUB?</p>

Answer 27

conservative

medical: GnRH analogues (anti-oestrogen so produce a pseudo-menopause)
surgical: treatment based on severity of symptoms and patients wishes