menstrual disorders Flashcards
what is normal in terms of menstruation?
loss, duration, length, menarche, menopause
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
<p>what is the menstrual cycle?</p>
<p>time from first day of a woman’s period to the day before her next period</p>
<p>what is menarche?</p>
<p>woman's first period</p>
what is the average age for menarche and menopause?
menarche: 12 years
menopause: 50-55 years
<p>what are some examples of disturbances of menstruation?</p>
<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>
<p>what are some indicators for heavy menstrual bleeding?</p>
- 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
<p>what is the aetiology of heavy menstrual bleeding?</p>
uterine and ovarian pathologies (PALM COEIN)
- polyps
- adenomyosis (endometrial hyperplasia or carcinoma)
- leiomyoma/fibroids
- malignancy
- coagulopathy
- ovulation dysfunction
- endometrial/hyperplasia
- iatrogenic
- not yet classified
<p>what investigations should be done for heavy menstrual bleeding?</p>
<ul><li>pelvic USS</li><li>examination</li><li>blood tests: clotting profile, thyroid function</li><li>endometrial biopsy</li></ul>
<p>describe the management for heavy menstrual bleeding?</p>
<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>
<p>what is a hysterectomy?</p>
<p>surgical removal of uterus</p>
what are fibroids (aka myoma or leiomyoma)
non-cancerous growths made of muscle and fibrous tissue
diagnosis: uss
complications: HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility, miscarriage
<p>describe the management for fibroids?</p>
- fibroid embolisation
- hysteroscopic fibroid resection
- hysterectomy
<p>what is endometriosis?</p>
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
<p>what is the presentation of endometriosis?</p>
<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>
<p>what are the investigations and management for endometriosis?</p>
investigation
- pelvic examination, USS, laparoscopy
management:
analgesia
hormonal
- COCP, POP, mirena IUS, depot provera, GnRH analogues
surgical
- endometrial ablation
- hysterectomy
<p>what is adenomyosis?</p>
endometrium becomes embedded in myometrium
management: hysterectomy
what are endometrial polyps?
overgrowth of endometrial lining can lead to formation of pediculated structures
diagnosis: USS, hysteroscopy
management: polypectomy
<p>Describe the treatment options for menstrual disorders?</p>
<p>what are the different kinds of hysterectomy?</p>
total hysterectomy: cervix and uterus removed
subtotal hysterectomy: uterus removed
<p>what is salpingo-oophorectomy?</p>
<p>Removal or ovaries with uterus</p>
what is oligo/amenorrhea?
infrequent, absent or abnormally light menstruation
what are the causes of oligo/amenorrhea?
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
<p>what is polycystic ovarian syndrome?</p>
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
<p>what is the management of polycystic ovarian syndrome?</p>
<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>
<p>what is dysfunctional uterine bleeding?</p>
excessive uterine bleeding affecting premenopausal woman that is not due to pregnancy or any recognisable uterine or systemic diseases
<p>what is the aetiology of DUB?</p>
<p>underlying pathophysiology due to ovarian hormonal dysfunction</p>
<p>what is the management for DUB?</p>
conservative
medical: GnRH analogues (anti-oestrogen so produce a pseudo-menopause)
surgical: treatment based on severity of symptoms and patients wishes
