Menstrual disorders Flashcards
Define dysfunctional uterine bleeding
any symptomatic variation from normal menstruation (regularity, frequency, duration, volume) when not pregnant. Includes IMB
normal - 24-38 day cycle, variation of no more than 9 days, duration up to 8 days, volume - subjectively intervening with life
What are the physiological/endocrine factors that can impact on bleeding?
Thyroid - hypothyroidism can cause HMB (mainly causes Oligo- or amenorrhoea)
HPA - responsible for normal menstrual cycle
coagulation cascade/clotting factors
What are the risk factors for DUB?
- obesity
- PCOS
- Tamoxifen
- Hypothyroidism
- Nulliparity
- unopposed estrogen
- Lynch syndrome
- diabetes
What are two non hormonal treatments for DUB and what are their MOA?
- TXA - inhibits fibrinolysis and slows clot break down
- NSAIDs - inhibit prostaglandin production in the endometrium –> vasoconstriction and reduced bleeding
What is the incidence of PMS?
40%
What is the pathogenesis of PMS?
- sensitivity to progesterone (elevated in luteal phase)
- serotonin and GABA receptors being activated by progesterone and estrogen
What is the definition of PMS?
cyclical emotional or physical symptoms that are worse in the luteal phase and improve with menstruation
symptom free week during menses
interfere with daily activities
How should PMS be managed?
- exclude other pathology
- confirm diagnosis with symptom diary
- treat with COCP/SSRI/CBT/VIt B6/Topical estrogen/GnRH agonist/TAH + BSO (???)
Why is normal menstruation self limiting?
- shedding of functional layer of endometrium
- vasoconstriction within basal layer
- coagulation cascade
- muscle contraction of myometrium compressing uterus and vessels
How effective is the mirena for menorrhagia?
90% of cases but may take up to 6 months to work
How effective is ablation for treatment of menorrhagia?
97% effective
list 4 disadvantages of ablation for treatment of menorrhagia
still require contraception (if fall pregnant risk of placentation issue)
may require repeat procedure
risks of procedure itself
cannot easily sample endometrium in future (risk of endometrial cancer)
What regimen of SSRI would you use as first line treatment for someone with PMS?
10mg citalopram in luteal phase e.g day 15 -28
List 5 advantages of uterine artery embolisation of treatment of fibroids
- avoid surgery/anaesthesia
- shorter hospital stay
- potentially fertility sparing
- potentially cheaper than surgical management
- shorter recovery time
list 5 disadvantages of uterine artery embolisation (when cf myomectomy)
- unproven for fertility sparing
- more post procedure pain than surgical management
- higher re-operation rate
- requires arterial anatomy compatible with embolisation
- exposure to radiation